Protein-energy Malnutrition In Patients Research Articles

Protein-energy malnutrition prevalence and influence on complications and outcome of severe stroke, requiring mechanical ventilation: a multicenter prospective observational trial

INTRODUCTION: Stroke is characterized by high prevalence and mortality. Protein-energy deficiency is a common syndrome in this category of patients, affecting the course and outcomes of cerebral stroke. OBJECTIVE: The purpose of the study was to analyze the prevalence and impact on the course and outcome of stroke of protein-energy deficiency in patients with mechanical ventilation. MATERIALS AND METHODS: A multicenter observational clinical study “Register of respiratory therapy in patients with stroke (RETAS)” was conducted under the auspices of the Russian Federation of Anesthesiologists and Reanimatologists. The study involved 14 centers, included 1289 acute stroke patients received respiratory support. RESULTS: Protein-energy deficiency in patients with stroke on mechanical ventilation was associated with a tendency to a greater risk of a lethal outcome (p = 0.0003). The absence of protein-energy malnutrition in patients with stroke severity less than 14 points during mechanical ventilation was associated with a greater likelihood of a positive outcome (Glasgow Outcome Scale, GOS 4 and 5) compared with patients with signs of malnutrition (p = 0.000002). Protein-energy malnutrition is associated with prolonged stay in ICU of patients with stroke on mechanical ventilation (p < 0.0001). At the same time, the group of patients with prolonged mechanical ventilation was characterized by a high prevalence of bedsores (p < 0.0001), hypoproteinemia, hypoalbuminemia (р = 0.0001), and decreased body weight 10 percent or more (p < 0.0001). The presence of protein-energy malnutrition was accompanied by an increased risk of ventilator-associated tracheobronchitis in patients with stroke (p < 0.0001). CONCLUSIONS: Protein-energy malnutrition significantly influences on the course and clinical outcome parameters of severe cerebral stroke patients on mechanical ventilation.

Предикторы белково-энергетической недостаточности у пациентов с боковым амиотрофическим склерозом

Введение. Одним из факторов, общим для пациентов с боковым амиотрофическим склерозом (БАС), является нарушение обмена веществ, а именно наличие гиперметаболизма, которое характеризуется значительным увеличением скорости всех реакций и процессов в покое с развитием белково-энергетической недостаточности (БЭН). Цель. Оценить особенности антропометрического статуса и ряда биохимических показателей у пациентов с БАС с выявлением предикторов развития у них БЭН. Материалы и методы. В основную группу вошло 25 пациентов с БАС; в группу сравнения – 20 человек без признаков нервно-мышечной патологии. Проводили клиническое и антропометрическое обследование, изучали биохимические показатели обмена веществ у пациентов с БАС с длительностью заболевания 12,9 [8,9; 16,3] мес. и в группе сравнения. Результаты. В дебюте БАС пациенты имели незначительный избыток индекса массы тела (ИМТ). Через 12,9 [8,9; 16,3] мес. от начала заболевания показано значимое снижение массы тела, ИМТ и ухудшение функционального состояния пациентов по шкале ALSFRS-R. Установлено уменьшение обхватных размеров груди, талии, ягодиц, плеча, предплечья, запястья, бедра и голени; величин подкожно-жировых складок на груди, по задней поверхности плеча с двух сторон и на передней брюшной стенке, а также снижение уровня трансферрина и повышение концентрации общего холестерина в крови у пациентов с БАС через год от начала заболевания относительно группы сравнения, что характеризует наличие БЭН у этих пациентов. По результатам ROC-анализа установлены пороговые уровни изученных антропометрических и метаболических показателей развития БЭН с достаточно высокой чувствительностью и специфичностью. Заключение. Установлены предикторы выявления ранних признаков развития БЭН у пациентов с БАС, такие как ИМТ, величины подкожно-жировых складок на груди слева и справа, передней брюшной стенке, концентрации трансферрина и холестерина в крови, пороговые уровни которых имеют высокую чувствительность, специфичность, а значение AUC под ROC-кривой больше 0,7, что соответствует хорошему качеству диагностической модели. Introduction. One of the factors common for patients with amyotrophic lateral sclerosis (ALS) is a metabolic disorder, same as a hypermetabolism, the characteristic of which leads to the emergence of a rate of all reactions and processes at rest with the development of protein-energy malnutrition (PEM). Purpose. To assess the characteristics of the anthropometric status and a number of biochemical parameters in ALS patients, identifying predictors of the development of PEM in them. Materials and methods. The main group included 25 ALS patients; the comparison group included 20 people without signs of neuromuscular pathology. A clinical and anthropometric examination was carried out, and biochemical parameters of metabolism were studied in ALS patients with a disease duration of 12.9 [8.9; 16.3] months and in the comparison group. Results. At the onset of ALS, patients had a slight excess of body mass index (BMI). After 12.9 [8.9; 16.3] months from the onset of the disease, a significant decrease in body weight, BMI and deterioration in the functional state of patients according to the ALSFRS-R scale was shown. A decrease in the girth dimensions of the chest, waist, buttocks, shoulder, forearm, wrist, thigh and lower leg was established; the size of subcutaneous fat folds on the chest, along the back surface of the shoulder on both sides and on the anterior abdominal wall, as well as a decrease in the level of transferrin and an increase in the concentration of total cholesterol in the blood in patients with ALS one year from the onset of the disease relative to the comparison group, which characterizes the presence of PEM in these patients. Based on the results of ROC analysis, threshold levels of the studied anthropometric and metabolic indicators of the development of PEM were established with fairly high sensitivity and specificity. Conclusion. Predictors for identifying early signs of PEM development in ALS patients have been established, such as BMI, the size of subcutaneous fat folds on the chest on the left and right, the anterior abdominal wall, the concentration of transferrin and cholesterol in the blood, the threshold levels of which have high sensitivity, specificity, and an AUC value under The ROC curve is greater than 0.7, which corresponds to the good quality of the diagnostic model.

