Screening Of Nutritional Status Research Articles

Healthy Lifestyle Education to Teenagers in The Adaptation Era of New Normal at SMK Negeri 7 Makassar

One of the problems for teenagers in the post-pandemic adaptation era is an unhealthy lifestyle. The lifestyle of SMK 7 Makassar students is mostly classified as sedentary life is playing gadgets and sitting relaxed. The importance of healthy lifestyle educational activities and nutritional status screening in teenagers can identify and reduce the risk of disease in children in the future. The purpose of this program is to educate and increase teenagers knowledge about the importance of a healthy lifestyle, assess the nutritional status of teenagers and find out the description of teenagers blood pressure in the adaptation era of new normal at SMK Negeri 7 Makassar. Based on the results of community service activities on 149 teenagers, the average value obtained includes age is 16 years, body weight is 51 kg, height is 155 cm, systolic blood pressure is 110.88 mmHg and diastolic is 71.84 mmHg, good nutritional status is 70.5% and normal blood pressure as much as 81.2%. There was a significant difference in the level of knowledge of teenagers based on the pre-post test after education, namely p=0.001. This shows the importance of education given to teenagers to increase understanding of a healthy lifestyle as a preventive action. The important role of health workers in the Puskesmas work area to identify and intervene the effects of unhealthy lifestyles as well as the support of the school and parents to prevent short and long term health impacts that occur in teenagers.

The role and relevance of nutritional diagnosis in pediatric oncology

In the Russian Federation the incidence of cancer remains high. Depending on the nosology of the tumor, the probability of malnutrition during primary hospitalization may be 10-50%, and during treatment it may reach 100%. Undernutrition and obesity are independent factors of poor prognosis, reducing the overall effectiveness of treatment. At the same time, the diagnosis of nutritional status (NS) in pediatric oncology is not clearly regulated, which, in the presence of a large number of factors affecting the functioning of the digestive, nervous, endocrine and other systems, creates prerequisites for untimely recognition of nutritional disorders and, accordingly, inadequate nutritional support. Taking into account the mentioned tendencies above it is of great value to establish the foundations for recommendations on the assessment of NS and for making nutritional diagnosis in pediatric oncology. In order to highlight and resolve this challenge the interpretation of clinical aspects, advantages and disadvantages of existing screening scales for NS assessing, anthropometric indicators, methods for body composition evaluation, eating disorders classification according to the World Health Organization, the International Classification of Diseases 10 revision and specialized medical associations was carried out. Based on modern convictions regarding the pathogenesis of protein-energy malnutrition and cachexia, side effects and complications of antitumor treatment, available tools for assessing NS, their systematization, a unified nutritional diagnosis structure was formed. It includes: NS screening, nutritional history, anthropometry dynamics, evaluation of the gastrointestinal tract state and the presence of metabolic disorders, alimentation level, determination of nutritional risk factors. NS is a complex indicator and its reflection can be a nutritional diagnosis, which will potentially allow determining the current NS state, predicting the risks of malnutrition developing, implementing rational nutritional support, and thus improving the effectiveness of cancer treatment.

Are Guideline Recommendations on Supportive Nutrition and Exercise Therapy for Cancer Patients Implemented in Clinical Routine? A National Survey with Real-Life Data.

Malnutrition and cancer cachexia are highly prevalent comorbidities of cancer, limiting patients' quality of life and being relevant to prognosis. International and national clinical guidelines recommend supportive nutrition and exercise therapy for cancer patients. However, there is little current epidemiological evidence on the implementation of these guideline recommendations in clinical routine. To close this data gap, a national survey in Germany using an online questionnaire was conducted. There were 261 of a total of 5074 contacted hospitals and medical offices who participated in the survey (5.1% response rate). The data indicated that nutrition and exercise therapy for cancer patients is so far inadequately implemented, with 59% of the respondents reporting nutrition therapy as an integral part of oncological treatment, 66.7% having a nutrition specialist/team, and 65.1% routinely conducting a screening for nutritional status. Only half of the participants stated that there are defined goals in nutrition therapy. The majority of respondents (85.8%) generally recommend exercise therapy, but only a few of them provide specific offers at their own institution (19.6%) or at cooperation partners (31.7%). In order to implement the recommended combined nutrition and exercise therapy as part of regular care, there is a need for nationwide availability of multidisciplinary nutrition teams and targeted offers of individualized exercise therapy. Health policy support would be important to create the structural, financial, and staff conditions for appropriate guideline implementation in order to achieve the optimal treatment of cancer patients.

