Prognostic Inflammatory Nutritional Index Research Articles

Evaluation of Anemic Pupils Nutritional Status Fed with Recipes Based on Sweet Potatoes, Soya and Cowpea in Nawa Region, Côte d’Ivoire

In underdeveloped countries a great number of school-age children suffered of malnutrition and anemia. This is due to a less diversified diet and had an impact on their intellectual capacities. A study was conducted in four schools in Nawa region of Cote d’Ivoire with the aim to evaluate the impact of selected foods on anemic children nutritional status. One meal was proposed by school: rice with tomato sauce and meat, sweet potatoes stew with soya, sweet potatoes stew with cowpea and sweet potatoes stew with soya and cowpea. A total of 75 children aged from 6 to 15 years old participate, and they ate the meals twice in a week for 3 months. Anthropometric measurements (weight and height) and blood sampling were taken at 3 periods: at the beginning, middle and end of the study. The results showed that hemoglobin values were under normal rate for all children except in Petit-Bondoukou and Takoreagui in period 1 (11.67 and 11.82 g/dl respectively). There was an increase of anemia prevalence from 18.18 % to 40.91 % for children who ate rice with tomato sauce and meat and from 43.75 % to 50.00 % for children who ate potatoes stew with cowpea. But there was a decrease of anemia rate from 61.54 % to 53.83 % for children who ate potatoes stew with soya. Nutritional status according to anthropometric measurement increased for children of Gnaboya and Petit-Bondoukou. Albumin (33.25 g/l) and orosomucoid (0.69 mg/l) value of children who ate tomato sauce and meat were lower in period 1 than that of children of the other villages. According to prognostic inflammatory nutritional index, children present a low malnutrition risk which varied between 7.69 to 43.75 %. Diet diversification should be applied for a long period to better appreciate their impact on nutritional and anemia status improvement.

Consumption of an Extremely Biodiverse Probiotic and a Supplement based on Microbial Chondroitin Sulfate is Associated with Very Low Serum Alpha-N-acetylgalactosaminidase (Nagalase) Activity and Decrease of C-reactive Protein Values

We describe the case of a 57-years-old male healthy professional who added to his nutritional plan a novel, extremely biodiverse, probiotic and a supplement based on microbial chondroitin sulfate, vitamin D3 and ultrapure phosphatidylcholine to improve his healthy life expectancy. After three months of such a nutritional regimen, serum alpha-N-acetylgalactosaminidase (nagalase) activity was 0.40 that is a value below the minimum level established for adults (normal values: 0.50-0.95 nMol/mL/min). C-reactive Protein (CRP) was less than 1 (normal values: 0.00-5.00 mg/L), a value significantly lower than that recorded before this experience. At the end of the observation period, serum albumin level was 45 g/L, a value very close to the maximum reference value (normal values: 32.00-46.00 g/L). The Prognostic Inflammatory Nutritional Index (PINI) score was 0.05, a value that is close to the minimum calculated value (normal values: 0.00-1.00) and suggests a very low risk of death for all causes. Observation in silico and experiments in vitro demonstrated that both the probiotic and the supplement formed complexes with human nagalase with an efficiency 100 fold higher than that of purified Gc protein-derived Macrophage Activating Factor (GcMAF). The collection of these observations suggests that the combination of this probiotic and this supplement may lead to overall beneficial effects on health as evidenced by positive changes of indicators of immune system function and healthy aging such as nagalase, CRP, albumin and PINI score.

Association Between Nutritional Status, Inflammatory Condition, and Prognostic Indexes with Postoperative Complications and Clinical Outcome of Patients with Gastrointestinal Neoplasia

ABSTRACTThe aim of this study is to describe and relate nutritional and inflammatory status and prognostic indexes with postoperative complications and clinical outcome of patients with gastrointestinal malignancies. Twenty-nine patients were evaluated; nutritional assessment was carried out by subjective and objective parameters; albumin, pre-albumin, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) were determined. To assess prognosis, the Glasgow scale, the Prognostic Inflammatory Nutritional Index (PINI), and CRP/albumin ratio were used; the clinical outcomes considered were hospital discharge and death. A high Subjective Global Assessment (SGA) score was associated with the occurrence of postoperative complications: 73% of the patients with postoperative complications had the highest SGA score, but only 6% of those without postoperative complications had the highest SGA score (P < 0.001). Greater occurrence of death was observed in patients with a high SGA score, low serum albumin, increased CRP, PINI > 1, and Glasgow score 2. There was a positive correlation between weight loss percentage with serum CRP levels (P = 0.002), CRP/albumin (P = 0.002), PINI (P = 0.002), and Glasgow score (P = 0.000). This study provides evidence that the assessment of the nutritional status and the use of prognostic indexes are good tools for predicting postoperative complications and clinical outcome in patients with gastrointestinal neoplasia.

