Risk Factors For Poor Quality Research Articles

Sleep disruption as a predictor of quality of life among patients in the subpopulations and intermediate outcome measures in COPD study (SPIROMICS).

Sleep quality is poor among patients with chronic obstructive pulmonary disease (COPD), and studies show that sleep disturbance is associated with low overall quality of life in this population. We evaluated the impact of patient-reported sleep quality and sleep apnea risk on disease-specific and overall quality of life within patients with COPD enrolled in the SPIROMICS study, after accounting for demographics and COPD disease severity. Baseline data from 1341 participants [892 mild/moderate COPD (FEV1 ≥ 50% predicted); 449 severe COPD (FEV1 < 50%)] were used to perform three nested (blocks) regression models to predict quality of life (Short Form-12 mental and physical components and St. George's Respiratory Questionnaire). Dependent measures used for the nested regressions included the following: Block1: demographics and smoking history; Block 2: disease severity (forced expiratory volume 1 s; 6 min walk test); Block 3: risk for obstructive sleep apnea (OSA; Berlin questionnaire); and Block 4: sleep quality (Pittsburgh Sleep Quality Index [PSQI]). Over half of participants with COPD reported poor sleep quality (Mean PSQI 6.4 ± 3.9; 50% with high risk score on the Berlin questionnaire). In all three nested regression models, sleep quality (Block 4) was a significant predictor of poor quality of life, over and above variables included in blocks 1-3. Poor sleep quality represents a potentially modifiable risk factor for poor quality of life in patients with COPD, over and above demographics and smoking history, disease severity, and risk for OSA. Improving sleep quality may be an important target for clinical interventions. SPIROMICS. http://www2.cscc.unc.edu/spiromics/. ClinicalTrials.gov NCT01969344.

Evaluation of nutritional status in chronic kidney disease patients undergoing hemodialysis

Background: Kidneys perform the important function of excreting nitrogenous waste products and regulating the volume and composition of body fluids. Malnutrition is common phenomenon in maintenance dialysis patients and risk factor for poor quality of life and increased morbidity and mortality. An association of low albumin levels with increased mortality and morbidity in hemodialysis patients has been hypothesized. Present study aims to go through nutritional status of CKD patients in our institute and their relation to disease or dialysis outcome.Methods: Study is conducted on 100 CKD patients on haemodialysis admitted in various medical wards of the Mc Gann hospital attached to Shimoga institute of medical sciences, Shimoga, Karnataka, India. From August 1st, 2016 to April 30th, 2017 detailed history was taken in all the patients and a thorough physical examination was done. Dietary history was taken and blood is collected for analysis of Hb, blood urea, SR electrolyte, serum calcium, phosphorus, serum albumin, cholesterol, creatinine and CRP. BMI is calculated in all patients.Results: There were 60 males and 40 females. Average age is 46±3.6 years. Most of these patients belong to the age group of 41-50 years (37%). According to WHO BMI classification 55% had BMI between 18.5 to 24.9. 17% less than 18.5. 13% more than 30BMI. Blood urea, serum creatinine was elevated as expected. Mean Hb is 8.21±2.57 gm/dl. Serum albumin is lower mean being 2.66±1.86 gm/dl. CRP elevated 16.5±2.36. low calcium is also seen.Conclusions: The malnutrition in CKD is associated with increased morbidity and mortality rates. Despite the better understanding of the pathophysiologic mechanisms of uremic malnutrition and the improvements made in nutritional support, the nutritional condition of CKD and ESRD patients remains a significant cause for concern. Multimodal therapeutic strategies should be considered. Present study showed elevated prevalence of malnutrition in HD subjects. The nutritional status in patients on HD needs more attention. The role of nutrition in the management of CKD is important and needs to be further researched and newer guidelines are need of the hour.

