Presence Of Malnutrition Research Articles

Nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea.

To evaluate the nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea. Children <18years diagnosed with HIV between 2009 and 2017 were included. Clinical, immunological and nutritional data were collected. Weight-for-height, weight-for-age and height-for-age Z-scores were calculated using WHO Child Growth Standards. The population was assessed in two equal periods (2009-2013 and 2014-2017) from the time of diagnosis. A total of 213 children were diagnosed with HIV (49.3% males), median age 3.8years (IQR: 1.5-8.2). A total of 121 cases (56.8%) were at WHO clinical stage III, and 53 (24.9%) were at WHO clinical stage IV. CDC immunological stage II was diagnosed in 51/130 (39.2%) and CDC stage III in 44/130 (33.8%). About 56.2% of children were underweight (weight-for-age <-2 SD); 20.1% moderately and 36.1% severely so. About 27.6% of children were wasted (weight-for-height <-2 SD); 11.9% moderately and 15.7% severely so. About 56.3% of children were stunted (height-for-age <-2 SD); 20.7% moderately and 35.6% severely so. The prevalence of wasting was higher in children ≤5years than in children >5years (36.4% vs. 19.1%, P=0.026). In the second period, the prevalence of moderate-severe immunodeficiency decreased (87.2% to 67.0%, P=0.018), without significant differences in the other nutritional or clinical data. Severe underweight was a risk factor for moderate-severe immunodeficiency (aOR: 4 [95% CI: 1.4-11.4], P=0.010). We highlight a high proportion of malnutrition at the time of HIV diagnosis in Guinea´s paediatric population. Early diagnosis of HIV infection is a priority, achievable by training Guinea´s physicians to suspect HIV early, introducing HIV molecular diagnostic techniques and ensuring intensive nutritional treatment.

Correlation of anti-heat shock protein 70 antibodies serum level with malnutrition-inflammation score in hemodialysis patients.

Increased levels of circulating heat shock protein 70 antibodies (anti-Hsp70) have been reported in hemodialysis (HD) patients. Since the anti-Hsp70 correlates with inflammation, it may associate with the malnutrition-inflammation score (MIS). The aim of this study was to determine whether the increased MIS score in HD patients are related to circulating levels of anti-Hsp70. Ninety HD patients with an arteriovenous fistula, aged 30-65years, who underwent three hemodialysis sessions a week for at least the past 3months at a hemodialysis center were enrolled in this cross-sectional study. Patients were divided based on MIS score to two groups, and the clinical and biochemical variables were compared between them. MIScutoffscore of ≥ 5 indicated the presence of malnutrition. The association between categorized MIS and anti-Hsp70 was examined using regression models adjusted for diabetes mellitus, hemodialysis vintage, BMI, albumin, hs-CRP, IL6 and endotoxin levels as confounding factors. The univariate regression analysis revealed a significant association between MIS ≥ 5 and hemodialysis vintage, uric acid, hs-CRP, IL-6, endotoxin and serum anti-Hsp70 level. After adjusting the confounders, the association between MIS ≥ 5 and serum anti-Hsp70 level remained significant. These data support the role of serum anti-Hsp70 in the development of malnutrition in HD patients. However, further studies with body composition assessments and better generalizability are required to investigate the association between nutritional status and circulating anti-Hsp70 level in HD patients.

Comprehensive approach to weaning in difficult-to-wean infantile and juvenile-onset glycogen-storage disease type II patients: a case series