Screening of nutritional status and education on balanced nutrition for boarding school students

Nutritional status is a condition that reflects the balance between nutrient intake and nutrient needs for body metabolism. Malnutrition is still a priority for national health development. Malnutrition in children causes growth and development problems and affects the quality of resources. The risk of malnutrition can occur to the students at the Islamic boarding school because they do not live and are cared for by their parents. Therefore, this community service focuses on screening and anticipating calorie deficiency in elementary school students.
 Ash Sholihah Islamic Boarding School is a boarding school in Sleman Regency with simple facilities. The number of boarding school students is approximately 700 male and female students, consisting of elementary to high school students. Elementary school students need more attention because they cannot take care of themselves and maintain food intake properly. The results of the anthropometric examination of 198 children showed that 166 (83.6%) were underweight, 24 (12.1%) had ideal body weight, and 8 (4.04%) were overweight. The results of the anthropometric examination of 198 children showed that 166 (83.6%) were underweight, 24 (12.1%) had ideal body weight, and 8 (4.04%) were overweight. The results of the mini nutritional assessment (MNA) questionnaire screening showed 10 (5.1%) malnutrition, 165 (83.3%) risk of malnutrition, 8 (4%) good nutrition, and 15 (7.6%) unknown. The service activities were continued with medical examinations and administration of drugs if necessary. 
 Then carried out education and provision of additional calories to 166 children with underweight. Dormitory administrators are involved in supervising the implementation of additional nutrition. Additional intake given is a preparation equivalent to 100 kcal/day for each child as modified Formula 100.

#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.

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

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

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

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

Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group.

Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.

The relationship between the baseline geriatric nutritional risk index (GNRI) and neurological function at the convalescence stage in patients with stroke: a cross-sectional study

BackgroundMalnutrition is a common complication after stroke and may worsen neurological outcomes for patients. There are still no uniform tools for screening nutritional status for the patients with stroke. We aimed to explore the relationship between the baseline geriatric nutritional risk index (GNRI) and neurological function at the convalescence stage for patients with stroke and assessed the predictive value of the GNRI for adverse neurological outcomes.MethodsA total of 311 patients with stroke were enrolled retrospectively. Basic information and laboratory results on admission since onset of stroke were collected. The GNRI on admission was calculated and neurological outcomes evaluated by the Barthel index at 1 month after the onset of stroke. Statistical analyses, including correlation coefficient tests, multivariate regression analyses, and receiver operating characteristic (ROC) analyses, were applied in this study.ResultsCompared with the good outcome group, the poor outcome group showed a significantly lower GNRI on admission (P < 0.05). GNRI was associated with Barthel index (r = 0.702, P < 0.01). The GNRI was independently correlated with the Barthel index (Standardization β = 0.721, P < 0.01) and poor outcome 0.885 (95% CIs, 0.855–0.917, P < 0.01) after adjusting for covariates. Compared with no nutritional risk grades (Q4), the OR of GNRI to poor neurological outcome increased across increasing nutritional risk grades of GNRI (OR = 2.803, 95% CIs = 1.330–5.909 in Q3, 7.992, 95% CIs = 3.294–19.387 in Q2 and 14.011, 95% CIs = 3.972–49.426 in Q1, respectively, P for trend < 0.001). The area under ROC curves (AUC) of the GNRI was 0.804, which was larger than that of the NIHSS, BMI, or Albumin (P < 0.01), with an optimal cut-off value of 97.69, sensitivity of 69.51% and specificity of 77.27%. Combined GNRI with NIHSS gained the largest AUC among all the variables (all P < 0.05), with an AUC of 0.855, sensitivity of 84.75 and specificity of 72.73%.ConclusionsFor patients with stroke, higher nutritional risk grades at baseline indicated worse neurological function at the convalescence stage. Compared with NIHSS, BMI, and Albumin, GNRI was a competitive indicator for the risk of poor neurological outcome. The predictive property of GNRI for adverse neurological outcomes might be more powerful when combined with NIHSS.