The Relationship between Non-Communicable Diseases History and Health-Related Quality of Life

Disaster-prone population is vulnerable for suffering non-communicable diseases (NCDs) which become risk factors for poor quality of life (QoL). The study aims at investigating the effect of history of NCDs to the QoL. QoL was measured by WHODAS. NCDs with prevalence more than 1% were involved in analysis. Those NCDs included shortness of breath, diabetes, hypertension, joint disease and stroke. Among 1,872 respondents of Riskesdas, 7.7% of them have a poor QoL, suffering hypertension (8.7%), shortness of breath (7.3%) and asthma (6.9%). Risks of poor QoL six times higher among those with a history of PTM (PORadj 5.987; 95% CI 4.210-8.514) after adjusted by age, gender, education, socioeconomic status and region of residence. Stroke gives the greatest impact with POR 25.00 (95% CI 10.406 to 60.063). We recommend that the promotion and prevention of NCDs should be integrated with both mitigation-related and community resilience activities to disasters.

Lived post-stroke of a Senegalese cohort: What risk factor for what quality of life items?

Therefore, the aim of our study was to determine risk factors for poor quality of life by considering disability after stroke in its multidimensional aspects but also to see the impact of each risk factor on the dimensions of quality of life. A prospective study of stroke patients confirmed, followed by neurovascular consultation at Fann Hospital in Dakar has been achieved. Quality of life was evaluated by the 65 Sikness Impact Profile (SIP 65), the depression by the scale of Beck. We included 70 men and 30 women with a mean age of 55.25 years. The education rate was 56.12%. Hypertension (65%); musculoskeletal diseases (26.26%) were the major associated defects. Ischemic stroke was predominant. Depression was observed in 53% of cases. The outputs of the house and in the city were respectively arrested in 50% and 73% of cases. Most of the patients, 61%, were conducting any activity at home. Age was associated with an orientation problem in time significantly ( P = 0.02), musculoskeletal diseases to need help dressing ( P = 0.03); the degree of disability to need help to sit and sleep ( P = 0.00003), a lack of sleep the night ( P = 0.00002) and a home asset; depression suffering of sexual life ( P = 0.002), a shortened working time ( P = 0.005) and reduced leisure time ( P = 0.0004). The sedentary post stroke Senegalese patients can’t be explained solely by altering the physical dimensions of quality of life. All the more that disability assessed by the Barthel showed that locomotion is possible in over 50% of cases.

Risk Factors for Poor Quality of Life among Patients with Age-Related Macular Degeneration

ABSTRACTPurpose: The purpose of this study was to evaluate the quality of life in patients with age-related macular degeneration (AMD) and compare it with that of healthy controls. Additionally, our study aims to investigate the possible risk factors for poor quality of life in AMD patients. Methods: Participants in the study were 114 patients with AMD, 63 male and 51 female, mean-aged 76.5 ± 6.1 years. Demographic data, lifestyle factors, and medical history were recorded. All patients underwent a routine examination for AMD, including best-corrected visual acuity measurement, dilated fundoscopy and optical coherence tomography, and completed three questionnaires assessing quality of life (SF-36, EQ-5D, NEI VFQ-25). In addition, 100 controls, adjusted for gender and age, were included in the study. Risk factors for quality of life in AMD patients were investigated. Univariate analysis was performed using SPSS 22.0. Results: Patients with AMD scored lower in vision- and health-related quality-of-life questionnaires compared to controls. Risk factors associated with quality of life in patients with AMD were found to be the female gender, alcohol consumption, the presence of hypertension, diabetes mellitus, cardiovascular diseases, myosceletal problems, migraine, anxiety/depression, subretinal or intraretinal fluid, pigment epithelium detachment, previous treatment for AMD, visual acuity, the stage of the disease, and the integrity of the ellipsoid zone. Conclusion: Patients with AMD presented lower quality of life in comparison with controls. Potential risk factors should be taken into account and clinicians should thus focus on the most vulnerable subgroups.

Quality of life and related factors of nursing home residents in Singapore.