BackgroundGlycogen storage disease type II (GSD II) is caused by acid alpha-glucosidase (GAA) deficiency. Both infantile-onset and juvenile-onset GSD II lead to proximal muscle weakness and respiratory insufficiency and require mechanical ventilation. However, GSD II is also independently associated with delayed weaning from mechanical ventilation. This study aimed to describe a comprehensive approach including sequential invasive-noninvasive mechanical ventilation weaning and enzyme replacement therapy (ERT) in patients with weaning difficulties.Case presentationWe studied six difficult-to-wean GSD II (three juvenile-onset, three infantile-onset) patients at the First Affiliated Hospital, Sun Yat-sen University from October 2015 to December 2017. Difficulty in weaning was defined as follows: the need for more than three spontaneous breathing trials or more than 1 week to achieve successful weaning. All patients received comprehensive treatment including sequential invasive-noninvasive mechanical ventilation weaning, ERT and general treatment. Recombinant human acid alpha-glucosidase enzyme therapy (20 mg/kg every 14 days) was used after diagnosis, and Patients 1–6 received ERT for 15.5, 4.5, 2, 2.5, 17, and 2 months, respectively. The therapeutic effect of the comprehensive treatment was observed.The patients’ respiratory function and limb muscle strength improved after each ERT session. Patients who successfully completed a spontaneous breathing trial could proceed to extubation, and then start non-invasive ventilation. The patients’ age range at initial mechanical ventilation was 3–47 (median 26.5) months, duration of invasive ventilation was 1–36 (median 2.75) months, and duration of noninvasive ventilation was 0–0.6 (median 0.05) month. The patients’ nutritional status improved after enhanced nutritional support. Patients 2, 3, and 5 were successfully weaned off the ventilator. Patient 1 underwent tracheal intubation after six weaning failures, and Patients 4 and 6 died after therapy was abandoned by their parents.Discussion and conclusionsMale sex, GSD II type, and the presence of malnutrition and neurological impairment may predict poor respiratory outcomes. The above-described comprehensive sequential invasive-noninvasive mechanical ventilation weaning strategy may increase the success rate of weaning from mechanical ventilation.

Identifying and Managing Malnourished Hospitalized Patients Utilizing the Malnutrition Quality Improvement Initiative: The UPMC Experience

Registered dietitian nutritionists at University of Pittsburgh Medical Center, a group of 40 academic, community, and specialty hospitals in Pittsburgh, PA, recognized the need to improve the identification and management of malnourished adult patients at their institutions. It was decided to pilot the Malnutrition Quality Improvement Initiative (MQii) at two institutions within their health care system. The MQii is based on the dual-pronged approach of malnutrition-focused electronic clinical quality measures and a quality improvement toolkit (MQii Toolkit), to help identify and manage malnourished adult patients. The quality improvement implementation focused on hospital-wide adoption of the Nutrition Focused Physical Examination (NFPE). The MQii team was guided by the malnutrition electronic clinical quality measures focused on completing a nutrition assessment (the NFPE) within 24 hours of identification of malnutrition risk and ensuring documentation of a malnutrition diagnosis when it was identified. Performance on both measures improved significantly (P<0.01). Performance on appropriate timing of nutrition risk screening improved slightly, and there was almost perfect compliance for completion of nutrition care plans in the presence of malnutrition. Overall, the performance data demonstrated the effectiveness of using the MQii to improve the nutrition processes and the ability to implement NFPE into the process of malnutrition identification. Funding/SupportPublication of this supplement was supported by Abbott. The Academy of Nutrition and Dietetics does not receive funding for the MQii. Avalere Health's work to support the MQii was funded by Abbott.

Malnutrition is associated with dynamic physical performance

BackgroundMalnutrition and poor physical performance are both conditions that increase in prevalence with age; however, their interrelation in a clinically relevant population has not been thoroughly studied.AimsThis study aimed to determine the strength of the association between malnutrition and measures of both static and dynamic physical performance in a cohort of geriatric outpatients.MethodsThis cross-sectional study included 286 older adults (mean age 81.8, SD 7.2 years, and 40.6% male) who were referred to geriatric outpatient mobility clinics. The presence of malnutrition was determined using the Short Nutritional Assessment Questionnaire (SNAQ, cut-off ≥ 2 points). Measures of dynamic physical performance included timed up and go (TUG), 4-m walk test, and chair stand test (CST). Static performance encompassed balance tests and hand grip strength (HGS). Physical performance was standardized into sex-specific Z-scores. The association between malnutrition and each individual measure of physical performance was assessed using linear regression analysis.Results19.9% of the cohort was identified as malnourished. Malnutrition was most strongly associated with CST and gait speed; less strong but significant associations were found between malnutrition and TUG. There was no significant association between malnutrition and HGS or balance.DiscussionPhysical performance was associated with malnutrition, specifically, dynamic rather than static measures. This may reflect muscle power being more impacted by nutritional status than muscle strength; however, this needs to be further addressed.ConclusionsMalnutrition is associated with dynamic physical performance in geriatric outpatients, which should inform diagnosis and treatment/prevention strategies.

