Severe Malnutrition Group Research Articles

Prognostic importance of the Controlling Nutritional Status (CONUT) score in patients undergoing cardiac resynchronisation therapy

AimsMalnutrition is common and associated with worse clinical outcomes in patients with heart failure (HF). The Controlling Nutritional Status (CONUT) score is an integrated index for evaluating diverse aspects of...

B-PO05-185 CLINICAL SIGNIFICANCE OF THE CONTROLLING NUTRITIONAL STATUS (CONUT) SCORE IN PATIENTS UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY

The Controlling Nutritional Status (CONUT) score is an index of nutritional status. Malnutrition has recently been reported to be a common condition that is associated with adverse prognosis in patients with heart failure (HF). However, the relationship between nutritional status and clinical outcomes in patients with HF undergoing cardiac resynchronization therapy (CRT) is unclear. We investigated the prognostic value of the CONUT score in CRT recipients. Clinical records were retrospectively evaluated for 263 patients who underwent CRT implantation between March 2003 and August 2020. Blood samples were collected before CRT implantation. Nutritional status was assessed using the CONUT score. Patients were divided into three groups by CONUT score: normal group (CONUT score 0-1, n=56), mild malnutrition group (CONUT score 2-4, n=132), and moderate or severe malnutrition group (CONUT score ≥5, n=75). The primary endpoint was all-cause mortality. The moderate or severe malnutrition group had significantly advanced NYHA functional class, higher N-terminal pro-brain natriuretic peptide (NT pro-BNP) levels, and higher Clinical Frailty Scale scores (all p<0.05). During a median follow-up of 31 months (interquartile range, 10-67), 103 patients (39.1%) died. Kaplan-Meier analysis revealed that mortality was significantly higher in the moderate or severe malnutrition group (log-rank p<0.001). Even after adjustment for a conventional risk score (VALID-CRT risk score), CONUT score (as a continuous variable) remained associated with mortality (p<0.05). Nutritional status as assessed by the CONUT score is significantly associated with the severity of HF and frailty, and subsequent mortality in patients with HF undergoing CRT.

Evaluation of the global leadership initiative on malnutrition criteria using different muscle mass indices for diagnosing malnutrition and predicting survival in lung cancer patients

Background Malnutrition is prevalent in lung cancer (LC) patients, yet there are no globally accepted criteria for diagnosing malnutrition. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed. However, the role of these criteria in prospective LC cohorts remains unclear. Methods We performed a multicenter, observational cohort study including 1219 LC patients. Different anthropometric measures were compared for assessment of reduced muscle mass (RMM) in the GLIM criteria. Least absolute shrinkage and selection operator and multivariate Cox regressions were performed to analyze the association between the GLIM criteria and survival. Independent prognostic predictors were incorporated to develop a nomogram for individualized survival prediction, and decision curve was applied to assess the clinical significance of the nomogram. Results Patients in the stage II (severe) malnutrition group, diagnosed using combined calf circumference (CC) plus body weight-standardized handgrip strength (HGS/W) criteria, had the highest hazard ratio (HR, 2.07; 95%CI, 1.50-2.86) compared with other methods used to evaluate RMM. The GLIM criteria diagnosed malnutrition in 24% of cases (292 patients, using the CC and HGS/W criteria) and were effective for determining the nutrition status of LC patients. GLIM-diagnosed malnutrition was an independent risk factor for survival, and malnutrition severity was monotonically associated with death hazards (P = .002). The GLIM nomogram showed good performance in predicting the survival of LC patients, and the decision-curve analysis demonstrated that the nomogram was clinically useful. Conclusion These findings support the effectiveness of GLIM in diagnosing malnutrition and predicting survival among LC patients.