Malnutrition associated with readmission in elderly patients with chronic obstructive pulmonary disease.

Malnutrition associated with readmission in elderly patients with chronic obstructive pulmonary disease.

SOCIOECONOMIC AS STUNTING PREDICTOR ON CHILDREN AGED 24-59 MONTHS AT BEFORE AND DURING COVID-19 PANDEMIC

Background: Stunting is a high-priority malnutrition problem globally. The COVID-19 pandemic was predicted to increase hunger and worsen the condition of stunted children. Purpose: To determine the socioeconomic factors for stunting in children aged 24-59 months before and during the COVID-19 pandemic in the Magelang Regency. Methods: This study used a case-control design from August to November 2021. Subjects were children under five aged 24-59 months from the Magelang Regency. The subjects consisted of 162 stunted children and 166 normal children. The nutritional status screening was derived from e-PPGBM data, and was further validated through repeated anthropometric measurements. Phone interviews with mothers or trustees were done to obtain primary data. Data were analyzed using a chi-square test and declared significant if the p-value was below 0.05. Results: Socioeconomic status factors significantly related to stunting before the COVID-19 pandemic were family income below the region’s minimum wage (cOR = 2.18; 95% CI = 1.31-3.64), incapability to fulfill food and household needs (cOR = 2; 95% CI = 1.25-3.23), and incapability to save income (cOR = 2; 95% CI = 1.32-3.33). During the COVID-19 pandemic, a socioeconomic factor that was found to be significantly related to stunting was incapability to fulfill food and household needs (cOR = 1.57; 95% CI = 1-2.46). Conclusion: Low family income and incapability to fulfill food and household needs was strongly associated with stunting. Improvements to community empowerment and stunting prevention programs in response to COVID-19 need to be made to prevent new stunting cases.

Correlation between nutritional status screening by MNA-SF and acute stroke-associated infections in older adults.

This study aimed to explore the correlation between nutritional status screening using the MNA-SF and stroke-associated infections (SAI) in older adults. A retrospective study of patients aged over 70years with acute stroke was conducted. The patients were divided into normal nutritional status, malnutrition risk, and malnutrition groups depending on their baseline MNA-SF scores. The correlation between nutritional status and SAI was identified using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to demonstrate the predicted value of MNA-SF. 497 patients were included, 101 (20.32%) developed SAI. 32.29% of patients with malnutrition developed SAI, while 25.14% of those with malnutrition risk developed SAI. Malnutrition (aOR 4.58, 95% CI 2.34-8.96, p < 0.001) and risk of malnutrition (aOR 3.70, 95%CI 2.01-6.85, p < 0.001) were independent risk factors for SAI in older stroke patients. The area under the curve (AUC) value of MNA-SF was 0.713. MNA-SF is a simple and effective nutritional screening tool for predicting the occurrence of SAI in older patients with acute stroke.