Relationship Between Nutritional Status and Insomnia Severity in Older Adults

ObjectivesBoth insomnia and malnutrition are quite common and can cause similar negative consequences, such as falls, depression, and cognitive impairment in older adults, but there is no study investigating the relationship between the 2. The aims were to investigate relationships between insomnia/insomnia severity and Mini Nutritional Assessment (MNA) score and serum nutrient levels. Setting and participantsAged 65 years or older, 575 outpatients were included. MethodsMNA scores >23.5, 17-23.5, and <17 were categorized as normal nutritional status, malnutrition risk, and malnutrition, respectively. Serum vitamin B12, vitamin D, and folate deficiencies were also evaluated. Insomnia Severity Index (ISI) with scores of 8 and higher indicated insomnia, which was further stratified as mild (8-14), moderate (15-21), or severe (22-28). ResultsThe mean age was 73.1 ± 7.7 years, with 73.2% being female. The prevalence of patients with no insomnia, mild insomnia, moderate insomnia, and severe insomnia were 34.4%, 20.9%, 30.1%, and 14.6%, respectively. After adjusting for gender, education, number of drugs, Charlson Comorbidity Index, presence of depression, and Mini-Mental State Examination scores, patients with insomnia had lower MNA scores than those without insomnia (OR = 0.84, 95% CI: 0.7-0.9, P < .001). There were significant relationships between moderate/severe insomnia and the presence of malnutrition and risk of malnutrition (OR = 1.6, 95% CI: 1.0-2.5, P = .046; OR = 1.6, 95% CI: 1.0-2.7, P = .042) and MNA scores (OR = 0.83, 95% CI: 0.7-0.9, P < .001)/OR = 0.82, 95% CI: 0.7-0.9, P < .001). There was no significant difference between insomnia severity status and serum vitamin D, vitamin B12, folate levels, or classification of these nutrients (P > .05). Conclusions/ImplicationsThere is a close relationship between MNA scores and insomnia or insomnia severity in older adults. Therefore, when evaluating an older patient with insomnia, malnutrition should be evaluated, or insomnia should also be questioned in an older patient with malnutrition. Thus, more effective management of the 2 can be possible.

Nutritional status as a predictor of hospitalization in inflammatory bowel disease: A review.

BACKGROUNDInflammatory bowel disease (IBD) presents an inflammatory picture that in the long run can lead to complications and consequently more hospitalizations compared to other diseases.AIMTo evaluate the influence of nutritional status on the occurrence of IBD-related hospitalization.METHODSThis integrative review was conducted in the online databases PubMed and MEDLINE, using the terms “obesity” and “malnutrition” accompanied by “hospitalization”, each combined with “Crohn’s disease” or “ulcerative colitis”. Only studies conducted with humans, adults, and published in English or Spanish were selected, and those that were not directly associated with nutritional status and hospitalization were excluded from this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guide was used as the basis for selection of studies.RESULTSOf the 80 studies identified, only five met the proposal of this review. None evaluated the association of good nutritional status with the risk of hospitalization. Malnutrition had a strong correlation with the risk of hospitalization related to IBD, and there was disagreement among three studies regarding the association of obesity and hospitalization rates.CONCLUSIONFew studies have evaluated nutritional status as a predictor of IBD-related hospitalization. The presence of malnutrition appears to be associated with hospitalization in these patients, but further studies are needed to elucidate the issue.

Malnutrition in Non-Hodgkin Lymphoma Patients at Dr. Hasan Sadikin General Hospital Bandung

Background : Non-hodgkin lymphoma (NHL) has the highest prevalence among hematologic malignancies. The prognosis and response to therapy in NHL patients may worsen in the presence of malnutrition. The aim of the study was to describe the malnutrition status in NHL patients. Methods : This was a cross-sectional descriptive study. Nutritional status was assessed using Subjective Global Assessment (SGA) obtained from the medical records of all NHL patients at Dr. Hasan Sadikin General Hospital registered in 2017. Results : In total, there were 78 medical records of NHL patients that fulfilled the inclusion criteria. All NHL patients had experienced malnutrition, categorized as mild-moderate malnutrition (70.5%) and severe malnutrition (29.5%). In NHL patients with mild-moderate malnutrition, 29% had 5–10% weight loss; 60% had suboptimal solid diet; 56.4% experienced anorexia; and 50.9% had subcutaneous fat loss. In NHL patients with severe malnutrition, 78.3% had more than 10% weight loss; 73.9% had suboptimal solid diet; 78.3% experienced anorexia; and 100% had subcutaneous fat loss. Conclusions : Based on subjective assessment, all NHL patients were malnourished and experienced change of food intake and loss of subcutaneous fat, therefore, a better nutritional support scheme are crucial for NHL patients.

