Nutritional Status Of Patients Research Articles

Nutritional optimization in liver transplant patients: from the pre-transplant setting to post-transplant outcome.

malnutrition and its clinical phenotypes, sarcopenia, and frailty, are prevalent conditions that affect patients with cirrhosis awaiting liver transplantation. The link between malnutrition, sarcopenia, and frailty and a higher risk of complications or death (before and after liver transplantation) is well established. Accordingly, the optimization of nutritional status could optimize both access to liver transplantation and the outcome following the surgery. Whether optimization of nutritional status in patients awaiting LT is associated with improved outcomes after transplant is the focus of this review. This includes the use of specialized regimens such as immune-enhancing or branchedchain amino-acids-enhanced diets. we discuss here the results of the few available studies in the field and provide an expert opinion of the obstacles that have led, so far, to an absence of benefit of such specialized regimens as compared to standard nutritional support. In the next future, combining nutritional optimization with exercise and enhanced recovery after surgery (ERAS) protocols could help optimize outcomes following liver transplantation.

Risk screening, nutrition assessment and associated factors of malnutrition among elderly inpatients in Hue University of Medicine and Pharmacy Hospital

Background: Undernutrition is a significant risk factor for mortality, complications, hospital infections, length of hospital stay, quality of life, and prognosis. Patients with proper nutrition will help prevent undernutrition, prevent the development of the disease, and improve the effectiveness of treatment. Nutrition is an integral part of the comprehensive treatment process. Nutritional risk screening is one criterion that shows the hospital’s nutritional care capacity. Assessing nutritional status plays an essential role in treating and recovering health. This study aims (1) to screen and assess the nutritional status of inpatients aged from 60 years old in Hue University Medicine and Pharmacy Hospital and (2) to identify some factors related to malnutrition. Methods: A cross-sectional study was carried out on 389 inpatients at two departments of internal medicine, Hue University of Medicine and Pharmacy Hospital, from 11/2020 - 03/2021. We used the mini nutritional assessment tool for screening nutrition risks. The subjective global assessment tool was used to assess nutritional status and questionnaires to understand some related factors. Results: There were 68.9% of patients at risk of malnutrition and 38.8% of patients had malnutrition. There were significant relationships between the nutrition status of patients with re-admitted status (p < 0.05), including diseases (p < 0.05), oral pathology (p < 0.05), decreased taste (p < 0.05). Conclusion: The prevalence of inpatients with nutritional risk in two departments of internal medicine was relatively high. It is necessary to conduct nutrition screening in all inpatients to improve the effectiveness of treatment and comprehensive care. Key words: malnutrition, inpatients, nutrition treatment, subjective global assessment tool, mini nutritional assessment tool.

The effect of inflammatory-nutri̇tional prognosti̇c scori̇ng (INPS) system on treatment response and prognosi̇s i̇n pati̇ents wi̇th locally advanced gastroesophageal juncti̇on and gastri̇c cancer wi̇th neoadjuvant systemi̇c treatment.