Association of malnutrition with all-cause mortality in the elderly population: A 6-year cohort study

Background and aimsFew studies have explored the association between malnutrition, defined by the Geriatric Nutritional Risk Index (GNRI), and all-cause mortality, particularly in the Chinese population. This study aimed to investigate the association between the GNRI and all-cause mortality in the elderly population. Methods and resultsParticipants aged ≥60 years were eligible for this study and were divided into three groups by the GNRI: An adequate nutrition group, participants with a GNRI ≥98; mild malnutrition group, participants with a GNRI ≥82 but <98; and a severe malnutrition group, participants with a GNRI <82. The results implied that there was a positive association between severe malnutrition and all-cause mortality in the total population (hazard ratio (HR): 2.591 and 95% confidence interval (CI): 1.729–3.884), male subjects (HR: 2.903 and 95% CI: 1.718–4.906), and female subjects (HR: 2.081 and 95% CI: 1.071–4.046). Similar associations between severe malnutrition and all-cause mortality were observed in both the 60–69 and 70–79 years age groups (HR: 2.863 and 2.600, 95% CI: 1.444–5.678 and 1.394–4.849, respectively). However, no significant association was observed between mild malnutrition and all-cause mortality. ConclusionsSevere malnutrition could increase all-cause mortality in the 60- to 79-year-old population. However, there was no association of mild malnutrition with all-cause mortality.

Nutritional survey in critically ill children: a single center study in China.

BackgroundThe incidence of malnutrition in children, who were admitted to the pediatric intensive care unit (PICU), has kept high level over the past 30 years. In addition, nutrition status of critically ill children deteriorates further during the changing of their conditions and may have a negative effect on patients’ outcomes. This study aimed to determine the nutritional status of critically ill children and to survey current nutrition practices and support in PICU.MethodsIn this prospective observational study, 360 critically ill children stayed in the PICU not less than 3 days from Feb. to Nov. in 2017 were enrolled. Each patient underwent nutrition assessment. Nutritional status was determined using Z-scores of length/height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ), body mass index-for-age (BAZ), based on the World Health Organization child growth standards. We also observed the patients’ intake of calories and protein during the first 10 days after admission.ResultsThree hundred and sixty were enrolled in the study. One hundred and eighty-six patients (51.67%) were malnourished at PICU admission, above 50% and 56.45% (105/186) of malnourished patients had severe malnutrition. Except fasting in case of clinical instability in 5.3% (19/360), nutrition was provided in the form of oral feeding in 26.6% (96/360), enteral nutrition (EN) in 56.1% (202/360), parenteral nutrition (PN) in 6.4% (23/360) and mixed support (EN + PN) in 5.6% (20/360). Totally 384 times interruption of feeding happened in the process of EN, and 1.9 times feeding interruption happened to each patient. Twenty-seven point two percent of these patients had more than three times feeding interruption. The severe malnutrition group had significantly greater length of ICU stay and higher mechanical ventilation support rate (P=0.007, P=0.029). Total 44 (44/360, 12.22%) patients died in the study, and the malnutrition was not statistically different between survivor group and death group (P=0.379). More than 85% of the patients had lower daily nutritional intake compared with prescribed goals. Sixty-eight point three percent of the patients received the required calories during EN with median time of 2 [2–4] days. Only 32.7% of patients underwent EN received estimated protein requirements.ConclusionsThese results showed that malnutrition was common among children admitted to PICU. Furthermore, nutrition delivery was generally inadequate in critically ill children, and nutritional status was getting worsening during PICU.

Evaluation of the Global Leadership Initiative on Malnutrition Criteria Using Different Muscle Mass Indices for Diagnosing Malnutrition and Predicting Survival in Lung Cancer Patients.