Factors related to the presence of hospital malnutrition in patients under five years old in a third level unit

Objective: to identify the factors related to the presence of hospital malnutrition (HM) in patients under five years of age hospitalized in a third level care unit. Material and methods: cohort study. Patients under five years of age hospitalized were included. The record identified age, sex, pathological history, reason for admission and nutritional status by calculating weight/age (W/A), height/age (H/A) and weight/height (W/H). The entire somatometry intake process was performed upon admission, and was repeated on days 2, 4 and 7 of follow-up. The HM was defined as a decrease of more than 0.25 standard deviations in the W/H after seven days of hospitalization. Results: eighty-three patients were identified. The reason for admission was non-surgical pathology in 77% (n = 64). Seventy per cent (n = 58) had underlying disease. At the time of admission, 66% (n = 55) presented malnutrition. A progressive decrease in the Z score of W/H was observed as hospitalization progressed (p < 0.001). An incidence of 67.5% of HM was identified. It was shown that the presence of malnutrition at admission of hospitalization increased the risk of HM (OR 2.9, 95% CI 1.05 to 8.10, p = 0.03). In patients with malnutrition from admission, an age younger than two years decreased the risk of HM (OR 0.093, 95% CI 0.009 to 0.959, p = 0.046), while the underlying disease increased the risk (OR 6.34, 95% CI 1.009 to 39.89, p = 0.049). Conclusions: the presence of malnutrition and underlying disease prior to admission were risk factors to present HM.

Association of Nutritional Status with Cognitive Stage in the Elderly Korean Population: The Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease.

Background and PurposeEpidemiological studies have suggested the presence of strong correlations among diet, lifestyle, and dementia onset. However, these studies have unfortunately had major limitations due to their inability to fully control the various potential confounders affecting the nutritional status. The purpose of the current study was to determine the nutritional status of participants in the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease (KBASE) and to identify clinical risk factors for being at risk of malnutrition or being malnourished.MethodsBaseline data from 212 participants [119 cognitively unimpaired (CU), 56 with mild cognitive impairment (MCI), and 37 with dementia] included in the KBASE database were analyzed. All participants underwent a comprehensive cognitive test and MRI at baseline. The presence of malnutrition at baseline was measured by the Mini Nutritional Assessment score. We examined the cross-sectional relationships of clinical findings with nutritional status using multiple logistic regression applied to variables for which p<0.2 in the univariate analysis. Differences in cortical thickness according to the nutritional status were also investigated.ResultsAfter adjustment for demographic, nutritional, and neuropsychological factors, participants with dementia had a significantly higher odds ratio (OR) for being at risk of malnutrition or being malnourished than CU participants [OR=5.98, 95% CI=1.20–32.97] whereas participants with MCI did not (OR=0.62, 95% CI=0.20–1.83). Cortical thinning in the at-risk/malnutrition group was observed in the left temporal area.ConclusionsDementia was found to be an independent predictor for the risk of malnutrition compared with CU participants. Our findings further suggest that cortical thinning in left temporal regions is related to the nutritional status.

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients

Background: Body composition monitoring is the only clinically available method for distinguishing among the three body components. This study aimed to determine the relationship between body composition and all-cause mortality in Chinese hemodialysis patients and examine whether the lean tissue index (LTI) derived from body composition monitoring can accurately diagnose malnourished patients.Methods: Hemodialysis patients (n = 123) with nutritional and body composition assessment records in 2015 were examined. Body composition was assessed using a body composition monitor machine.Results: Fifty-seven patients (46.3%) had low LTI (LTI less than the 10th percentile of the respective normal distribution). Significant differences in the fat tissue index (FTI) were observed, with the low LTI group having a higher FTI (10.8 kg/m2 vs. 9.0 kg/m2, p= .007). The kappa coefficient of agreement between LTI and subjective global assessment (SGA) was 0.26 for the presence of malnutrition. During the mean observation period of 26.7 months, 20 of 123 (16.3%) patients died. Low LTI remained highly predictive of survival in the Cox regression analysis (hazard ratio: 3.24, 95% confidence interval 1.06–9.91, p= .04). Malnourishment defined by SGA predicted survival in the Kaplan–Meier analysis (log-rank χ2=4.05; p= .04) but not in the multivariate analysis.Conclusions: LTI is a predictor of mortality, and its predictive power was not affected when FTI, SGA, and hydration status were included in the multivariate analysis. However, SGA may not be adequate to identify patients at a risk of death among Chinese hemodialysis patients.