DETEKSI DINI STUNTING PADA SISWA KB/RA MANBAIL FUTUH BEJI KECAMATAN JENU TUBAN

Nutritional status at kindergarten nutritional status at this age is influenced by nutritional status as a toddler and will affect nutritional status during adolescence, the age when growth spurts occur. Malnutrition early intervention is important if nutritional problems are found, this can be done if nutritional status screening data is available. The rampant cases of stunting are of concern to the government, where the cause of stunting itself is due to a lack of intake since I was still in the womb, a lack of awareness to have health checks, and a lack of sanitation and clean water. Therefore, it is necessary to improve diet, parenting patterns and good sanitation. This study aims to screen the nutritional status of KBRA Manbail Futuh Beji students, Jenu District, Tuban. A total of 33 KB children and 61 RA children participated in this study. Demographic data and anthropometric data were collected. An overview of nutritional status based on weight/age shows the percentage of children with nutritional status of overweight, at risk of being overweight, and underweight, the results are the same, namely 1 child with a percentage of 3.03%. Nutritional status based on height/age shows the percentage of children with short nutritional status as many as 6 children with a percentage of 18.8%. Nutritional status based on weight/height shows the percentage of children with overweight and obese nutritional status with the same results, namely 1 child with a percentage of 3.03% for each result for overnutrition status of 3 children with a percentage of 9.09%. Nutritional status based on BMI/U shows the percentage of children with obese nutritional status as many as 3 children with a percentage of 4.92% overweight and malnutrition as many as 4 children with a percentage of 6.56% the risk of overweight is 1 child with a percentage of 1.64%.

NRS‑2002 scale impact on nutritional status screening of patients with acute cerebrovascular accident

Evaluation of the nutritional status at an early stage of hospitalization in patients with acute cerebrovascular insufficiency (CVA) is important for providing timely nutritional support. According to the Russian clinical guidelines for nutritional support of patients with stroke, the NRS‑2002 scale is essential to assessment the nutritional status. However, due to the obesity, about 30 % of patients do not entered into the general category of patients with CVA to get the standard examination.Aim. To analyze the NRS‑2002 scale effectiveness in patients with acute cerebrovascular accident, taking into account the somatic and visceral protein pools.Materials and methods. In the case of the prospective study the 140 patients with CVA were hospitalized in the primary vascular department of the City Clinical Hospital n. a. V. V. Vinogradov (Moscow, Russia), and were screened by the simplified malnutrition scoring system and the NRS‑2002 scale.Results. The research reveals: A low risk of malnutrition in 34,3 % of all cases and 72,7 % in patients under 70 years; the high BMI – Me‑26,6 (24,2–30,8) kg/m²; the protein deficiency in 140 (25.7 %) of patients with normal somatic protein pool and in 66 (28.8 %) of patients under 70 years.Conclusions. Detecting the risk of malnutrition with the NRS‑2002 scale in the early stage after hospitalization is not always informative due to the overweight and the age less than 70 years. The visceral protein pool analysis should be performed in all patients, independently of the NRS‑2002 scale and the somatic protein pool results.

Nutritional status evaluation in critical care: A study of clinical practices

Background & aimsMalnutrition is a common consequence in critically ill patients admitted to the intensive care unit (ICU). ObjectiveThe aim of this study was to assess the current clinical practices concerning nutritional screening and assessment in multiple Tunisian intensive care units. MethodsThe study was conducted through a survey. It was intended for all intensivists: certified specialists and residents. The content of the questionnaire was guided by literature review and latest Clinical Practice Guidelines. ResultsThis study involved 105 physicians. Concerning the nutritional status screening: the clinical history and disease related effects were considered by 70% of physicians and weight changes were considered in 60%. Screening a recent and unintentional weight loss before hospital or ICU admission was done by 90% of intensivists. While only 45% screened the reduced dietary intake. Physical signs of malnutrition (loss of subcutaneous fat or muscle mass, oedema, ascite) were assessed by 52% of respondents. Using scores to evaluate the risk of malnutrition was considered by 26% of physicians. Weight evaluation based on actual body weight and BMI calculation were practiced by 59% of respondents. In order to evaluate the energy expenditure, indirect calorimetry (IC) was performed in 20% and predictive equations were used in 27%. Only 7% of respondents used VO2/VCO2 (VO2 (oxygen consumption) from pulmonary arterial catheter or VCO2 (carbon dioxide production) derived from the ventilator) measurement method. Over the half of the respondents (54%) had fixed a caloric target of 20 to 25 Kcal/day. Whereas, 16% of respondents reported that they did not consider the correct optimal calorie target. Albumin was prescribed by the majority of respondents (99%) to assess the nutritional state. Other biochemical parameters as Prealbumin and Transferrin were only known and prescribed in 8% and 7% respectively. ConclusionResults have shown that physicians responded differently regarding nutritional evaluation and that they were globally not sensibilized by the importance of this step. We highlight the necessity of an appropriate nutrition screening and assessment that will set the basis of an effective nutritional management.