Malnutrition is prevalent in lung cancer (LC) patients, yet there are no globally accepted criteria for diagnosing malnutrition. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed. However, the role of these criteria in prospective LC cohorts remains unclear. We performed a multicenter, observational cohort study including 1219 LC patients. Different anthropometric measures were compared for assessment of reduced muscle mass (RMM) in the GLIM criteria. Least absolute shrinkage and selection operator and multivariate Cox regressions were performed to analyze the association between the GLIM criteria and survival. Independent prognostic predictors were incorporated to develop a nomogram for individualized survival prediction, and decision curve was applied to assess the clinical significance of the nomogram. Patients in the stage II (severe) malnutrition group, diagnosed using combined calf circumference (CC) plus body weight-standardized handgrip strength (HGS/W) criteria, had the highest hazard ratio (HR, 2.07; 95%CI, 1.50-2.86) compared with other methods used to evaluate RMM. The GLIM criteria diagnosed malnutrition in 24% of cases (292 patients, using the CC and HGS/W criteria) and were effective for determining the nutrition status of LC patients. GLIM-diagnosed malnutrition was an independent risk factor for survival, and malnutrition severity was monotonically associated with death hazards (P = .002). The GLIM nomogram showed good performance in predicting the survival of LC patients, and the decision-curve analysis demonstrated that the nomogram was clinically useful. These findings support the effectiveness of GLIM in diagnosing malnutrition and predicting survival among LC patients.

P786Plasma volume status is associated with the change in nutritional status during hospitalization in acute decompensated heart failure patients with preserved left ventricular ejection fraction

Abstract Introduction Plasma volume (PV) expansion has an essential role in heart failure (HF). PV can be estimated by a simple formula using hematocrit and body weight, and PV status (PVS) provides prognostic information in patients (pts) with chronic HF. Nutritional status (NS) based on the prognostic nutritional index (PNI) and NS change during hospitalization have been shown to predict prognosis in pts admitted with acute decompensated HF (ADHF). Purpose We sought to assess the hypothesis that PVS is associated with NS change during hospitalization in pts with HF with preserved LVEF (HFpEF) who are admitted with ADHF. Methods We prospectively studied 411 pts who were admitted for ADHF with LVEF ≥50% and survived to discharge. Body weight measurement and venous blood sampling were performed on admission and at discharge. PVS was defined as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The pts were divided into 3 groups by PNI: normal (&gt;38), moderate malnutrition (35–38), and severe malnutrition (&lt;35). During admission, pts who remained in the moderate or severe malnutrition group or whose NS worsened were defined as no improvement in NS. Follow-up data was obtained in 203 cases. They were followed for up to 18 months, and the incidence of all-cause death was evaluated. Results On admission, PVS in the moderate (n=71, 13.3±13.9%) or severe malnutrition group (n=69, 14.8±10.8%) was significantly higher than in the normal PNI group (n=271, 5.4±10.8%, p&lt;0.001). During hospitalization, 123 pts had no NS improvement. Admission PVS was significantly higher in pts with no NS improvement than in pts with improved NS (13.9±11.2% vs 5.9±12.8%, p&lt;0.0001). In multivariate logistic regression analysis, admission PVS was independently associated with no NS improvement during hospitalization (OR 1.06, 95% CI 1.03–1.08, p&lt;0.0001). Receiver operating characteristics curve analysis revealed that the optimal cut-off value of admission PVS for predicting no NS improvement was 9.4% (sensitivity: 72%, specificity: 63%). The area under the curve for predicting no NS improvement using admission PVS was significantly greater than for other independent factors (Figure 1A). During the follow-up period (median 12.4 months), 68 of 203 patients had all-cause death. Kaplan-Meier analysis showed that the patients with no NS improvement had a significantly higher risk of all-cause death (Figure 1B). Figure 1 Conclusions In this multicenter study, admission PVS was shown to be associated with poor improvement in NS during hospitalization in HFpEF pts admitted for ADHF. Acknowledgement/Funding Roche diagnostics, FUJIFILM Toyama Chemical

The association of klotho protein and nutrition status for maintenance hemodialysis patients