#5405 MALNUTRITION DIAGNOSIS IN CKD PATIENTS

Abstract Background and Aims Malnutrition is a prevalent condition in patients with chronic kidney disease (CKD) receiving replacement therapy by peritoneal dialysis (PD). Geriatric nutritional risk index (GNRI) is an effective tool for screening nutritional status in maintenance hemodialysis patients. The purpose of this study was to determine the information content of GNRI for the diagnosis of protein-energy malnutrition in patients with CKD receiving replacement therapy with PD when compared to malnutrition inflammation score (MIS) and 7-point subjective global assessment (7p-SGA). Method A prospective cohort study included 222 adults PD-patients (man 100, female 112, age 44±14). All patients received continuous ambulatory peritoneal dialysis. Median duration PD before inclusion in the study was 12 months, the observation period of patients was 36 months. Nutritional status assessment included anthropometric (body mass index, triceps skinfold thickness, midupper arm muscular area) and biochemical (albumin, C-reactive protein, total iron-binding capacity, total cholesterol, hemoglobin and others) examinations as well as bioelectrical impedance analysis (BIA – fat mass). GNRI calculated according to the formula GNRI = 1.489 × albumin (g/dL)] + [41.7 × (body wt/ideal body wt)], where the ideal body weight for women is: height (cm)–100–[(height–152) × 0.2], ideal body weight for men is equal to: height (cm) -100 - [(height - 152) × 0.4]. We used MIS and 7p-SGA as a reference standard, a score ≥6 and ≤5, respectively, defined malnutrition. The cutoff of GNRI the diagnosis of malnutrition were derived from these ROC-analysis. Results Most of the individual nutritional indexes, including the anthropometric, biochemical and BIA indexes, were significantly (P<0.001) lower in the patients with MIS score ≥6 and 7p-SGA score ≤5, thus both nutritional screening tools were considered reasonable as a reference standard to determine the information content GNRI in PD-patients. The GNRI fluctuated in the range 66–126 (median 99), MIS score – 2–24 (median 7) and 7p-SGA score – 2–7 (median 5). The GNRI showed a significantly negative correlation with MIS (r = -0,708, p<0.0001) and a significantly positive correlation with 7p-SGA (r = 0.636, p<0.0001) (Fig. 1). The most accurate GNRI cutoff to identify a malnourished patient according to the MIS was ≤99 (Fig. 2). The frequency of malnutrition among the observed patients was 52.3% when using GNRI≤99, 55.9% when using MIS≥6 and 51.4% when using 7p-SGA≤5 (n.s.). The values for sensitivity and specificity with a GNRI of ≤99 in predicting malnutrition based on the MIS were 77.4% (95%CI 69.0-84.4%) and 79.6% (95%CI 70.3-87.1%) respectively. Positive predictive value and negative predictive value also had high scores respectively 73.7% (95%CI 64.9-80.9%) and 72.2 (95%CI 63.1-79.8%). The application of the GNRI to the PD-patients found significant (p<0.001) differences in the various nutrition-related indexes (anthropometric, biochemical and BIA) between the group with a GNRI≤99 and that with GNRI>99. Mortality from all causes among patients with GNRI>99 was one case per 54.9 patient-years, among patients with GNRI≤99 was one case per 29.7 patient-years. Conclusion In PD-patients GNRI closely correlates with MIS and 7p-SGA, characterized by high sensitivity and specificity. GNRI can be used to determine the nutritional status of PD patients.