e16092 Background: We aimed to reveal the prognostic value of inflammatory-nutritional prognostic score (INPS), which is a new scoring system created by using frequently used immune-nutritional markers, as a biomarker, on nutrition and immune status in patients with locally advanced GEJ and gastric cancer. Methods: Patients who were treated in Dokuz Eylul University Medical Oncology Department between 2010-2022 years and diagnosed with locally advanced GEJ and gastric cancer and receiving NACT were included in this study retrospectively. We selected the most valuable biomarkers (Albumin, ABR, CRP, CAR, De-Ritis, HALP, MLR, NLR, PLR, PNI, SII) to develop INPS by the least absolute shrinkage and selection operator (LASSO) Cox regression model. A prognostic nomogram incorporating INPS and other independent clinicopathological factors was developed based on the stepwise multivariate Cox regression method. The retained features with nonzero coefficients were used to establish a novel INPS. The selected four biomarkers were used to construct the novel INPS for our patients. Results: Median follow-up time of 101 patients was 16.7 months (95% CI= 3.7-73.7), DFS was 20.5 months (95%CI= 16.2-24.8 ), OS was 36.6 months (95%CI=25.4-47.8). The 101 patients in the study were randomly assigned to train (n = 71) and test (n = 30) sets in a 7:3 ratio. Using the LASSO Cox regression model, four inflammatory-nutritional biomarkers (INB) with nonzero coefficients, namely, PLR, DeRitis, PNI and LAR, of the 13 parameters were selected. The LASSO coefficient profiles of the 13 INB and 10-fold cross-validation for tuning parameter selection in the LASSO model were presented. The optimal cut-off values for these four biomarkers based on disease-free survival were determined using the Maximally Selected Rank Statistics. The respective cut-off values for PLR, DeRitis, PNI, and LAR were obtained to be 107.93, 1.75, 33.92, and 58.17. Both the patients in the Train set and the in the Test set were classified as low-risk (INPS score ≤ 1) and high-risk (INPS score >1) groups. There was a statistically significant difference in survival probabilities between low and high risk groups in both groups (respectively; p=0.009, p=0.029). A prognostic nomogram including INPS and other independent clinicopathological factors was developed. Conclusions: The search for biomarkers with prognostic value in GEJ and gastric adenocarcinoma receiving NACT continues. With this study, it has been shown for the first time in the literature that the new screening system, INPS, created with nutritional and inflammatory markers, can be used as a prognostic tool to predict disease-free survival in this patient group.

Prevalence of poor nutrition status in multiple sclerosis patients assessed by different diagnostic tools

147 patients were included in the study. The nutritional status was assessed by NRS 2002, GLIM, and body composition analysis. The routine biochemical parameters were measured. Deterioration of the nutritional status was observed in 87.8% of patients. GLIM criteria indicated that 20% of patients were malnourished and 80% were at risk. The percentage of patients with excess body mass was 46.8%, and of underweight patients was 6.6%. The risk of malnutrition was positively associated with low content of adipose tissue (R=-0.24; p=0.00), low BMI (R=-0.22; p=0.00), and higher weight loss in the last 6 months (R=0.47; p=0.00). Additionally, a significant (p<0.05) correlation between malnutrition state and s-albumin (R=-0.2) and CRP (R=0.23) was observed. Overweight and obesity concerned a large proportion of the studied group of MS patients, but this does not exclude the risk of malnutrition. Dietary care and regular outpatient nutritional status assessment should be provided throughout the disease.

Relationship of Inflammatory Parameters and Nutritional Status in Cancer Patients.

Chronic inflammation and cytokine storm can cause uncontrolled events in cancer. Pro-inflammatory molecules released by malignant cells send signals to the brain, liver, and neuroendocrine cells, interfering with appetite and promoting anorexia. Malnutrition in cancer patients is associated with increased treatment toxicity, reduced physical efficiency, and decreased survival. Therefore, early recognition of malnutrition could improve quality of life, treatment compliance, and survival. The aim of the study was to explore the relationship between inflammatory parameters with disease stage and nutritional status in patients with solid cancers. We screened 77 consecutive patients from 3 clinical Institutions in Sicily, Italy, with solid tumors who were either in follow-up after curative treatment or being treated for metastatic disease using the Mini Nutritional Assessment (MNA) questionnaire. Inflammatory parameters, including interleukin 6 (IL6), C-reactive protein (CRP), β2-microglobulin, ferritin, and transferrin were evaluated. A statistically significant difference was found in mean values of IL6, CRP, β2-microglobulin, ferritin, and transferrin between patients without evidence of disease and metastatic patients. Among the metastatic group, there was a significant difference in mean values of these inflammatory parameters between patients with malnutrition and those with normal nutritional status. The difference in average IL6, CRP, β2-microglobulin, and ferritin between patients at risk of malnutrition and those with normal nutritional status was also significant. However, the difference between patients at risk of malnutrition and those with malnutrition was not significant. IL6, CRP, transferrin, ferritin, and β2-microglobulin are functional inflammatory parameters that indicate risk of malnutrition and support the MNA screening test to identify patients with solid tumors who require nutritional support.

Nutrient Status among Latvian Children with Phenylketonuria.