ROLE OF ANGIOTENSIN-CONVERTING ENZYME AND VITAMIN D RECEPTOR GENE POLYMORPHISMS IN CANCER ANOREXIA-CACHEXIA SYNDROME

The ubiquitin-proteasome pathway is a crucial conne ction between aberrant immune system activation, systemic inflammation and Cancer Anorexia-Cachexia Syndrome (CACS), a syndrome that culminates in hyper-activation of the ubiquitin-proteasome pathwa y. Angiotensin directly up-regulates this pathway, while vitamin D down-regulates it indirectly through the insulin-like growth factor-1 pathway. We investigat ed the genetic predisposition towards CACS in a cancer population, examining Insertion/Deletion (I/D) polymorphism of angiotensin-converting enzyme gene and FokI and BsmI polymorphisms of vitamin D receptor gene. Sixty-two cancer patients were recru ited and divided into three groups: primary cachect ic (C1, n = 14; dysmetabolic body weight loss ≥5% in 6 months); secondary cachectic (C2, n = 34; similar weight loss, mechanic or iatrogenic origin); and non-cachectic ( NC, n = 16). C2+NC were merged in the control group. The three groups showed significant differences in average prognostic inflammatory nutritional index ( C1: 26.4±23.4; C2: 5.4±5.6; NC: 0.37±0.5), C-reactive protein serum levels (C1: 6.6±2.1; C2: 2.4±2.2; NC: 1.0±2.0 mg/dl), albumin serum levels (C1: 3.1±0.6; C2: 3.5±0.4; NC 3.7±0.6 g/dl), weight loss (C1: 22±8; C2: 1 5±6.7; NC 5±6%) and life expectancy (C1: 6.4±3.3; C2: 25±28; NC: 45±25 months). However, none of the chosen polymorphisms showed any statistically significant correlation with CACS. The complexity of the changes of the immune system in the chronic inflammation state associated with CACS is far greater than expected and further studies are required to identify genetic independen t markers of progression toward CACS.

Malnutrition, Inflammation: Which Parameter Is Interesting to Detect in Planned Oncologic Surgery?

We are grateful to Dr. Muscaritoli and colleagues [1] for their comment and their recommendation concerning the need to assess inflammation parameters before surgery, especially C-reactive protein (CRP), and we totally agree with their advice. This point was recently confirmed in the study published this year by Moyes et al. [2], in which the Glasgow prognostic score (GPS) [3] using albumin (Alb) and C-reactive protein (CRP) values to determine the level of risk, was significantly associated with an increased risk of developing a postoperative infection during elective surgery in 385 colorectal cancer resections (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.17–2.63; p = 0.007). The goals of our study were to detect easily collected data on nutritional parameters that would allow us to define a group for which a nutritional treatment could reduce the number of complications after surgery. In the course of our study [4] CRP data were collected before surgery in 76% of the cases. Three CRP threshold values were studied: [15, [50, and 100 mg/l. In the univariate analysis, only a CRP value of [50 mg/l was found to be associated with total major complications (TMC) (p = 0.02), with major infectious complications (p = 0.03) and with major non-infectious complications (p = 0.05). No statistically significant relationship was found for a CRP value [15 mg/l or for CRP [ 100 mg/l. In the multivariate analysis, CRP was no longer associated with the occurrence of postoperative complications. We also analyzed the frequency of complications according to the Prognostic Inflammatory Nutritional Index: [PINI = CRP (mg/l) 9 orosomucoid (mg/l)]/[albumin g/ l 9 transthyretin (mg/l)], determined before surgery. Overall, PINI values were obtained for 72% of the patients. A relationship with the frequency of TMC was found only in the univariate analysis (p = 0.04), not in the multivariate analysis. As reported by some authors [5], as well as by Dr. Muscaritoli, albumin is dependent not only on the patient’s nutritional status but also on the inflammatory status. McMillan et al. [3] obtained better survival at 3 years in colorectal cancer patients using the GPS: 86% for a GPS 0 (Alb [ 35 g/l and CRP \ 10 mg l), 71% for a GPS 1 (Alb \ 35 g/l or CRP \ 10 mg/l), and 46% for a GPS 2 (Alb \ 35 g/l and CRP [ 10 mg/l) (p \ 0.0001). After analyzing our results according to the same threshold values, a similar role was found for the inflammatory factor. Major complications were more frequent (p = 0.03) for the highest GPS values; respectively, 23, 31, and 47% for a GPS of 0, 1, and 2. In the study by McMillan et al. [3], only 16/109 patients had an isolated low albumin level without elevation of CRP. The survival of these patients at 3 months (94%) was similar to that of the patients with a GPS 0 (84%). In our study, 14 patients had an Alb \ 35 without elevated CRP with 43% of TMC, and 35 patients had elevated CRP without a low albumin level with 29% of TMC. These groups were too small to allow statistical comparisons, but when we performed a chi square test adjusted for CRP, it showed that Alb was correlated with TMC (p = 0.02), whereas this was not the case for CRP when adjusted for Alb. The results of the multivariate analysis, as well as the chi square test, show that a low albumin level is a risk factor for TMC, independent of the inflammation status S. Antoun (&) A. Rey Institut Gustave-Roussy, Villejuif, France e-mail: sami.antoun@igr.fr