The role of interleukin-6 in the pathogenesis of protein-energy malnutrition in patients treated with haemodialysis

BACKGROUND. Protein-energy malnutrition (PEM) often develops in patients receiving long-term treatment with programmed haemodialysis (HD). Its main causes are decreased intake of basic nutrients, increased losses, disorders inherent to the terminal renal failure itself (including chronic inflammation), as well as the influence of factors associated with the HD procedure. THE AIM: to clarify the role of interleukin-6 (IL-6 ) in the pathogenesis of BEN in patients treated with programmed haemodialysis. PATIENTS AND METHODS. We examined 645 patients receiving HD treatment, including 300 men and 345 women aged 56.8±12.8 years, the duration of renal replacement therapy was 8.4±5.3 years. Nutritional status was assessed according to International Society of Renal Nutrition and Metabolism (ISRNM) recommendations. Serum IL-6 levels were determined by a three-step "sandwich" version of a solid phase enzyme immunoassay using mono- and polyclonal antibodies to IL-6 using a commercial kit "Interleukin-6-IFA-BEST" from Vector-Best, Russia, under the manufacturer's instructions. The reference values for IL-6 are 0-7 pg/ml. RESULTS. The prevalence of BEN was 24.9 % (160 patients). Mean IL-6 concentration was 6.47±2.64 pg/ml in patients without evidence of BEN, and 23.20±10.40 pg/ml in patients with BEN, p<0.001. Elevated IL-6 levels revealed statistically significantly lower levels of total protein, albumin, prealbumin, total cholesterol, transferrin and blood lymphocyte counts. Patients with elevated IL-6 levels were also characterized by statistically significantly lower values of body mass index, skeletal muscle mass index and skeletal muscle mass index. CONCLUSION. The results of this study suggest that the high prevalence of PEM in patients treated with HD is closely related to an imbalance of pro- and anti-inflammatory cytokines. An increase in the duration of renal replacement therapy is accompanied by an increase in serum IL-6 levels. Therefore, this cytokine can be considered as a therapeutic target for prevention and treatment of sarcopenia in dialysis patients.

Supportive care against correcting protein-energy malnutrition in patients with generalized gastrointestinal cancer

Introduction. A decrease in nutrition of cancer patients affects all vital functions of the body, which is, according to numerous studies, typical of patients with gastrointestinal disturbances.Materials and methods. The study was set out to investigate the effect of correcting protein-energy malnutrition on the symptoms manifestation, including pain, fatigue, sleep disorder, poor appetite, nausea, vomiting, constipation and diarrhea in patients with generalized forms of gastrointestinal cancer. The study involved questionnaire method applied prior to the study and three months after. Three groups, equivalent in terms of selection criteria, participated in the study. For this purpose, the study participants were given nutridrink compact protein and omega-3 polyunsaturated fatty acid.Results and discussion. This study found out that timely nutritional support contributes toward reducing the negative symptoms of cancer and, when combined with supportive care and pain management, leads to significantly better results in terms of improving quality of life.Conclusion. Timely nutritional support has a positive effect on reducing the negative symptoms associated with cancer (pain, fatigue, sleep disorder, poor appetite, nausea, vomiting, constipation and diarrhea), and, along with supportive care and pain management, improves the quality of life more significantly.