(1) Introduction: Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine metabolism. The main treatment for PKU is to manage nutrition, thereby restricting phenylalanine intake. Part of patient management is analyzing eating habits to substitute missing nutrients and limit the overdose of nutrients. This is mainly done by analyzing food diaries. This is the first review of Latvian PKU patients eating habits performed by analyzing 72-h food diaries (FD). (2) Materials and Methods: This study included individuals between the ages of 18 and 31 years, PKU patients and 31 age- and sex-matched control groups. All respondents kept 72-h food diaries (FD) and underwent testing for zinc, selenium and ferritin levels in the blood. Food diary data were analyzed by Nutritics software to calculate the theoretical intake of nutrients, and these values were compared with the Ministry of Health of the Republic of Latvia's recommended values. (3) Results: A lack of motivation and diet therapy compliance in PKU patients was observed during this research. A total of 32% of PKU patients refused to fill out their FD or filled it out incorrectly. The analysis of nutrient intake was observed, and there was a statistically significant difference between PKU patients in the 1-3 age group and the control group in fat intake. Fat intake in PKU patients was below MRHL recommendations. The intake of iron was found to be surplus in all PKU patients in the age group of 1-3, 91% of PKU patients in the age group of 4-6 years, 63% in the age group of 7-12 and 71% in the 13-18 year age group. Although there were no instances in the PKU patients nor the control group who had ferritin levels above the normal range. Selenium intake was surplus in 80% of PKU patients in the 1-3 age group, 91% in PKU patients in the 4-6 age group, 88% in the 7-12 age group and 86% in the 13-18 age group. None of the patients had Se levels in the blood above the normal range. Zn intake was surplus in 100% of PKU patients in the 1-3 age group, 82% in PKU patients in the 4-6 age group, 88% in the 7-12 age group and 57% in the 13-18 age group, and no PKU patients had high Zn levels. None of the control group participants had levels below the normal range of Zn and Se while 11% of PKU patients in the 13-18 age group had inadequate levels of Se, although Se intake based on their FD was optimal. (4) Conclusions: Regular PKU patient nutritional status evaluation is important to define and prevent possible nutrient deficiency, and further investigation should be continued to find out the mechanism of nutrient absorption in PKU patients. To prevent macronutrient deficiency such as fat and micronutrient deficiency in PKU patients, one could use supplements or try an improved nutrient content of Phe-free formula in the future.

Characterisation of frailty phenotypes and analysis of the association with peri-operative/interventional complications in elderly cardiac patients

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Identifying the key frailty phenotypes that impact functional health outcomes in older cardiovascular patients (CVD) in clinical practice is a step towards solving the complex "Rubik's Cube" of frailty. It should be pointed out which frailty phenotypes representing the patient's physical (e.g. mobility, strength, gait speed), cognitive (e.g. dementia) or nutritional status (e.g. risk of malnutrition, protein levels) correlate with major complications (e.g. mortality, delirium) in elderly patients. Phenotypes of frailty that correlate with complications could be used to identify patients at higher risk of poor postoperative outcomes and could be addressed through preventive strategies (e.g. prehabilitation). Purpose Identification of physical, nutritional and cognitive frailty phenotypes and investigate the correlation with complications in elderly patients undergoing cardiac surgery (e.g. coronary artery bypass graft, isolated single valve) or transcatheter aortic valve implantation (TAVI). Methods Between 06/2021 and 07/2022, patients (77.6 ± 4.3) referred for elective cardiac surgery or TAVI were included in the study. At hospital admission, physical frailty was identified by the simultaneous presence of: low gait speed (5-meter Walk Test), moderate impaired mobility (Timed Up-and-Go), reduced handgrip (dynamometer) and legs strength (5-repetitions chair rise). Mild dementia (Mini-Mental State Examination) characterised cognitive frailty and risk of malnutrition (Mini Nutritional Assessment) plus low serum protein level (serum albumin) nutritional frailty. The primary outcome was the presence of perioperative complications (mortality and major morbidity, e.g. delirium, pneumonia). Additionally, the total number and type of complications and the length of hospital stay (LoS) were collected. Correlations between frailty phenotypes, complications and LoS were calculated (Spearman). Results In total, 63 patients were referred to cardiac surgery (n=34, 54%) or TAVI (n=29, 46%) and were included (Table 1). Overall, 20 patients (36%) were characterized as physically frail. 33 patients (52%) were found to be cognitively frail, and 17 patients (26%) identified as nutritionally frail; no significant differences were found between the surgical and TAVI groups (Figure 1). Altogether, 37 patients (59%) experienced ≥ 1 complication such as need of transfusion (n=24, 38%), atrial fibrillation (n=14, 22%), delirium (n=12, 19%), pneumonia (n=8, 13%) or renal failure (n=6, 10%); one patient died. Physical and nutritional frailty correlate with the presence and total number of complications and prolonged LoS, but only in TAVI patients (Figure 1). Conclusion If these results are confirmed in a multivariate analysis, preventive strategies targeting physical and nutritional frailty should be considered, especially in TAVI patients, to reduce the incidence of complications and prolonged LoS.