Objective To explore the association between klotho protein and nutrition status for maintenance hemodialysis patients. Methods From June 2016 to November 2016, 100 patients who received maintenance hmodialysis were divided into three groups, group A: 28 cases in good nutrition group, group B: 44 cases in mild and moderate malnutrition group, and group C: 28 cases in severe malnutrition group in our hospital and 60 health controls were enrolled in our study. Subjective global assessment of nutritional status(SGA) was used to assess the nutrition status between two groups, the level of serum klotho protein was measured by ELISA, and other related· biochemical indexes were detected. Pearson correlative analysis was used to analyze the relationship between serum klotho protein and related biochemical indexes. Results There was a significant difference of the incidence of malnutrition between study group and control group (72%>18.32%, P<0.05), and there was significant difference of biochemical indexes among different nutrition status of groups A, B and C (P<0.05), compared with A group, the level of ALB, Hb, MAMC, klotho protein and BMI were lower in group B and C, and the level of PTH and FGF-23 was higher (P<0.05). Compared with group B, the level of Scr, ALB, Hb, MAMC, klotho protein was lower, and the level of PTH and FGF-23 was higher (P<0.05). Serum klotho protein was positively related with ALB, MAMC and Hb (P<0.05), and negatively related with Scr, BUN, FGF23 and PTH (P<0.05), while there was no relationship between serum klotho protein and BMI (P=0.165). Conclusions There is a high incidence of malnutrition in maintenance hemodialysis patients, and the low expression of serum klotho protein may be related with maintenance hemodialysis patients, which may provide a new basis for the diagnosis and treatment of malnutrition in uremic patients. Key words: Renal Dialysis; Proteins; Nutritional Status

Nutritional Status in Iranian Non-Syndromic Patients with Acyanotic Congenital Heart Disease Undergoing Surgical Repair

Background: To normally grow and develop, children with congenital heart diseases (CHD) in the hypermetabolic state need 50% more energy than healthy ones. Objectives: This study aimed to investigate the prevalence of malnutrition and its association with other factors among the non-syndromic acyanotic patients with CHD undergoing palliative or corrective surgery. Methods: A retrospective study of medical records of 812 children with acyanotic congenital heart disease undergoing palliative or corrective surgery was performed from March 2011 to March 2017. Collected data consisted of the age at the time of the surgery, gender, weight at the time of the surgery, height at the time of the surgery, birth weight, length of ICU stay, and 1-year mortality. The WAZ, WLZ, LAZ, and BMI Z-scores were calculated based on World Health Organization (WHO) standards. We classified the Z-scores into 4 groups, including normal (Z-scores > -1), mild (-2 to > -1), moderate (-3 to > -2), and severe (< -3) malnutrition groups. Results: Total amount of 812 patients, 375 (46.2%) were female and 437 (53.8%) male, participated in this study. The average age, weight, and height at the time of the surgery were 23.52 + 29.38 months, 9.086 + 6.71 kilograms, and 76.93 + 23.37 centimeters, respectively. Moreover, 68.7% and 66.4% of the patients suffered from mild to severe forms of malnutrition based on WAZ and WLZ, respectively (P value < 0.0001, 0.025). There was no significant difference between males and females in WAZ, WLZ, LAZ and, BMIZ (P value: 0.154, 0.265, 0.965, and 0.667, respectively). Generally, in acyanotic defects, we found that more severe malnutrition causes an increment in length of ICU stay (P value = 0.001) and lesser birth weight has a significant relationship with the severity of growth failure in infancy or childhood (P value < 0.0001). Conclusions: In our study, the high prevalence of the malnutrition and related complications during and after surgical repair shows the importance of nutritional support and interventions in patients with CHD.

Impact of Dietary Counselling to Improve Nutritional Status of Hemodialysis Patients