Influence of initial nutritional status on rehabilitation potential and motor abilities of children with cerebral palsy after orthopedic single-event multilevel surgery

Introduction. Protein-energy malnutrition in patients with cerebral palsy is an urgent problem. Given the high frequency of cerebral palsy orthopedic complications requiring surgical treatment, it is necessary to determine the impact of the initial nutritional status on the effectiveness of treatment. Purpose of the study: to analyze the impact of the initial nutritional status on the rehabilitation potential and motor abilities of children with cerebral palsy after orthopedic single-event multilevel surgeries. Materials and methods. The inclusion criteria were the age less than 18 years at the time of examination, spastic form of cerebral palsy, and a single-event multilevel surgical intervention due to orthopedic complications of cerebral palsy in medical history. Results. Lower indices of motor abilities after single-event multilevel surgeries were registered in patients with protein-energy malnutrition according to the FMS (5,50, and 500 meters) and the Gillette scale (p = 0.020, p = 0.026, p = 0.048, p = 0.008, respectively). Conclusion. The initial normal nutritional status before surgery has a positive effect on the rehabilitation potential and motor abilities of children with cerebral palsy after orthopedic single-event multilevel surgeries. Further research on this issue is needed.

PROTEIN-ENERGY MALNUTRITION IS ASSOCIATED WITH HIGHER MORTALITY AND ADVERSE CLINICAL OUTCOMES IN PATIENTS WITH COPD AND CO-EXISTING OSA

TYPE: Abstract TOPIC: Sleep Disorders PURPOSE: Protein-Energy Malnutrition (PEM) worsens outcomes for patients with chronic obstructive pulmonary disease(COPD). To our knowledge, the impact of PEM on COPD with Co-existing Obstructive sleep apnea(OSA) is not well known. Therefore, our study sought to measure the effect of PEM on clinical outcomes in patients with COPD and OSA. METHODS: We queried the National Inpatient Sample (NIS) between 2017 and 2018. We searched the NIS for adult patients hospitalized with COPD & co-existing OSA as a principal diagnosis with and without PEM as a secondary diagnosis using ICD-10codes. The primary outcome was inpatient mortality, while secondary outcomes were length of stay (LOS), Hospital Charges (HC), respiratory failure (RF), and intubation. Multivariable logistic and Poisson regression model was used for clinical outcomes. RESULTS: A total of 126,575 patients with COPD and Co-existing OSA were admitted,and 1.66% had PEM. PEM vs No PEM cohorts include;(Mean Age of 67.8 years[CI 68.8 - 68.76] vs 65.2 years[CI 65.0 - 65.3]), Males(44% vs 45.5%), Whites(75.7% vs 72.7%), Black(14.9% vs 19.1%), & Hispanic (5.9% vs 5.5%). PEM in patients hospitalized with COPD with OSA had a significant increase in inpatient mortality (adjusted odds ratio [aOR] 2.6 [95% CI 1.30-5.2, p=0.007]), RF(aOR 2.24 [CI 1.78-2.82]), and intubation(aOR 5.18 [CI 1.98-13.5]). PEM also resulted in higher hospital charges and longer LOS. (Table 1). CONCLUSIONS: PEM was associated with worsening inpatient clinical outcomes in patients hospitalized with COPD and concomitant OSA. CLINICAL IMPLICATIONS: Clinicians should be aware of how PEM may impact the outcomes of patients with COPD and concomitant OSA. DISCLOSURE: Nothing to declare. KEYWORD: PROTEIN-ENERGY MALNUTRITION, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, OBSTRUCTIVE SLEEP APNEA

PROTEIN-ENERGY MALNUTRITION IS ASSOCIATED WITH HIGHER MORTALITY AND ADVERSE CLINICAL OUTCOMES IN PATIENTS WITH COPD WITH CO-EXISTING ATRIAL FIBRILLATION