Prognostic value of nutritional status in post-implant CRT outcomes in patients with chronic heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction There’s a close relationship between chronic heart failure (CHF) and malnutrition, and their main pathophysiological modifications are well known. Cardiac resynchronization therapy (CRT) has proven to be a promising therapy in symptomatic heart failure (HF) patients with broad QRS complexes and impaired systolic function with optimized medical therapy. However, there is still a considerable amount of non-responder patients. The role of nutritional status in CRT therapy response has yet still not been well assessed. Purpose Assess the prognostic value of nutritional status in post-op outcomes in patients with Chronic Heart Failure and (CRT) Methods Single-center retrospective study of patients submitted to CRT implantation between January 2007 and march 2021. Inclusion criteria were patients meeting criteria for CRT implantation, QRS duration ≥ 120ms, FEVE ≤ 35%, NYHA class II–IV and no adverse events during the follow up. Primary outcomes measured were all-cause mortality, cardiovascular mortality, and hospitalizations due to HF in a 1-year follow-up. To evaluate patient's nutritional status the CONUT score was used with patients being categorized in 2 groups: Low CONUT (Score 0-4: normal/low malnutrition) and Hight CONUT (Score 5-12: moderate/severe malnutrition). Results 198 patients (83%) exhibited Low CONUT status, and 41 patients (17%) exhibited High CONUT status. Patients with Hight CONUT were older (72.9 yrs vs 65.9 yrs, p&amp;lt;0.001), and exhibited higher percentage of chronic obstructive pulmonary disease (43.9% vs 27.3%, p=0.004), atrial fibrillation (72.9%, vs 25.3%, p&amp;lt;0.001), hypertension (78.1% vs 60.6%, p=0.038), chronic kidney disease (39.1% vs 21.2%, p=0.016) and NYHA IV (19.5% vs 5.1%, p&amp;lt;0.001). Cardiovascular mortality was 3.7% in the low CONUT group vs 29.3% in the Hight CONUT group (p&amp;lt;0.001; HR, 0.12; 95% CI, 0.05-0.29) and total HF hospitalizations were 16 and43, respectively (p=0.013; HR, 0.482, 95% CI, 0.27 to 0.86). The nutritional status prior to CRT assessed by the CONUT score showed to be an independent predictor of cardiovascular mortality (p=0.007; HR, 0.16 95% CI, 0.04-0,60). Conclusion Malnutrition was a common condition in our CRT patients showing that deficient nutrition status remains highly underdiagnosed. Patients with worse nutritional status before CRT device implantation presented higher morbidity and were more prone to worst outcomes such as cardiovascular mortality and mortality by all causes as well as higher incidence of hospitalizations secondary to HF decompensation. Assessment of nutritional status using screening tools may provide additional prognostic information in patients with HF and help early identification of those who may benefit from further assessment and nutritional intervention.

Diagnostic Test Using Subjective Global Nutrition Assessment in Determining Nutritional Status in Patients with Cerebral Palsy in M Djamil Hospital Padang