BackgroundLitter is known about the well-being of nursing home (NH) residents in Singapore. This study aimed to identify predictors of self-reported quality of life (QOL) of NH residents in Singapore.MethodsIn face-to-face interviews, trained medical students assessed each consenting resident recruited from 6 local NHs using a modified Minnesota QOL questionnaire, and rating scales and questions assessing independence, cognitive function, depression, and communication. Predictors of residents’ QOL in five aspects (comfort, dignity, food enjoyment, autonomy, and security) were identified using the censored least absolute deviations (CLAD) models.ResultsA total of 375 residents completed the interviews. A higher score on comfort was negatively associated with major depression while a higher score on dignity was positively associated with no difficulty in communication with staff. Higher scores in food enjoyment were negatively associated with major depression and poorer cognitive function. Higher scores in autonomy were negatively associated with major depression, greater dependence, and difficulty in communication with staff. A higher score on security were negatively associated with major depression.ConclusionIt appears that depression and difficulty in communication with staff are the two main modifiable risk factors of poor quality of life of local NH residents.

Good quality of life outcomes after treatment of prosthetic joint infection with debridement and prosthesis retention

Patients treated for early prosthetic joint infection (PJI) with surgical debridement and prosthesis retention have a rate of successful infection eradication that is similar to patients treated with the traditional approach of prosthesis exchange. It is therefore important to consider other outcomes after prosthetic joint infection treatment that may influence management decisions, such as quality of life (QOL). Our aim was to describe infection cure rates and quality of life for patients with prosthetic joint infection treated with debridement and prosthesis retention and to determine if treatment with this approach was a risk factor for poor quality of life outcomes. Prospectively collected pre and post-arthroplasty data were available for 2,134 patients, of which PJI occurred in 41. For patients treated for prosthetic joint infection, the 2-year survival free of treatment failure was 87% (95%CI 84-89). Prosthetic joint infection cases treated with debridement and retention had a similar improvement from pre-arthroplasty to 12-months post-arthroplasty as patients without PJI in QOL according to the SF-12 survey. Prosthetic joint infection treated with debridement and retention was not a risk factor for poor quality of life on univariate or multivariate analysis. Prosthetic joint infection treated with debridement and prosthesis retention results in good cure rates and quality of life. Further studies are required that directly compare quality of life for different surgical approaches for prosthetic joint infection to better inform management decisions. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:898-902, 2016.

Predictors of Poor Quality of Life 1 Year After Subarachnoid Hemorrhage.

Risk factors for poor quality of life (QOL) after subarachnoid hemorrhage (SAH) remain poorly described. To identify the frequency and predictors of poor QOL 1 year after SAH. We studied 1-year QOL in a prospectively collected cohort of 1181 consecutively admitted SAH survivors between July 1996 and May 2013. Patient clinical, radiographic, surgical, and acute clinical course information was recorded. Reduced QOL (overall, physical, and psychosocial) at 1 year was assessed with the Sickness Impact Profile and defined as 2 SD below population-based normative Sickness Impact Profile values. Logistic regression leveraging multiple imputation to handle missing data was used to evaluate reduced QOL. Poor overall QOL was observed in 35% of patients. Multivariable analysis revealed that nonwhite ethnicity, high school education or less, history of depression, poor clinical grade (Hunt-Hess Grade ≥3), and delayed infarction were predictors of poor overall and psychosocial QOL. Poor physical QOL was additionally associated with older age, hydrocephalus, pneumonia, and sepsis. At 1 year, patients with poor QOL had increased difficulty concentrating, cognitive dysfunction, depression, and reduced activities of daily living. More than 91% of patients with poor QOL failed to fully return to work. These patients frequently received physical rehabilitation, but few received cognitive rehabilitation or emotional-behavioral support. Reduced QOL affects as many as one-third of SAH survivors 1 year after SAH. Delayed infarction is the most important in-hospital modifiable factor that affects QOL. Increased attention to cognitive and emotional difficulties after hospital discharge may help patients achieve greater QOL.

Is high job control a risk factor for poor quality of life in workers with high autism spectrum tendencies? A cross-sectional survey at a factory in Japan.