TYPE: Abstract TOPIC: Obstructive Lung Diseases PURPOSE: Poor nutritional status worsens clinical outcomes in those afflicted by cardiopulmonary disease. Protein-Energy Malnutrition (PEM) worsens outcomes for patients with chronic obstructive pulmonary disease(COPD). The impact of PEM on COPD with co-existing atrial fibrillation (COPD-AF) is not well known. Therefore, our study sought to measure the effect of PEM on clinical outcomes in patients with COPD & co-existing AF (COPD-AF). METHODS: We queried the National Inpatient Sample (NIS) between 2017 & 2018. We searched the NIS for adult patients hospitalized with COPD with co-existing AF (COPD-AF) as a principal diagnosis with & without PEM as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality, while secondary outcomes were cardiac arrest (CA), cardiogenic shock (CS), respiratory failure (RF), length of stay (LOS), & total hospital charge (THC). A multivariable logistic and Poisson regression analysis was applied for clinical outcomes. RESULTS: A total of 170,355 patients with COPD-AF were admitted, & 5% had PEM. PEM vs No PEM cohorts include;(Mean Age 75.6 years[CI 75.1-76] vs 73.7 years[CI 73.5-73.8]), Males (45% vs 48.6%), Whites(83.8% vs 81.9%), Black(8% vs 10%), & Hispanic(4.2% vs 4.8%). PEM in patients hospitalized with COPD-AF had a significant increase in inpatient mortality(p<0.0001), RF (p<0.0001), Intubation(p<0.0001) and CS (p=0.025)(Table 1). PEM also resulted in higher THC $73,876 vs $40,351(p<0.0001) & Longer LOS 7.2 vs 4.6 days (p<0.0001),(Table 1). CONCLUSIONS: PEM raised the risk of adverse clinical outcomes & hospital expense in patients hospitalized with COPD & Co-Existing AF. CLINICAL IMPLICATIONS: Clinicians should be aware of the increased inpatient mortality in COPD-AF with Co-existing PEM. DISCLOSURE: Nothing to declare. KEYWORD: PROTEIN-ENERGY MALNUTRITION, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, ATRIAL FIBRILLATION.

Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection

Background. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints.&#x0D; The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the difficult-to-treat (DTT) prosthetic joint infection (PJI) of the hip.&#x0D; Methods. The retrospective study included 132 patients with chronic DTT PJI of the hip. The patients underwent orthopedic implant removal, radical debridement of the infected tissues, and resection arthroplasty with non-free transplantation of an axial vastus lateralis muscle flap (n = 57) or installation of an antimicrobial spacer (n = 75). DTT PJI was defined as an infection caused by rifampicin-resistant staphylococcal strains, ciprofloxacin-resistant gram-negative bacteria, fungi of the genus Candida, and their associations. The assessment of the patients protein-energy status included the evaluation of reference laboratory parameters, such as levels of hemoglobin, total protein, and albumin and number of lymphocytes. The degree of PEM was determined by the number of laboratory markers below the threshold values. The statistical comparison was performed using Fishers test. The odds ratio (OR, 95% confidence interval [CI]) was calculated to assess the risk of PJI recurrence. Differences were considered significant at p0.05.&#x0D; Results. More than 70% of patients with chronic DTT PJI included in the study were diagnosed with preoperative PEM of varying degrees of severity. Hypoalbuminemia and decreased hemoglobin levels were diagnosed more often: 64.3% and 57.1% in the muscle flap plasty and 57.3% and 31.1% in the antimicrobial spacer group, respectively. In muscle plasty and antimicrobial spacer groups, a decrease in the values of three or more reference PEM markers was detected in 28.5% and 16.0% of patients, and this advanced impairment of the nutritional status increased the risk of early revision intervention by two (OR 2.0; CI 95% 0.478.56; p = 0.35) and six times (OR 6.11; 95% CI 1.0635.35; p0.04), respectively.&#x0D; Conclusion. In general, the analysis of publications and results of our study show that PEM is associated with the development of surgical site infection and recurrence of PJI after revision surgery. A decrease in the values of three or more reference PEM markers is a significant predictor of repeated revisions after debridement surgery with the installation of an antimicrobial spacer. PEM complicates the postoperative course in patients with resection arthroplasty. Given the high incidence of PEM in patients with DTT PJI of the hip joint, further research is needed to develop methods for nutritional status correction and assessment of their effect on the outcomes of debridement surgery.

The application of domestic specialized mixtures for enteral nutrition in children with bronchopulmonary&#x0D; pathology

Adequately organized nutritional support allows avoiding the development of protein-energy malnutrition in patients with bronchopulmonary diseases and cystic fibrosis (CF). The satisfying of increased protein and energy needs of CF patients can only be implemented under the administration. The aim of the study is to analyze the tolerance and effectiveness of the use of domestic sterilized liquid specialized high-protein high-calorie mixtures «Nutrien Pulmo» and «Nutrien Energiya with Dietary Fibers» in children over three years of age with acute (pneumonia) and chronic (cystic fibrosis) forms of bronchopulmonary pathology. Patients and methods. Fifty-five children, including 41 patient suffered from CF, 14 cases with pneumonia, aged from 3 to 18years, were under observation. Of these, 23 (42%) children received Nutrien Pulmo, 32 (58%) children received Nutrien Energiya with Dietary Fibers. Nutritional status was assessed using the WHO-Anthro programs (for children from 3 to 5 years old) and WHO-Anthro Plus (for patients over five years) and clinical and biochemical blood test indices. The observation period was accounted for three weeks. Results. All patients highly appreciated the taste of the products, there were no refusals to take specialized mixtures, neither adverse events during the observation period. While taking specialized mixtures, there was a positive trend in anthropometric indices and a significant improvement in biochemical markers of nutritional status: an increase in prealbumin, total protein, transferrin level. Conclusion. The use of specialized domestic products «Nutrien Pulmo» and «Nutrien Energiya with Dietary Fibers» in the diet therapy of children with acute and chronic bronchopulmonary pathology has the safe and positive effect on the nutritional status of patients.