Assessment of nutritional status and prognosis in advanced metastatic cancer (AMC) of gastrointestine (GI)

18573 Background: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients (pts) with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The PINI (prognostic inflammatory nutritional index) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill pts. The aim of this study was designed to investigate the relationship between nutritional status after the palliative chemotherapy and prognosis in AMC of GI. Methods: This study included 130 pts with ECOG PS 1∼3 in AMC of GI following the palliative chemotherapy. ECOG PS, body mass index (BMI), alpha 1-acid glycoprotein (AGP), C-reactive protein (CRP), albumin (ALB), prealbumin (PALB), transferrin, protein, lactate dehydrogenase (LDH), PINI ratio [PINI = (AGP × CRP)/(ALB × PALB)], and survival time were evaluated. Results: In 130 patients, the median age was 57 years. The ECOG PS was 1: 68 patients, 2: 43 patients, 3: 19 patients. The mean value of PINI was PS 1: 16.0 ± 47.8, PS 2: 55.6 ± 106.9, PS 3: 106.3 ± 141.6. The mean survival was PS 1: 144.0 ± 71.8, PS 2: 68.9 ± 41.2, PS 3: 32.0 ± 6.9 days. In the PS 3 group, the mean values of AGP, CRP, and LDH were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of ALB, PALB, and transferrin were significantly lower than in the PS 1 group. The survival time was correlated with the ECOG PS (r = −0.602, p &lt; 0.001,), PINI (r = −0.318, p &lt; 0.001,), AGP (r = −0.265, p = 0.002), CRP (r = −0.345, p &lt; 0.001), ALB (r = 0.324, p &lt; 0.001), PALB (r = 0.260, p = 0.003) and transferrin (r = 0.377, p = 0.001). Conclusions: The PINI should be considered nutritional status and prediction of prognosis in AMC of GI following palliative chemotherapy. [Table: see text] No significant financial relationships to disclose.

Assessment of nutritional status and prognosis in advanced metastatic cancer (AMC)

8146 Background: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients (pts) with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The Prognostic Inflammatory Nutritional Index (PINI) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill pts. The PINI has been rarely evaluated in AMC. The aim of this study is to evaluate the interrelationships between the PINI and survival time (S), and performance status (PS) in pts with advanced solid malignancies following palliative chemotherapy. Methods: This study included 47 pts with PS (ECOG) 1–3 in AMC following palliative chemotherapy. PS, body mass index (BMI), alpha 1-acid glycoprotein (AGP), C-reactive protein (CRP), albumin (ALB), prealbumin (PALB), protein, LDH, PINI ratio [PINI = (AGP x CRP)/(ALB x PALB)], and S were evaluated. We investigated the interrelationships between PS and biochemical indices, PINI, and S. Results: In 47 pts, the median age was 60 yrs (40–69 yrs). The PS was: PS 1: 19 pts, PS 2: 17 pts, PS 3: 11 pts. The mean value of PINI was: PS 1: 7.4±13.4, PS 2: 78.0±155.0, PS 3: 145.6±173.0. The mean day of S was: PS 1: 108.8±49.6, PS 2: 50.9±20.1, PS 3: 20.2±18.3. In the PS 3 group, the mean values of AGP, and CRP were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of ALB, and PALB were significantly lower than in the PS 1 group. However, BMI, Protein, and LDH were not significant. The severity of PS was correlated with the PINI (p=0.004, r=0.408), AGP (p=0.001, r=0.481), CRP (p=0.003, r=0.421), ALB (p<0.001, r=-0.517), PALB (p<0.001, r=-421), and S (p<0.001, r=-0.718). The value of PINI was correlated with S (p=0.004, r=-0.418). Conclusions: The PINI may be a useful scoring system for the assessment of nutritional status and prognosis. Altered nutritional and inflammatory status correlate with PS, and S following anticancer chemotherapy. No significant financial relationships to disclose.