Predictors of multiple readmissions or death in the first year after Nissen fundoplication in children.

Nissen fundoplication (NF) is commonly performed in children with gastro-esophageal reflux disease (GERD). Patients undergoing NF often have co-morbidities. Reported outcomes of NF vary considerably. This study investigated which factors might predict multiple readmissions or death in the first year following NF at our institution. A retrospective chart review of 187 children who underwent NF at our institution between January 2004 and December 2015 was undertaken. Underlying medical conditions, age, weight, presence of malnutrition, length of hospital stay prior to surgery and type of surgery were recorded. Patients who had more than one admission in the first post-operative year were compared to those who had one or none, and patients who died within the first post-operative year were compared to those who did not. Risk factors for multiple readmissions were underlying cardiac disease (p = 0.011), esophageal atresia (EA) (p = 0.011), and esophageal stricture (p = 0.0002). Risk factors for death included younger age (p = 0.028), need for gastrostomy tube (GT) (p = 0.01) and prolonged pre-operative hospital admission (p = 0.0003). This study identified multiple factors associated with readmission and death in the first year after NF. These findings will help with the counseling patients and caregivers regarding expectations following NF.

Interactions Between Malnutrition, Inflammation, and Fluid Overload and Their Associations With Survival in Prevalent Hemodialysis Patients

Predialysis fluid overload (FO) in hemodialysis (HD) patients is associated with an increased risk of death, further increased by the presence of inflammation. Malnutrition is also associated with outcome. Study objectives were, firstly, to investigate if the presence of FO is associated with malnutrition and whether this association is influenced by the presence of inflammation. Second, we assessed the associations of FO, malnutrition, and inflammation with outcome individually and in combination. International cohort study. European patients of the Monitoring Dialysis Outcome Initiative cohort where bioimpedance and C-reactive protein measurements are performed as standard of care. 8883 prevalent HD patients. Body composition, nutritional and inflammation status were assessed during a 3-month baseline period, and all-cause mortality was noted during 1year follow-up. Malnutrition was defined as a lean tissue index <10th percentile (of age and gender matched healthy controls), FO as a predialysis overhydration >+1.1L and inflammation as a C-reactive protein>6.0mg/L. We used Cox models to investigate the association with outcome. The presence of malnutrition was associated with higher levels of FO, this amount further increased when inflammation was present. Only 11.6% of the patients did not have any of the 3 risk factors and only 6.5% of the patients were only malnourished, which was not associated with an increased risk of death (Hazard Ratio [HR] 1.22 [95% Confidence Interval [CI]: 0.75-1.97]), whereas the combination of severe malnutrition, FO, and inflammation comprised the highest risk of death (HR 5.89 [95% CI: 2.28-8.01]). In HD patients, predialysis FO associates with both malnutrition and the presence of inflammation, with the highest levels of FO observed when both are present. Malnutrition as singular risk factor was not associated with increased mortality risk. The highest mortality risk was observed in patients where all 3 risk factors were present.

Association of positive screening for dysphagia with nutritional status and long-term mortality in hospitalized elderly patients

ObjectivesTo assess the prevalence of oropharyngeal dysphagia (OD) using the Eating Assessment Tool (EAT-10) and its association with malnutrition and long-term mortality. Material and methodsA retrospective cohort study of patients admitted to the general internal medicine ward. In the first 48h after hospital admission, OD was assessed using the EAT-10, and presence of malnutrition with the Mini Nutritional Assessment-Short Form (MNA-SF). Association of OD to malnutrition and long-term mortality was analyzed. ResultsNinety patients with a mean age of 83 (SD: 11.8) years were enrolled. Of these, 56.7% were at risk of OD according to EAT-10. This group of patients had greater prevalence rates of malnutrition (88.2% vs. 48.7%; p=0.001) and mortality (70% vs. 35.9%; p=0.001). During follow-up for 872.71 (SD: 642.89) days, risk of DO according to EAT-10 was an independent predictor of mortality factor in a multivariate analysis (HR: 2.8; 95%CI: 1.49–5.28; p=0.001). ConclusionsThe EAT-10 is a useful tool for screening OD. Adequate screening for OD is important because of its associated risks of malnutrition and long-term mortality.