Incidence, mortality and hospital resource utilization in patients with gastrointestinal cancer and malnutrition: A nationwide analysis.

466 Background: Malignancies are associated with a high prevalence of cachexia, protein energy malnutrition (PEM) and failure to thrive. We analyzed the National inpatient Sample database (NIS) to understand the temporal trends and differences between gastrointestinal cancers (GIC) patients with and without malnutrition. Methods: All adults admitted with GIC including esophageal, gastric, pancreatic, hepatic, gall bladder, small and large intestine and anal cancers from 2012-2016 were identified from the NIS using the ICD 9 and ICD 10 codes. We analyzed the temporal trends of mortality and resource utilization. Multivariable logistic regression was used to evaluate the risk factors for malnutrition in patients with GIC. Results: There were 2,645,285 GIC inpatient admissions between 2012-2016, out of which 6.1% patients died. 11.1% (±0.22) patients had PEM and three most common GIC associated with PEM were Esophageal (19.7±0.24%), gastric (16.5±0.22%) and small intestine (15.2±0.41%). On multivariate analysis, PEM was more common in male gender (OR: 1.07, 95% CI:1.05-1.08, P&lt;0.01), African- American race (OR:1.14, 95% CI: 1.10-1.17, P&lt;0.01) and Charlson comorbidity index &gt;=2(OR:1.5, 95% 1.42-1.51, P&lt;0.01). Malnourished patients were often terminally ill (48.8% vs 39.8%), in intensive care unit (7.89% vs 3.75%), were more likely to be seen by palliative care team (17.6 % vs 9.8%) and were more likely to die (9.6% vs 5.70%, OR-1.76; p &lt;0.01). The incidence, mortality, and total charge of PEM in patients with GIC significantly increased from 2012 to 2016 as shown in the table below. Conclusions: Malnourished patients with GIC tend to have more advanced disease and have an increased mortality as compared to patients with adequate nutritional status. Optimization of their nutritional status can greatly improve outcomes and curb healthcare costs. [Table: see text]

Protein Energy Malnutrition Significantly Increases Mortality and Adverse Outcomes in Acute Myelogenous Leukemia (AML) Patients with Neutropenic Fever: Findings of a Nationwide Inpatient Sample Analysis