Real world prognostic utility of platelet lymphocyte ratio and nutritional status in first-line immunotherapy response in stage IV non-small cell lung cancer

BackgroundElevated platelet lymphocyte ratio (PLR) and low body mass index (BMI) are associated with inferior survival in non-small cell lung cancer (NSCLC) patients receiving immunotherapy (IO). We evaluated real-world prognostic utility of PLR, BMI, and albumin level in stage IV NSCLC patients receiving first line (1L) IO. MethodsWe identified 75 stage IV patients who received 1L IO therapy at USC Norris Comprehensive Cancer Center and Los Angeles General Medical Center from 2015 to 2022. The primary outcome was overall survival (OS) from time of IO with attention to pre-treatment BMI < 22, albumin < 3.5 g/dL, and PLR > 180. ResultsMedian age was 66.5 years with 49 (65.3%) males. 25 (33.3%) had BMI < 22. 45/75 (60%) had PLR > 180. Patients with BMI < 22 had inferior OS (13.1 months (m) vs. 37.4 m in BMI > 28, p-value = 0.042) along with patients with albumin<3.5 g/dL (OS: 2.8 m vs. 14.6 m, p-value = 0.0027), and patients with PLR>180 (OS: 8.7 m vs. 23.0 m, p = 0.028). Composite BMI < 22, PLR > 180 had the worst OS, p-value = 0.0331. Multivariate analysis controlling for age, smoking, gender, PD-L1 tumor proportion score (TPS), and histology (adenocarcinoma, squamous, adenosquamous, and large cell) showed that BMI (HR: 0.8726, 95% CI: 0.7892–0.954) and PLR > 180 (HR: 2.48, 95% CI: 1.076–6.055) were significant in OS mortality risk. ConclusionPatients with a composite of BMI < 22, albumin < 3.5 g/dL, and PLR > 180 had significantly worse OS. This highlights the importance of screening for poor nutritional status and high PLR to better inform stage IV NSCLC patients receiving IO therapy of their prognosis and supportive care. MicroAbstractWe evaluated real-world prognostic utility of platelet lymphocyte ratio (PLR), body mass index (BMI), and albumin level in 75 Stage IV NSCLC patients receiving first line IO. Patients with a composite of BMI < 22, albumin < 3.5 g/dL, and PLR > 180 had significantly worse OS. This highlights the importance of screening for poor nutritional status and high PLR to better inform stage IV NSCLC patients of their prognosis and to emphasize supportive care needs.

Kritički osvrt na koncept ubrzanog oporavka nakon operacije u vaskularnoj hirurgiji - ERAS protokol u vaskularnoj hirurgiji

The concept of enhanced recovery after surgery (Enhanced Recovery After Surgery-ERAS) represents a multimodal approach to surgical treatment of patients, based on evidence, starting preoperatively and continuing postoperatively. The concept aims to improve patient recovery while reducing complications and reducing length of hospital stay. The ERAS concept has become the standard of care in colorectal surgery. It is also used in vascular surgery, especially aortic and carotid surgery. In 2022, the Society for Vascular Surgery and the ERAS Society published the latest recommendations for vascular surgery for patients undergoing open aortic surgery. The study included 590 abstracts. The recommendations refer to the period before the admission of the patient, as well as to the preoperative, intraoperative and postoperative period. Among the most important recommendations are the introduction of preoperative patient education, screening of anemia and nutritional status, optimization of risk factors, reduction of the use of nasogastric tubes and drainage, use of multimodal analgesia, targeted replacement of fluid, early removal of urinary catheters, active and early mobilization, and early enteral nutrition. There is more and more evidence about the importance of the ERAS protocol in elective vascular surgery, as well as its impact on reducing the length of hospital stay, reducing complications and better recovery of patients, lower treatment costs. Its application depends on the medical staff, so the education of healthcare workers is needed in this field.