Association between neutrophil-to-lymphocyte ratio and nutritional status in geriatric patients.

Neutrophil-to-lymphocyte ratio (NLR) and presence of malnutrition have been found to be associated with mortality and morbidity in various clinical conditions. We investigated the association between NLR and nutritional status in geriatric patients. This cross-sectional study included 95 geriatric (age≥65years) patients from general internal medicine outpatient clinic of a university hospital. Nutritional status of the patients was evaluated using Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index, albumin, total cholesterol, body mass index, mid-arm circumference, and calf circumference. NLR was calculated from the complete blood count results. A total of 59 patients were female, and the mean age was 73±9.8years. According to the MNA, 51.6% of patients had a normal nutritional status, and 48.4% were malnourished or at risk of malnutrition. The mean NLR of patients with malnourished or at risk of malnutrition was significantly higher than that of patients with normal nutritional status (P=0.004). There was a negative correlation between NLRs and the MNA scores (r=-0.276, P=0.007). Optimal NLR cutoff point for patients with malnourished or at risk of malnutrition was 1.81 with 71.7% sensitivity and 63.3% specificity [95% confidence interval (CI): 0.562-0.780, P=0.004]. Logistic regression analysis revealed that elevated NLR was an independent factor in prediction of malnutrition or risk of malnutrition in geriatric patients. These results demonstrated that NLR was associated with the nutritional status of geriatric patients. NLR may be a useful nutritional marker for evaluating the nutritional status of geriatric outpatients.

Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points

The prevention and management of malnutrition is increasingly recognised as a significant element of cancer care. By identifying and comparing cancer malnutrition in two large cross-sectional cancer populations, this study aims to provide a greater understanding of clinical characteristics and trajectories relating to cancer malnutrition. A multi-centre point prevalence study was conducted in Victoria, Australia at two time points (March 2012, May 2014). Adults with cancer receiving ambulatory chemotherapy, radiotherapy and multi-day inpatients were included. The presence of malnutrition was determined using Patient Generated-Subjective Global Assessment (PG-SGA). Demographic, clinical information and 30-day outcomes were collected. The study included 1677 patients in 2012 (17 sites) and 1913 patients in 2014 (27 sites). Older age, ≥5% weight loss, hospital admission and metastatic disease were factors significantly associated with malnutrition. Patients with upper gastrointestinal, head and neck and lung cancers were more likely to be malnourished. Malnutrition was associated with infection and poor outcomes at 30-days. Malnutrition prevalence reduced from 31% in 2012 to 26% in 2014 (p=0.002). This reflects a reduction in patients with malnutrition receiving ambulatory chemotherapy, those with upper gastrointestinal or colorectal cancers and those residing in regional areas. The study has provided a comprehensive description of cancer malnutrition prevalence representative of all treatment settings, tumour types and stages of disease. This provides valuable insight into cancer malnutrition enabling oncology services to identify opportunities to embed identification and prevention strategies into models of care, resulting in improved patient outcomes and reduced health care costs.

Asociación de un cribado positivo para disfagia con el estado nutricional y la mortalidad a largo plazo en pacientes ancianos hospitalizados

ObjectivesTo assess the prevalence of oropharyngeal dysphagia (OD) using the Eating Assessment Tool (EAT-10) and its association with malnutrition and long-term mortality. Material and methodsA retrospective cohort study of patients admitted to the general internal medicine ward. In the first 48hours after hospital admission, OD was assessed using the EAT-10, and presence of malnutrition with the Mini Nutritional Assessment-Short Form (MNA-SF). Association of OD to malnutrition and long-term mortality was analyzed. ResultsNinety patients with a mean age of 83 (SD: 11.8) years were enrolled. Of these, 56.7% were at risk of OD according to EAT-10. This group of patients had greater prevalence rates of malnutrition (88.2% vs. 48.7%; P=.001) and mortality (70% vs 35.9%; P=.001). During follow-up for 872.71 (SD: 642.89) days, risk of DO according to EAT-10 was an independent predictor of mortality factor in a multivariate analysis (HR: 2.8; 95%CI: 1.49-5.28; P=.001). ConclusionsThe EAT-10 is a useful tool for screening OD. Adequate screening for OD is important because of its associated risks of malnutrition and long-term mortality.

Integral nutritional approach to the care of cancer patients: results from a Delphi panel.