To examine the effect of autism spectrum (AS) tendencies and psychosocial job characteristics on health-related quality of life (HRQOL) among factory workers. A questionnaire survey was administered to 376 Japanese factory employees from the same company (response rate: 83.6%) in 2010. Psychosocial job characteristics, including job demand, job control, and social support, were evaluated using the Job Content Questionnaire (JCQ). AS tendencies was assessed using the Autism-Spectrum Quotient (AQ), and HRQOL was assessed using the Medical Outcomes Study Short-Form General Health Survey (SF-8). Associations were investigated using multiple logistic regression analysis adjusted for confounders. In the multivariate analysis, AQ was positively (odds ratio [OR]: 3.94; 95% confidence interval [CI]: 1.70-9.73) and social support in the workplace was inversely (OR: 0.25; 95% CI: 0.10-0.57) associated with poor mental HRQOL. No significant interaction was observed between AQ and JCQ subitems. Only social support was inversely associated with poor physical HRQOL (OR and 95% CI for medium social support: 0.45 and 0.21-0.94), and a significant interaction between AQ and job control was observed (p=0.02), suggesting that high job control was associated with poor physical HRQOL among workers with high AQ, whereas low job control tended to be associated with poor physical HRQOL among others. Our results suggest that AS tendencies have a negative effect on workers' HRQOL and social support is a primary factor in maintaining HRQOL. Moreover, a structured work environment can maintain physical HRQOL in workers with high AS tendencies since higher job control will be stressful.

Mental adjustment to cancer: the role of anxious and depressive symptoms under treatment.

Depression is a risk factor for poor quality of life and mental adjustment to cancer. This research aims to evaluate the course of mental adjustment to illness of cancer patients with anxious-depressive symptoms who receive antidepressant therapy (ADT). Eighty oncological patients with and without depressive symptoms were divided into three groups. Group 1: 30 depressed cancer patients who underwent ADT with SSRI; Group 2: 30 depressed cancer patients who refused ADT; Group 3: 20 non-depressed cancer patients. Patients were evaluated at tO and 4 (tl) and 12 (t2) weeks later through: Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Hospital Anxiety Depression Scale (HADS), and MINI-MAC. HDRS and HARS mean scores were stable and under threshold across the study only in Group 3; at t2 they improved in Group 1 and worsened in Group 2. The improvements in anxiety and depression scores were associated with ADT and related to the changes in Mini-MAC helpless-hopeless, anxious preoccupations, cognitive avoidance and fighting spirit dimensions. The improvement of mental adjustment to illness is directly related to the decrease of anxious-depressive symptoms among depressed cancer patients under antidepressant therapy.

Olfactory Dysfunction and Asthma as Risk Factors for Poor Quality of Life in Upper Airway Diseases

The study of olfaction/quality of life (QoL) interaction has not been adequately discussed and remains to be further explored. Determination of clinical predictors for poor QoL may support consultation of respective patients. This study explores QoL of patients with olfactory dysfunction and evaluates associated clinical risk factors for QoL prediction. One hundred eight patients suffering from chronic rhinosinusitis (CRS) and allergic rhinitis (AR) and 30 healthy subjects were studied. Olfactory function was evaluated using objective olfactory test. All patients completed six validated questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits [QOD]) and for assessing psychological state (Zung Anxiety Scale [ZAS], State-Trait Anxiety Inventory, Zung Depression Scale, and Beck Depression Inventory [BDI]) or a generic one (Short Form 36). Significantly poorer QoL and more severe anxiety and depression symptoms were observed in anosmic (all p < 0.001) and hyposmic patients compared with controls. Anosmic patients presented significantly worse results compared with hyposmic and normosmic patients. However, higher scores were observed in hyposmic compared with normosmic patients only in the QOD, ZAS, and BDI scale. Patients with CRS presented significantly poorer QoL than patients with AR only. The presence of nasal polyps or concomitant AR in patients with CRS did not show any differentiation in the results. Asthma was associated with significantly worse scores in all the psychometric questionnaires. Olfactory dysfunction was found to decrease QoL among patients. Anosmia, CRS disease, and asthma as clinical predictors were proved to be independently correlated with QoL, anxiety, and depression levels.