Background: Malnutrition often occurs in children with cerebral palsy, and anthropometric measurement becomes a challenge due to spastic posture. Subjective Global Nutrition Assessment (SGNA) is a helpful non-invasive screening tool to determine the nutritional status of its simplicity, ease to use, comprehensive, and affordable. Objective: This study aimed to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SGNA in determining nutritional status in children with cerebral palsy Methods: A diagnostic test study was performed on 40 children with cerebral palsy who came to the outpatient clinic of M. Djamil Hospital from July to September 2022 where the caregiver signed the informed consent. Patients with a congenital anomalies and obesity were excluded. Measurements were carried out and nutritional status was determined by plotting weight and height data to WHO 2006/CDC 2000 anthropometric curve and caregivers were asked to fill in the questionnaire. Data analysis was performed with a 2x2 table using a computer program. Main outcome measures: sensitivity, specificity, positive predictive value, and negative predictive value of SGNA. Result: Data from 40 samples were collected to compare the sensitivity, specificity, positive predictive value, and negative predictive value of SGNA in determining nutritional status to anthropometric as a gold standard. The results were 91.3%, 88.2%, 91.3%, and 88.2 %, respectively. Conclusion: SGNA is recommended for screening nutritional status in children with cerebral palsy. Keywords: SGNA, nutritional status, cerebral palsy

Correction of nutritional status in patients with focal liver diseases

Purpose of the research. To study the effect of nutritional support on the results of treatment of patients after liver resection for its focal neoplasms.Materials and methods. Nutritional status at the pre- and inpatient stages was studied based on the examination of 74 patients with focal liver neoplasms. Through a comprehensive clinical and laboratory examination, were identified groups of patients with mild, moderate and severe malnutrition were identified. Comparison groups were formed from them to develop corrective measures aimed at minimizing the phenomena of nutritional deficiency and reducing the frequency ofpurulent- septic complications from wounds.Results. As a result of the study, it was revealed that after undergoing large and extended liver resections, a mild degree of malnutrition was noted in 18 (47.4%) patients in the main group and in 16 (44.4%) patients in the control group (p = 0.796). The average degree of malnutrition was recorded in 7 (18.4%) patients in the main group and in 5 (13.9%) patients in the control group (p = 0.641). Severe malnutrition was observed in 3 (7.9% and 8.3%, respectively) patients in the analyzed groups (p = 0.796). It has been proven that the use of ATP allows accelerating the normalization of nutritional status in patients who underwent liver resection, compared with patients who did not receive nutritional support, up to 5.5 ± 2.2 days compared to 12.8 ± 3.9 in the second group (p &lt;0.001). Nutritional support with the use of enteral nutrition on day 2 after surgery makes it possible to improve PS markers, which, as a result, helps to reduce the number of septic complications by 9% in the main group.Conclusion. The use of ATP allows to normalize the nutritional status in patients who underwent liver resection, compared with patients who did not receive nutritional support, up to 5.5 ± 2.2 days compared to 12.8 ± 3.9 in the second group (p &lt; 0.001). After liver resection in the early postoperative period, nutritional support with enteral nutrition on day 2 after surgery allows improving PS markers, which, as a result, helps to reduce the number of purulent- septic complications by 9% compared to patients who did not receive nutritional support.

Rectal prolapse in a 30-year-old bladder stone male patient: A case report

Rectal prolapse occurs most commonly in children and middle-aged and elderly women and is relatively rare in young men and is occasionally caused by bladder stones. Severe rectal prolapse, bilateral hydronephrosis, and renal insufficiency caused by bladder stones are rare in a 30-year-old man. We report the case of a 30-year-old male patient with cerebral palsy who presented with a large bladder stone that resulted in severe rectal prolapse, bilateral hydronephrosis, and renal insufficiency. Following a definitive diagnosis, the bladder stone was successfully removed, and his kidney function returned to normal. We assessed the patient's nutritional status and stone composition and concluded that the main cause was malnutrition. Rectal prolapse is a rare clinical manifestation of bladder stones, particularly in young adults. Cerebral palsy patients are a vulnerable group in society because of their intellectual disabilities and communicative impairments. Accordingly, besides taking care of their daily diet, abnormal signs in their bodies should receive the doctors' attention in a timely manner.

Imbalance of Microbacterial Diversity Is Associated with Functional Prognosis of Stroke.