Assessment of the nutritional status of patients before, one, and three months after liver transplantation: A multi-center longitudinal study

Nutrition management is an important pre-operative and post-operative challenge in liver transplantation. Preoperative malnutrition is associated with increased length of intensive care unit (ICU) stay, mortality, and length of hospital stay in liver transplant patients. This study aimed to evaluate the nutritional status of patients before and after liver transplantation and post-transplant complications. This longitudinal study was conducted on liver transplant patients in Montaserieh Hospital, Mashhad and Firoozgar Hospital, Tehran from May 2021 to January 2022. Demographic characteristics, Subjective Global Assessment (SGA) standard questionnaire, anthropometric indices, laboratory analyses, and 3-day food records were collected before, one, and three months after transplantation. Thirty-nine patients with a mean age of 48.4±14.2 were evaluated. Prevalence of severe malnutrition was 43.6% (56.3% women and 34.8% men) before transplantation. Body mass index (BMI), body weight, lean mass, total body water, and total serum protein significantly decreased after transplantation compared to before transplantation (P<0.001). One month after transplantation, 54% of the patients lost more than 10% of their weight. Energy intake increased significantly after transplantation (P<0.001). A significant relationship was observed between BMI (P=0.005) and metabolic complications and between Arm Muscle Circumference and renal complications (P=0.003) after transplantation. A cut-off point of 4.6 was determined for the phase angle in terms of SGA three months after transplantation. Malnutrition, weight loss, and nutritional problems were common in liver transplantation patients. Screening for nutritional status is necessary in these patients to treat or prevent malnutrition-related complications.

Review of ESPEN-2021 Practice Guidelines for Cancer Patients: Part 1

This study discusses the 2021 ESPEN Practical Guidelines for Nutritional Support in Oncology. The updated version of the 2021 ESPEN practice guidelines differs slightly from the 2017 version and contains flowcharts to facilitate the use of the guidelines in clinical practice, which is also relevant for domestic healthcare. ESPEN-2021 Clinical Guidelines, which offer practical solutions in all areas of oncology, are of particular interest to both oncologists and allied specialists working in oncology. The first part of the review discusses general recommendations for nutritional support for patients with cancer and the possibility of their use in our country: screening of nutritional status at the initial visit, indications for prescribing additional nutrition, benefits of one or another type of nutritional support in various situations, norms for providing macronutrients, vitamins, and minerals, and need for physical activity. This practical guide forms an algorithm of actions to ensure optimal nutrition for patients with cancer. The general principles of nutritional therapy for all patients with cancer are based on timely screening for nutritional deficiencies and adherence to appropriate nutritional support of patients, which can be achieved by modifying the diet or prescribing additional nutrition, mainly enteral nutrition.

Prevalence of depression, cognition impairment, nutrition and related factors in patients with chronic kidney disease stage 3 - 5

Introduction: Chronic kidney disease (CKD) affects mental health, cognition and nutrition. Objectives: (1) To determine the prevalence of depression, cognition impairment and nutrition in patients with CKD stage 3-5. (2) To explore the relationship between depression and cognitive disorders, nutritional disorders, and some characteristics in patients with CKD stage 3-5. Methodology: cross-sectional description on 433 patients with chronic kidney disease stage 3-5. Corresponding tools for assessing screening for depression, cognitive decline, and nutritional status are Beck Depression Inventory (BDI), the Mini Mental State Examination (MMSE), and the Mini Nutritional Assessment (MNA). Results: (1) The rate of depression, cognition impairment and malnutrition risk was 40.9%, 20.3%; 50.1% respectively. (2) Patients with CKD who were at risk of malnutrition and cognitive disorders were more likely to suffer from depression than patients with normal nutritional status and cognitive status. Conclusion: Depression is quite common in patients with chronic kidney disease stage 3 - 5, screening is needed in these patients. There is a positive relationship between depression and the risk of malnutrition, the level of cognitive dysfunction in patients with CKD stage 3 - 5. Key words: Chronic kidney disease, depression, cognitive disorders, nutrition status, prevalence, relevance.