Introduction: Neutropenic fever is a major cause of morbidity and mortality in all malignancies, especially acute leukemia. Protein energy malnutrition (PEM) is also a well-established risk factor for overall cancer related mortality. Acute myelogenous leukemia (AML) patients are frequently afflicted with neutropenic fever due to protracted neutropenia and community acquired, nosocomial, and opportunistic infections. They are also commonly malnourished due to poor oral intake, cachexia from underlying disease, and the toxicity of chemotherapy. To date, few studies have attempted to link neutropenic fever and PEM outcomes in AML. We thus aim to explore the prevalence and outcome of PEM in patients with AML and neutropenic fever. Methods: The Nationwide Inpatient Sample (NIS) database for 2016 and 2017 was searched for patients with primary discharge diagnosis of AML who had NF. This group was divided based on the presence or absence of PEM. The primary outcome was a comparison of inpatient mortality between the groups. Secondary outcomes included diagnosis of sepsis, mean total hospital charges (THC) and mean length of hospital stay (LOS). Outcomes were compared using multivariate regression analysis adjusting for sociodemographic and hospital characteristics and Charlson comorbidity index as a marker of severity. Results: A total of 10145 admissions met the inclusion criteria with AML and NF. Among the included patients, 1700 (16.7%) had PEM. Patient with PEM were significantly older (58.1 vs 55.2 years of age, p&amp;lt;0.001) but had no significant difference in sex (52.0 vs 55.0% females, p=0.308) and racial distribution, compared with patients without PEM. Overall, 825 (8.1%) hospitalizations had inpatient mortality. Patients with PEM had significantly higher adjusted odds ratio (aOR) of mortality (aOR: 2.00, 95% CI 1.335 - 2.998), developing sepsis (aOR: 2.06, 95% CI 1.514 - 2.812), as well as increase mean difference in LOS(8.6 days, 95% CI 5.77 - 11.37) and THC (105,600 USD 95% CI 57,000 - 154,000), compared to patients without PEM. Conclusion: PEM is associated with a significantly adverse outcome in patients with febrile neutropenia-- an almost double mortality rate and increased risk of complications like sepsis, increased LOS, and hospital costs. Neutropenic patients are markedly susceptible to fulminant systemic infections from various sources. PEM furthers this risk via weakening of host defenses including natural barriers and both innate and acquired immunity. Furthermore, in neutropenic patients with systemic infections, malnutrition may delay and impede wound healing along with immune responses which often contributes to a protracted course and adverse outcome. Nutrition in neutropenia has garnered limited attention, with some randomized trials showing limited to no benefit of the "neutropenic diet" in patients while depriving them of essential macro- and micronutrients. Nonetheless, current management guidelines for malnutrition in malignancies, particularly acute leukemias, are sparse. The profound impact of malnutrition in febrile neutropenia patients warrants further study, and we thus recommend further attention to screening practices and management strategies alongside primary treatment for malignancy and infection. Disclosures No relevant conflicts of interest to declare.

Elimination of Protein-Energy Malnutrition in Patients With HIV Using MOFLPP

Because the promotion of the safety system is so important in HIV-positive patients, and the health of the tissues and the ability to fight disease are reduced, nutrition as a principle for improving the health of these people is important and the availability of food is Nutrition and healthy water are very important for these people. The quantity of a nutrient in a food item can never be determined accurately and a certain amount can be attributed to it. This uncertainty about the numbers and figures available in the medical field makes it unrealistic to make decisions about providing a diet based on crisp data. Our goal in this paper is to prepare and regulate an optimal diet in the fuzzy environment. Due to the high-calorie and high-protein diet for these patients, the research problem is a fuzzy linear programming problem with two objective functions that include maximizing calories and daily protein. We have modeled it and then solved it in the right way. Finally, by implementing the diet in the fuzzy environment, we achieved good results, so that the obtained numbers are better and are more realistic considering all possible situations.

Изменение подходов к скринингу белково-энергетической недостаточности у пациентов, получающих лечение программным гемодиализом

Изменение подходов к скринингу белково-энергетической недостаточности у пациентов, получающих лечение программным гемодиализом

Assessment of nutritional status in a patient with chronic kidney disease: How Do I Do It?

Studies report a high prevalence of protein-energy malnutrition in patients with chronic kidney disease (CKD) and in dialysis-dependent end-stage kidney disease (ESKD) patients. The strongest evidence comes from the Modification of Diet in Renal Disease study, which showed that, in patients with CKD, as renal function decreases, dietary protein and energy intake, anthropometric parameters, and biochemical markers of nutrition progressively decline. Even we have observed that the calorie and protein intake of Indian patients with CKD and ESRD is poor. This article discusses the methods to assess dietary intake in CKD and ESKD on maintenance dialysis.

Protein blend ingestion before allogeneic stem cell transplantation improves protein-energy malnutrition in patients with leukemia

Severe protein-energy malnutrition (PEM) and skeletal muscle wasting are commonly observed in patients with acute leukemia. Recently, the ingestion of a soy-whey protein blend has been shown to promote muscle protein synthesis (MPS). Thus, we tested the hypothesis that the ingestion of a soy-whey blended protein (BP) may improve the PEM status and muscle mass in acute leukemia patients. In total, 24 patients from the same treatment group were randomly assigned to the natural diet plus soy-whey blended protein (BP) group and the natural diet only (ND) group. Our data showed that protein and energy intake decreased significantly (P < .05) after transplantation in both groups. In the absence of the BP intervention, dramatic decreases in muscle-related indicators (i.e., anthropometric variables, muscle strength and serum protein) were observed in the majority (>50%) of the patients. However, 66% of the patients who ingested the BP before transplantation showed obvious increases in arm muscle area. The gripping power value (△post-pre or △post-baseline) was significantly higher in the BP group than in the ND group (P < .05). The ingestion of the BP also increased the levels of serum albumin, globulin and serum total protein to different extents. Notably, the average time to stem cell engraftment was significantly shorter for patients in the BP group (12.2 ± 2.0 days) than for patients in the ND group (15.1 ± 2.9 days). Collectively, our data supported that soy-whey protein can improve PEM status and muscle mass in leukemia patients.