There is mounting evidence to suggest that the pathophysiology of stroke is greatly influenced by the microbiota of the gut and its metabolites, in particular short-chain fatty acids (SCFAs). The primary purpose of the study was to evaluate whether the levels of SCFAs and the gut microbiota are altered in poststroke patients and to examine the relationship between these alterations and the physical condition, intestinal health, pain, or nutritional status of patients. Twenty stroke patients and twenty healthy controls were enrolled in the current study, and their demographics were matched. Gas chromatography was used to determine the fecal SCFAs, and 16S rRNA gene sequencing was used to evaluate their fecal microbiota. Microbial diversity and richness were examined using the diversity indices alpha and beta, and taxonomic analysis was utilized to determine group differences. The relationships between the gut microbiome and fecal SCFAs, discriminant bacteria, and poststroke clinical outcomes were analyzed. Less community richness (ACE and Chao) was observed in the poststroke patients (P < 0.05), but the differences between the poststroke group and the healthy control group in terms of species diversity (Shannon and Simpson) were not statistically significant. The makeup of the poststroke gut microbiota was distinct from that of the control group, as evidenced by beta diversity. Then, the relative abundances of the taxa in the poststroke and control groups were compared in order to identify the specific microbiota changes. At the level of phylum, the poststroke subjects showed a significant increase in the relative abundances of Akkermansiaceae, Fusobacteriota, Desulfobacterota, Ruminococcaceae, and Oscillospirales and a particularly noticeable decrease in the relative abundance of Acidobacteriota compared to the control subjects (P < 0.05). In regard to SCFA concentrations, lower levels of fecal acetic acid (P = 0.001) and propionic acid (P = 0.049) were found in poststroke subjects. Agathobacter was highly correlated with acetic acid level (r = 0.473, P = 0.002), whereas Fusobacteria (r = -0.371, P = 0.018), Flavonifractor (r = -0.334, P = 0.034), Desulfovibrio (r = -0.362, P = 0.018), and Akkermansia (r = -0.321, P = 0.043) were negatively related to acetic acid levels. Additionally, the findings of the correlation analysis revealed that Akkermansia (r = -0.356, P = 0.024), Desulfovibrio (r = -0.316, P = 0.047), and Alloprevotella (r = -0.366, P = 0.020) were significantly negatively correlated with high-density lipoprotein cholesterol. In addition, the Neurogenic Bowel Dysfunction score (r = 0.495, P = 0.026), Barthel index (r = -0.531, P = 0.015), Fugl-Meyer Assessment score (r = -0.565, P = 0.009), Visual Analogue Scale score (r = 0.605, P = 0.005), and Brief Pain Inventory score (r = 0.507, P = 0.023) were significantly associated with alterations of distinctive gut microbiota. Stroke generates extensive and substantial alterations in the gut microbiota and SCFAs, according to our findings. The differences of intestinal flora and lower fecal SCFA levels are closely related to the physical function, intestinal function, pain, or nutritional status of poststroke patients. Treatment strategies aimed at modulating the gut microbiota and SCFAs may have the potential to enhance the clinical results of patients.

Morphofunctional assessment of nutritional status in patients with type 1 diabetes mellitus

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

To study on nutritional status in patients with ulcerative colitis

To study on nutritional status in patients with ulcerative colitis

Nutritional status in patients with active pulmonary tuberculosis and new nutritional risk screening model for active tuberculosis: a national, multicenter, cross-sectional study in China.

Tuberculosis (TB) remains a significant challenge for public health and is closely associated with malnutrition; however, few studies have attempted to screen malnutrition among TB patients. The study aimed to evaluate the nutrition status and build a new nutritional screening model for active TB. A retrospective, multicenter, large cross-sectional study was conducted in China from 1 January 2020 to 31 December 2021. All included patients diagnosed with active pulmonary TB (PTB) were evaluated both by Nutrition Risk Screening 2002 (NRS 2002) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Univariate and multivariate analyses were conducted to screen the risk factors associated with malnutrition, and a new screening risk model, mainly for TB patients, was constructed. A total of 14,941 cases meeting the inclusion criteria were entered into the final analysis. The malnutrition risk rate among PTB patients in China was 55.86% and 42.70%, according to the NRS 2002 and GLIM, respectively. The inconsistency rate between the two methods was 24.77%. A total of 11 clinical factors, including elderly, low body mass index (BMI), decreased lymphocyte cells, taking immunosuppressive agents, co-pleural TB, diabetes mellitus (DM), human immunodeficiency virus (HIV), severe pneumonia, decreased food intake within a week, weight loss and dialysis were identified as independent risk factors of malnutrition based on multivariate analyses. A new nutritional risk screening model was constructed for TB patients with a diagnostic sensitivity of 97.6% and specificity of 93.1%. Active TB patients have severe malnutrition status according to screening by the NRS 2002 and GLIM criteria. The new screening model is recommended for PTB patients as it is more closely tailored to the characteristics of TB.