Assessment of nutritional status and prognosis in advanced cancer: interleukin-6, C-reactive protein, and the prognostic and inflammatory nutritional index

The Prognostic Inflammatory Nutritional Index (PINI) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill patients. The PINI has never been evaluated in advanced cancer. Fifty consecutive patients with advanced cancer, weight loss, and anorexia were studied. C-reactive protein (CRP), albumin, pre-albumin, interleukin-6 (IL-6), and alpha 1-acid glycoprotein (AAG) were evaluated. The individual values for AAG, CRP, and IL-6 were markedly elevated. In contrast to albumin and prealbumin, CRP levels were very high. The PINI was significantly elevated, and higher than reported in critically ill intensive care patients. Elevated IL-6 levels correlated with high PINI and CRP values. CRP, IL-6, and PINI should be considered in future research on nutritional status and prediction of prognosis in advanced cancer.

Comparação entre a relação PCR/albumina e o índice prognóstico inflamatório nutricional (IPIN)

Objetivo: Simplificar o cálculo do índice prognóstico inflamatório nutricional (IPIN) empregando número menor de variáveis com conseqüente redução do custo da análise. Materiais e métodos: Foram estudados 54 pacientes e 12 indivíduos-controle com 48 ± 20 (média ± dp) anos de idade. As principais patologias dos pacientes eram: doença arterial periférica (22), pênfigo foliáceo (7), doença inflamatória intestinal (7), trauma (6) e pós-operatório de ortognatia (3). Foram obtidas amostras de sangue periférico, colhidas em jejum para dosagens de proteínas positivas (+) e negativas (-) de fase aguda (PFA) pelo método nefelométrico. Proteína C reativa (PCR), alfa-1-glicoproteína-ácida (alfa-1-GA), alfa-1-antitripsina (alfa-1-AT) e ceruloplasmina (CER) foram as PFA+ e albumina (Alb), transtiretina (TTR), transferrina (TF) e proteína ligadora do retinol (RBP) foram as representantes das PFA-. Esses valores foram analisados quanto à associação de correlação isolada ou associadamente na fórmula do índice prognóstico inflamatório e nutricional (IPIN = PCR + alfa-1-GA / Alb + TTR). De acordo com o índice prognóstico inflamatório e nutricional, os pacientes foram classificados em grupo-controle (G1); pacientes sem infecção/inflamação (IPIN < 1, G2) ou com risco de inflamação/infecção (IPIN > 1, G3). Em seguida os pacientes do G3 foram subdivididos em baixo risco (G3A, n = 16); médio risco ( G3B, n = 10); alto risco (G3C, n = 6) e com risco de morte (G3D, n = 11). Os resultados foram correlacionados entre si (teste de Spearman) ou submetidos às comparações entre grupos (teste de Kruskall-Wallis). Resultados: Houve relação significativa entre as variáveis PCR <FONT FACE=Symbol>´</FONT> alfa-1-GA (r = 0,49), Alb <FONT FACE=Symbol>´</FONT> TTR (r = 0,60), Alb <FONT FACE=Symbol>´</FONT> RBP (r = 0,58), Alb <FONT FACE=Symbol>´</FONT> TF (r = 0,39), TTR <FONT FACE=Symbol>´</FONT> RBP (r = 0,56) e TTR<FONT FACE=Symbol>´</FONT> TF (r = 0,43) e as melhores relações encontradas entre PFA+ e PFA- foram: PCR <FONT FACE=Symbol>´</FONT> Alb (r = - 0,71), PCR <FONT FACE=Symbol>´</FONT> TTR (r = - 0,54), PCR <FONT FACE=Symbol>´</FONT> TF (r = - 0,39) e alfa-1-GA <FONT FACE=Symbol>´</FONT> Alb (r = - 0,35). Os valores do IPIN mostraram a diferenciação G3 > (G1 = G2) e G3 > G3A. Entre todas as proteínas dosadas apenas PCR, Alb e TTR discriminaram os grupos: sendo G3 > (G1= G2) para PCR e G3< (G1= G2) para Alb e TTR. Apenas PCR, TTR e TF discriminaram a morbimortalidade com G3D > G3A (para PCR) e G3D < G3A (para TTR e TF). PCR/Alb e IPIN apresentaram concordância de valores para os riscos de complicações. Conclusão: Assim, conclui-se pela possibilidade de substituição do IPIN pela relação PCR/albumina, mais simples e de menor custo, mantendo-se o mesmo poder e sensibilidade para diagnóstico dos graus de risco de complicações.