Folgen der Pneumonektomie in der Früh- und Spätphase

Pneumonectomy can represent the appropriate surgical treatment option in advanced or centrally localized non-small cell lung cancer (NSCLC). A satisfactory oncologic tumor surgery can be reached in these cases although pneumonectomy is associated with a significantly higher mortality and morbidity than less extensive resection of the lung parenchyma.The aim of this article is a systematic review and the presentation of possible postoperative consequences of pneumonectomy in the early and late phases, which depend not only on the underlying disease but are also primarily affected by the state and function of the remaining contralateral lung parenchyma. Cardiopulmonary complications, especially pneumonia, pulmonary embolism, cardiac arrhythmia or myocardial infarction lead to increased 30-day mortality in the early postoperative period. Moreover, advanced ages over 70 years can be identified as a significant risk factor for poor quality of life after pneumonectomy.

Nocturia: Impact on quality of life in an Egyptian adult population

OBJECTIVE: To estimate the effects of nocturia on quality of life (QoL) and to assess the associated effects of sleep problems. Background: Nocturnal urination (nocturia) is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance. Methods: The current study was carried out to assess the prevalence of nocturia in elderly males and its impact on sleep quality and QoL. The study enrolled 200 elderly males aged 60 years old and above. All participants were recruited from geriatric clubs in Cairo. All participants in the study were subjected to: comprehensive geriatric assessment, American Urological Association (AUA) score used to measure the severity of nocturia ,assessment of sleep quality using Pittsburgh Sleep Quality Index (PSQI) and assessment of QoL using “SF-12 Short Form Health Survey”. Results: The study showed that the prevalence of nocturia in elderly males aged ≥60 years old was 68% with significant association between nocturia and diabetes mellitus, heart failure, stroke, prostatism, recurrent UTI and diuretic use. As regard sleep quality, the current study showed that the prevalence of poor sleep in the studied subjects is 70.5% with significant association between nocturia and poor sleep quality. Nocturia significantly affects sleep latency, sleep efficiency and daytime dysfunction, high significantly affecting sleep disturbance. Also diabetes mellitus, ischemic heart disease, heart failure, prostatism, recurrent UTI, osteoarthritis and diuretic use are significantly associated with poor sleep quality. As regard quality of life, the current study showed significant association between nocturia and physical and mental health components of HRQL in the univariate analysis. But after multivariate analysis, nocturia is not an independent risk factor for poor quality of life. Nocturia affects QoL through its effect on sleep quality which is an independent risk factor for poor physical and mental health components of QoL. Conclusion: Nocturia may lead to sleep insufficiency and consequently to a decrease in mental and physical health. Patients who consult a doctor for nocturia should thus be treated adequately. In addition, it is worthwhile for doctors to routinely check if patients’ who contact them for sleep problems also have nocturia.

P085 Primary sclerosing cholangitis in the course of inflammatory bowel disease in children

available data suggests that alexithymia could be highly prevalent and independent from disease activity in patients with inflammatory bowel disease (IBD) and it could affect disease management and symptom perception, which may in turn have an impact on health-related quality of life (HRQOL). The aim of this study was to assess the influence of alexithymia on HRQOL in IBD patients. Methods: A cross-sectional, prospective study with consecutive patient recruitment was designed. The case-studies consisted of consecutive patients with IBD (Crohn’s disease (CD) and ulcerative colitis (UC)) who attended the monographic IBD Unit at the University Hospital of Santiago de Compostela, Spain, from January 2009 to June 2010. To assess quality of life we used The Inflammatory Bowel Disease Questionnaire (IBDQ), which is an instrument specifically designed to assess HRQOL in patients with UC and CD. This is a self-administered questionnaire consisting of 36 items, distributed into five dimensions (Bowel Symptoms, Systemic Symptoms, Functional Impairment, Social Impairment, and Emotional Function), which are scored from 1 to 7 in the Likert scale (corresponding to the worst and best functioning levels respectively). Total scores range from 36 to 252, with higher scores reflecting a better HRQOL. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-26). This consists of 26 items which are scored from 1 to 5 in the Likert scale. Total scores range from 26 to 130. A cut-off point of 74 is used to identify a subject as alexithymic. Multivariate logistic regression was also used to estimate the factors associated with lower than normal values in the IBDQ. Results: 484 patients agreed to participate and were consecutively recruited; 192 patients (39.7%) had CD, and 292 (60.3%) had UC. The percentage of alexithymic patients was 30.2% (95% CI: 26.0 35.0) of the total sample with no differences in terms of clinical activity or type of disease. Multivariate logistic regression analysis showed that alexithymia (OR = 3.34, 95% CI: 1.98 5.65), depressive symptoms (OR = 3.65, 95% CI: 1.89 7.08), and presence of a psychiatric disorder (OR = 2.3, 95% CI: 1.27 4.20) were risk factors for poor quality of life. Conclusions: This study shows a high prevalence of alexithymia in IBD. In addition, alexithymia is a significant predictor of HRQOL in patients with IBD.