To study on nutritional status in patients with gallbladder inflammation

To study on nutritional status in patients with gallbladder inflammation

Pre-operative prognostic nutrition index and post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients.

Post-operative pneumonia (POP), a common complication, may be associated with prolonged hospitalization and long-term mortality in aneurysmal subarachnoid hemorrhage (aSAH) patients. This study aimed to explore the association between pre-operative prognostic nutrition index (PNI) and POP in aSAH patients. A total of 280 aSAH patients were enrolled from Nanjing Drum Tower Hospital. PNI was calculated as follows: [10 × albumin(gr/dl)] + [0.005 × absolute pre-operative lymphocyte count (per mm3)]. We utilized multivariate analyses, restricted cubic spline, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to elucidate the role of PNI in POP. Pre-operative PNI levels in the POP group were higher, compared with the non-POP group (41.0 [39.0, 45.4] vs. 44.4 [40.5, 47.3], P = 0.001). When we included PNI as a categorical variable in the multivariate analysis, the levels of PNI were associated with POP (odds ratio, 0.433; 95% confidence interval, 0.253-0.743; P=0.002). In addition, when we included PNI as a continuous variable in the multivariate analysis, the PNI levels were also associated with POP (odds ratio, 0.942; 95% confidence interval, 0.892-0.994; P = 0.028). The level of albumin was also a predictor of the occurrence of POP, with a lower diagnostic power than PNI [AUC: 0.611 (95% confidence interval, 0.549-0.682; P = 0.001) for PNI vs. 0.584 (95% confidence interval, 0.517-0.650; P = 0.017) for albumin]. Multivariable-adjusted spline regression indicated a linear dose-response association between PNI and POP in aSAH participants (P for linearity = 0.027; P for non-linearity = 0.130). Reclassification assessed by IDI and NRI was significantly improved with the addition of PNI to the conventional model of POP in aSAH patients (NRI: 0.322 [0.089-0.555], P = 0.007; IDI: 0.016 [0.001-0.031], P = 0.040). The lower levels of pre-operative PNI may be associated with the higher incidence of POP in aSAH patients. Neurosurgeons are supposed to pay more attention to pre-operative nutrition status in aSAH patients.

The controlling nutritional status score predicts postoperative mortality in patients with ruptured abdominal aortic aneurysm: a retrospective study.

Ruptured abdominal aortic aneurysms (rAAAs) are challenging for vascular surgeons because they have a high mortality rate. In many diseases, nutritional status is closely associated with prognosis. The Controlling Nutritional Status (CONUT) screening tool score is a prognostic factor in some malignant and chronic diseases; however, the impact of nutritional status on rAAA has not yet been reported. In this study, we explored the relationship between the CONUT score and the postoperative prognosis of patients with rAAA. This was a retrospective review of 39 patients with rAAA who underwent surgical treatment from March 2018 to September 2021 at one center. Patient characteristics, nutritional status (CONUT score), and postoperative status were recorded. The patients were divided into groups A and B based on the CONUT score. The baseline characteristics of the two groups were compared, and Cox proportional hazards and logistic regression analyses were used to determine independent predictors of mid-term mortality and complications, respectively. The overall mid-term mortality rate was 28.21% (11/39). Compared with group A, group B had higher intraoperative (P = 0.047) and mid-term mortality (P = 0.033) rates. The univariate analysis showed that age [hazard ratio (HR), 1.098; 95% confidence interval (CI), 1.019-1.182; P = 0.014], CONUT score (HR, 1.316; 95% CI, 1.027-1.686; P = 0.03), and surgical procedure (HR, 0.127; 95% CI, 0.016-0.992; P = 0.049) were associated with mid-term mortality, whereas the multivariate analysis showed that the CONUT score (HR, 1.313; 95% CI, 1.009-1.710; P = 0.043) was an independent predictor of mid-term mortality. The multivariate logistic regression analysis did not reveal any associations with complications. The Kaplan-Meier curves showed that group B had a lower mid-term survival rate (log-rank P = 0.024). Malnutrition is closely associated with the prognosis of patients with rAAA, and the CONUT score can be used to predict mid-term mortality.