Malnutrition is a common complication in cancer patients and can negatively affect the outcome of treatments. This study aimed to reach a consensus on nutritional needs and optimize nutritional care in the management of cancer patients at a national level. A qualitative, multicenter, two-round Delphi study involving 52 specialists with experience in nutritional support in cancer patients was conducted. Regarding the presence of malnutrition, 57.7% of the participants stated that <30% of the patients had malnutrition at the time of diagnosis, 40.4% considered that 31-50% had malnutrition during cancer treatment, and 26.9% that >50% at the end of the treatment. Forty percent of participants believed that the main objective of nutritional treatment was to improve quality of life and 34.6% to improve tolerability and adherence to chemotherapy. The quality nutritional care provided at their centers was rated as medium-low by 67.3%. Enteral and parenteral nutrition was administered to less than 10% and less than 5% of patients in 40.4 and 76.9% of cases, respectively. In relation to nutritional screening at the time of diagnosis, 62.9% of participants considered than screening to assess the risk of malnutrition was performed in <30% of patients. There is an important variability in the management of cancer patient nutrition, which is associated with the absence of a national consensus on nutritional support in this field. Given the incidence of nutritional disorders in cancer patients, a specialist in clinical nutrition (regardless of his/her specialty) should be integrated into the strategic cancer plan.

Factors predisposing to conversion from laparoscopic to open cholecystectomy

The conversion of a laparoscopic cholecystectomy (LC) to an open procedure seems to be multifactorial, be affected by factors related to the patient, the gallbladder’s pathology and the surgeon. Among the more than twenty parameters which have been studied as possible predisposing factors for conversion, current literature addresses that: a male patient, above 65 years old, with American Society of Anaesthesiology (ASA) score ≥3, suffering from acute cholecystitis, with a thickened gallbladder’s wall on preoperative CT and an impacted stone in infundibulum or Mirizzi syndrome as intraoperative finding, who was operated on more than 72 hours from the onset of symptoms, by a non-laparoscopic surgeon, represents the most likely candidate for conversion from LC to open surgery. The probability increases further in the presence of malnutrition and/or cirrhosis. The proposed predictive scores for conversion have not yet found worldwide acceptance and their use is limited to theoretical or training purposes. Even patients with maximum predictive score, do not have a 100% probability for conversion. An experienced surgeon can complete a difficult LC successfully in high-risk surgical patient using the subtotal LC. The need for conversion to laparotomy should be considered as neither a failure nor a complication, but as an attempt to be avoided intra- or post-operative complications. The present review attempts to present the most recent knowledge on the field “conversion from LC to open surgery”.

Malnutrition Rate in Stroke Patients on Admission.

Objectives:Malnutrition is frequently observed in patients with acute stroke and its prevalence after stroke varies widely among published reports. Differences in the timing of assessment, stroke type, comorbid medical conditions, and stroke complications may have contributed to this large variability. This study is conducted to investigate the prevalence of malnutrition, and its associated risk factors in stroke patients admitted to our stroke clinic.Methods:A prospective design was used to measure the nutritional status and nutritional risk of stroke patients during hospitalisation between June 2016 and February 2017. Nutritional status was measured at admission. Demographic data and information on clinical variables were collected, which included the patient’s age, gender, type of stroke and other comorbid disorders. Blood samples, including concentrations of high-sensitivity C-reactive protein (CRP), serum albumin, serum creatinine, lipid profile and serum lymphocyte count, were measured by routine methods. Nutritional status was measured using the Mini Nutritional Assessment (MNA); for elderly stroke patients (age older than 65). For stroke patients younger than 65 age, Nutrition Screening 2002 (NRS 2002) was used.Results:318 patients with acute stroke were assessed for their nutritional status at admission. There were 145 (45%) female and 173 (55%) male patients. Their mean age was 66.16±14.32. 66.1% of the patients elder than 65 years were malnourished. 12.2% of the patients younger than 65 years were found to be malnourished. We found no relationship between comorbidities and malnutrition, except hyperlipidemia. Nourished stroke patients older than 65 years had higher serum lipid levels than the malnourished patients. We also found no relationship between malnutrition biomarkers and being malnourished.Conclusion:Malnutrition is frequently observed in patients with stroke. Early recognition of malnutrition is crucial, but the absence of valid markers hampers to find out the presence of malnutrition. Thus, further research is needed in targeting the modifiable nutrition risk factors and give attention to nutrition in stroke patients.