Socioeconomic status and comorbidity as predictors of preoperative quality of life in cardiac surgery

Preoperative quality of life of patients undergoing cardiac surgical procedures has been associated with postoperative morbidity, survival, and quality of life. Patients of lower socioeconomic status have disproportionately greater cardiovascular disease burden and more complications of cardiovascular disease. We examined the interactive effects of demographic characteristics, socioeconomic status, and comorbidity on preoperative functional quality of life measured by the well-validated cardiovascular disease-specific Duke Activity Status Index. The patient population consisted of 5581 patients between May 1995 and January 1999 who underwent operations on cardiopulmonary bypass: isolated coronary artery bypass grafting, isolated valve procedures, or combined coronary artery bypass grafting and valve procedures and had a preoperative Duke Activity Status Index, along with socioeconomic status information from United States 2000 census data. Predictors were identified by logistic regression for maximum value of baseline DASI and linear regression for DASI scores less than maximum by means of bagging variable selection. Lower socioeconomic status was associated of lower risk-adjusted quality of life (maximum Duke Activity Status Index P = .0002, less than maximum Duke Activity Status Index P = .0007). Older age, female sex, certain comorbidities, higher New York Heart Association class, lower left ventricular function, and reoperation were also statistically significantly associated with lower preoperative Duke Activity Status Index. Lower socioeconomic status is associated with lower risk-adjusted quality of life for patients undergoing cardiac surgery. Quality of life affects morbid outcomes, so further characterization of risk factors for poor quality of life offers an opportunity for intervention.

Adipokines and Gut Hormones in End-Stage Renal Disease

Cachexia is common in end-stage renal disease (ESRD) patients, and it is an important risk factor for poor quality of life and increased mortality and morbidity. Chronic inflammation is an important cause of cachexia in ESRD patients. In the present review, we examine recent evidence suggesting that adipokines or adipocytokines such as leptin, adiponectin, resistin, tumor necrosis factor alpha, interleukin-6, and interleukin-1beta may play important roles in uremic cachexia. We also review the physiology and the potential roles of gut hormones, including ghrelin, peptide YY, and cholecystokinin in ESRD. Understanding the molecular pathophysiology of these novel hormones in ESRD may lead to novel therapeutic strategies.

Orexigenic and anorexigenic mechanisms in the control of nutrition in chronic kidney disease