Prognostic significance of low skeletal muscle mass compared with protein-energy malnutrition in liver cirrhosis.

To investigate the impact of low skeletal muscle mass (LSMM) on survival as compared with protein-energy malnutrition (PEM) in patients with liver cirrhosis (LC). A total of 206 individuals with LC were analyzed. We retrospectively examined the impact of LSMM, as defined by psoas muscle mass at the third lumber on computed tomography, on survival as compared with PEM. In terms of comparison of the effects of LSMM and PEM on survival, we used time-dependent receiver operating characteristics (ROC) analysis. Our study cohort included 115 men and 91 women with a median age of 67years. There were 140 patients with Child-Pugh A, 62 with Child-Pugh B, and 4 with Child-Pugh C. A total of 117 patients (56.8%) had LSMM and 52 patients (25.2%) had PEM. The proportion of PEM in patients with LSMM (31.62%, 37/117) was significantly higher than in patients without LSMM (16.85%, 15/89) (P = 0.0229). In the multivariate analysis for the entire cohort, the presence of hepatocellular carcinoma, lower body mass index, presence of LSMM, lower triglyceride value, poorer renal function, and higher des-γ-carboxy prothrombin value were found to be significant adverse predictors linked to overall survival, while presence of PEM tended to be significant. In the time-dependent ROC analysis, all area under the ROCs for survival in LSMM at each time point were higher than those in PEM except for Child-Pugh B patients. In this comparison of LSMM and PEM on clinical outcomes in LC patients, it was shown that LSMM may have stronger prognostic impact than PEM.

Нетрадиционный метод коррекции белково-энергетической недостаточности у пациентов на программном гемодиализе

Нетрадиционный метод коррекции белково-энергетической недостаточности у пациентов на программном гемодиализе

Serum hyaluronic acid predicts protein-energy malnutrition in chronic hepatitis C.

Serum hyaluronic acid (HA) is a well-established marker of fibrosis in patients with chronic liver disease (CLD). However, the relationship between serum HA level and protein-energy malnutrition (PEM) in patients with CLD is an unknown. We aimed to examine the relationship between serum HA level and PEM in patients with chronic hepatitis C (CHC) compared with the relationships of other serum markers of fibrosis. A total of 298 CHC subjects were analyzed. We defined patients with serum albumin level of ≤3.5 g/dL and nonprotein respiratory quotient <0.85 using indirect calorimetry as having PEM. We investigated the effect of serum HA level on the presence of PEM. Receiver operating characteristic curve (ROC) analysis was performed for calculating the area under the ROC (AUROC) for serum HA level, platelet count, aspartate aminotransferase (AST) to platelet ratio index, FIB-4 index, AST to alanine aminotransferase ratio, and Forns index for the presence of PEM. The median serum HA level in this study was 148.0 ng/mL (range: 9.0–6340.0 ng/mL). In terms of the degree of liver function (chronic hepatitis, Child-Pugh A, B, and C), the analyzed patients were well stratified according to serum HA level (overall significance, P < 0.0001). The median value (range) of serum HA level in patients with PEM (n = 61) was 389.0 ng/mL (43.6–6340.0 ng/mL) and that in patients without PEM (n = 237) was 103.0 ng/mL (9.0–783.0 ng/mL) (P < 0.0001). Among 6 fibrosis markers, serum HA level yielded the highest AUROC with a level of 0.849 at an optimal cut-off value of 151.0 ng/mL (sensitivity 93.4%; specificity 62.0%; P < 0.0001). In the multivariate analysis, serum HA level was found to be a significant prognostic factor related to the presence of PEM (P = 0.0001).In conclusion, serum HA level can be a useful predictor of PEM in patients with CHC.

Evaluation of vitamin A and protein energy malnutrition in patients with chronic pancreatitis-preliminary data

Evaluation of vitamin A and protein energy malnutrition in patients with chronic pancreatitis-preliminary data