Preoperative low muscle mass and malnutrition affect the clinical prognosis of locally advanced gastric cancer patients undergoing radical surgery.

Gastric cancer is a common and highly aggressive malignant tumor of the gastrointestinal tract that poses a serious threat to human life and health. As the clinical symptoms of early gastric carcinoma are not obvious, many patients are diagnosed in the middle or late stages. With the advancement of medical technology, gastrectomy has become a safer surgical procedure, but it still has a high recurrence and mortality rate after surgery. The prognosis of gastric cancer patients after surgery is not only related to tumor-related factors (i.e., tumor stage) but the patient's nutritional status. This study aimed to investigate the effect of preoperative muscle mass combined with the prognostic nutritional index (PNI) on clinical prognosis in locally advanced gastric carcinoma. The clinical data of 136 patients with locally advanced gastric carcinoma diagnosed by pathology and undergoing radical gastrectomy were retrospectively reviewed. To analyze the influencing factors of preoperative low muscle mass and its correlation with the prognostic nutritional index. Patients with both low muscle mass and low PNI (≤46.55) were assigned a score of 2, and those with only one or neither of these abnormalities were assigned a score of 1 or 0, respectively, according to the new prognostic score (PNIS). The relationship between PNIS and clinicopathological characteristics was analyzed. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Low muscle mass was associated with a lower PNI (P < 0.01). The optimal cut-off value of PNI was 46.55, the sensitivity was 48%, and the specificity was 97.1%. There were 53 (38.97%), 59 (43.38%), and 24 patients (17.65%) in the PNIS 0, 1, and 2 groups, respectively. A higher PNIS and advanced age were independent risk factors for postoperative complications (P < 0.01). The overall survival rate in patients with PNIS 2 score was significantly poorer than in patients with scores of 1 or 0 (3-year OS: 45.8% vs 67.8% vs 92.4%, P < 0.001). A Multivariate Cox hazards analysis showed that PNIS 2, depth of tumor invasion, vascular invasion, and postoperative complications were independent predictors of the poor 3-year survival in patients with locally advanced gastric cancer. The combination of muscle mass and the PNI score system can be used to predict the survival outcome of patients with locally advanced gastric cancer.

Taking a Deeper Dive Into Malnutrition and Revision Arthroplasty: When Do Nutritionists Get Involved?

BackgroundPerioperative malnutrition is associated with increased complications and mortality following revision total joint arthroplasty (rTJA). Nutritional consultations are useful in characterizing patient nutritional status but are inconsistently utilized post rTJA. We sought: 1) to describe the prevalence of nutritional consultations post rTJA, 2) to determine if septic rTJA patients needed consultations more often, and 3) if a diagnosis of ‘malnutrition’ from the nutritionist conferred increased readmission rates. MethodsA retrospective study of 2,697 rTJAs performed in a single institution over a 4-year period was performed. Patient demographics, reasons for rTJA, occurrences of nutritional consultation (indicated if body mass index < 20, malnutrition screening tool score ≥ 2, or poor oral intake postoperatively), specific nutritional diagnosis (according to 2020 Electronic Nutrition Care Process Terminology and 90-day readmission rates were recorded and analyzed). Rates of consultations and adjusted logistic regressions were calculated. ResultsThere were 501 patients (18.6%) who required nutritional consultations, with 55 (11.0%) of these patients receiving a ‘malnutrition’ diagnosis. Septic rTJA patients required significantly more nutritional consultations (P < .01) and were significantly more likely to have ‘malnutrition’ (P = .49). A diagnosis of malnutrition was associated with the highest odds of all-cause readmission (odds ratio (OR) = 3.89, P = .01), which was even higher than undergoing a septic rTJA. ConclusionNutritional consultations occur frequently following rTJA. Patients who receive a diagnosis of ‘malnutrition’ through consultation are at significantly higher risk for readmission and require close follow-up. Future efforts are needed to further characterize these patients in order to identify as well as optimize them preoperatively.