Malnutrition is defined as abnormalities caused by an inadequate diet, but this term is often used inappropriately to describe the syndrome of loss of body weight with muscle mass being replaced by fatty tissue and declining serum proteins present in adults and children with chronic kidney disease (CKD). This syndrome is more accurately described as cachexia, and manifests as growth failure in children with CKD. Cachexia is common and is an important risk factor for poor quality of life and increased mortality and morbidity in both adults and children with CKD. Anorexia, acidosis and inflammation are important causes of cachexia, but the underlying molecular mechanism is not well understood. Dietary intake is often poor and resting metabolic rate is increased in CKD. The energy cost of growth is increased in experimental CKD. Circulating concentrations of cytokines, such as leptin, tumor necrosis factor-alpha and interleukins 1 and 6 are increased in patients with CKD and correlate with the degree of cachexia in these individuals. We hypothesize that cytokines signal through orexigenic neuropetides such as agouti-related peptide and neuropeptide Y (NPY), and anorexigenic neuropetides such as proopiomelanocortin and alpha-melanocyte-stimulating hormone in the arcuate nucleus in the hypothalamus. This signaling system also involves the NPY receptor and the melanocortin receptors and controls appetite and metabolic rate in health and disease. Furthermore, the first order neurons of this system are located outside the blood-brain barrier and can therefore sense the circulating levels of cytokines, as well as long-term satiety hormones such as leptin and insulin and short-term satiety hormones such as ghrelin and peptide (P) YY. There is experimental evidence that this hypothalamic neuropeptide signaling system may have an important role in the pathogenesis of cachexia in CKD. Understanding the molecular mechanism of cachexia in CKD may lead to novel therapeutic strategies.

Impact of obesity on disease-specific health status after percutaneous coronary intervention in coronary disease patients.

Several investigators have focused on obesity as a specific risk factor for mortality in patients undergoing bypass surgery, but few have examined it as a risk factor among patients undergoing percutaneous coronary interventions (PCI). In addition, none have evaluated the impact of obesity on post-PCI quality of life or disease-specific health status. This study examined whether obesity is a risk factor for poor quality of life or diminished health status 12-months postprocedure among a large cohort of PCI patients. A total of 1631 consecutive PCI patients were enrolled into the study and classified as underweight (BMI <20 kg/m2), normal weight range (BMI >/=20 and <25 kg/m2), overweight (BMI >/=25 and <30 kg/m2), class I obese (BMI >/=30 kg/m2), or class II and III obese (BMI >/=35 kg/m2). The 12-month postprocedure outcomes included need for repeat procedure, survival, quality of life and health status, assessed using the Seattle Angina Questionnaire (SAQ) and the Short Form-12. Obese patients with and without a history of revascularization were significantly younger than overweight, normal weight range, or underweight patients at the time of PCI. However, obese patients demonstrated similar long-term recovery and improved disease-specific health status and quality of life when compared to patients in the normal weight range after PCI. In addition, mortality and risk for repeat procedure was similar to those patients in the normal weight range patients at 12-months postrevascularization. Underweight patients who had no previous history of revascularization reported lower quality of life (F=3.02; P=0.018) and poorer physical functioning (F=2.82; P=0.024) than other BMI groups. Obese patients presenting for revascularization were younger when compared to patients in the normal weight range, regardless of previous history of revascularization. However, weight status was not a significant predictor of differences in long-term disease-specific health status, quality of life, repeat procedures, or survival. Underweight patients demonstrated less improvement in quality of life and physical functioning than other BMI groups.

Relative contributions of nutrition and inflammation to clinical outcome in dialysis patients

Protein-energy malnutrition (PEM) is a common phenomenon in maintenance dialysis (MD) patients and a risk factor for poor quality of life and increased morbidity and mortality, including cardiovascular death, in these individuals. The association between undernutrition and adverse outcome in MD patients, which stands in contrast to that seen in the general population, has been referred to as reverse epidemiology. Measures of food intake, body composition tools, nutritional scoring systems, and laboratory values are used to assess the degree of severity of PEM, but no uniform approach is available for rating the overall severity of PEM. Epidemiologic studies suggest that inflammation is a missing link between PEM and poor clinical outcome in MD patients, and the existence of a malnutrition inflammation complex syndrome is suggested in these patients. Inflammation may be due to subclinical and clinically apparent illnesses. Some investigators suggest that PEM may predispose to illness and inflammation. There is a paucity of information concerning the effect of nutritional therapy on morbidity and mortality in MD patients. Interventional studies of the effect of nutritional support on outcome often are difficult to interpret because of small sample sizes, short duration of study, and other limitations. Large-scale, randomized, clinical trials of the effects of nutritional intake, nutritional status, and inflammation on clinical outcome are needed to define better the relationships between these factors in MD patients. © 2001 by the National Kidney Foundation, Inc.