Proper nutrition may reverse the malnutrition and can modulate renal function in hemodialysis patients. In majority of the dialysis units in Pakistan, nutritional advice is given by health professionals working in dialysis. We compared the impact of dietary counseling by a renal dietitian, on nutritional status with that by health professionals working in dialysis units in patients undergoing maintenance hemodialysis. Nutritional assessments were made using subjective global assessment (SGA) scale, which combines assessment of intake, physical findings, and functional status. Two hundred and seventy‑seven patients undergoing hemodialysis from two renal care units in Hayatabad Medical Complex Peshawar and Lahore Gernal Hospital Lahore Pakistan, were enrolled (138 patients in control group, 139 in experimental group). In the experimental group, patients were given repeated dietary counseling by a renal dietician, whereas control group patients were provided with the necessary nutritional information by another health professional. Detailed nutritional, biochemical, and SGA assessment were done on all of them at the beginning and completion of study after 6 months. Patients were categorized as well‑nourished (WN) (SGA = 1–14), mild to moderate malnourishment (MMM) (SGA = 15–35), and severe malnutrition (SM) (SGA = 36–49). In the present study, the overall malnutrition rate at baseline was 95.3%, and it dropped down to 91.7% after 6 months after nutritional counseling. In the experimental group, malnutrition status decreased from 97.2% to 89.8%, whereas in the control group, malnutrition situation remained same. Compared to baseline, in the control group, there was no improvement in the WN group. However, a shift has been observed from MMM group to SM group suggesting more number of patients are becoming malnourished. Contrarily, in the experimental group, an improvement of +7.2% in WN group and +14.3% in MMM group and a drop of −21.6% in severe malnourished group suggesting more number of patients gaining nutrition. The present study observed a significant improvement in nutritional status of patients who received counseling by the renal dietician. The reduction in SGA score was independent of reductions in serum creatinine and blood urea levels Keywords : Dietary Counselling, Nutritional Status, Hemodialysis Patients DOI : 10.7176/JMPB/55-16 Publication date :May 31 st 2019

Dietary Counseling by Renal Dietician Improves the Nutritional Status of Hemodialysis Patients.

Proper nutrition may reverse the malnutrition and can modulate renal function in hemodialysis patients. In majority of the dialysis units in India, nutritional advice is given by health professionals working in dialysis. We compared the impact of dietary counseling by a renal dietitian, on nutritional status with that by health professionals working in dialysis units in patients undergoing maintenance hemodialysis. Nutritional assessments were made using subjective global assessment (SGA) scale, which combines assessment of intake, physical findings, and functional status. Two hundred and seventy-seven patients undergoing hemodialysis from two renal care units in Nellore, Andhra Pradesh, South India, were enrolled (138 patients in control group, 139 in experimental group). In the experimental group, patients were given repeated dietary counseling by a renal dietician, whereas control group patients were provided with the necessary nutritional information by another health professional. Detailed nutritional, biochemical, and SGA assessment were done on all of them at the beginning and completion of study after 6 months. Patients were categorized as well-nourished (WN) (SGA = 1–14), mild to moderate malnourishment (MMM) (SGA = 15–35), and severe malnutrition (SM) (SGA = 36–49). In the present study, the overall malnutrition rate at baseline was 95.3%, and it dropped down to 91.7% after 6 months after nutritional counseling. In the experimental group, malnutrition status decreased from 97.2% to 89.8%, whereas in the control group, malnutrition situation remained same. Compared to baseline, in the control group, there was no improvement in the WN group. However, a shift has been observed from MMM group to SM group suggesting more number of patients are becoming malnourished. Contrarily, in the experimental group, an improvement of +7.2% in WN group and +14.3% in MMM group and a drop of −21.6% in severe malnourished group suggesting more number of patients gaining nutrition. The present study observed a significant improvement in nutritional status of patients who received counseling by the renal dietician. The reduction in SGA score was independent of reductions in serum creatinine and blood urea levels.

Relationship between nutritional status and the clinical outcomes of critically ill children

Objective To investigate the nutritional status and the clinical outcome of the critically ill children, and to provide scientific evidence for further clinical nutrition management. Methods Nutritional risk screening was performed on 1 183 critically ill children hospitalized at the Intensive Care Unit (ICU), Children′s Hospital of Nanjing Medical University from October 2016 to October 2017 by using the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), the ICU including of Pediatric Intensive Care Unit (PICU), Surgical Intensive Care Unit (SICU) and Coronary Care Unit (CCU). Median age of the children was (2.6±2.4) years (29 d-12.9 years). Nutritional status was estimated, and scores of anthropometric parameters such as weight-for-age Z-score (WAZ) (<5 years) or body mass index-for-age Z-score (BAZ) (≥5 years)were calculated.The data on incidence of infectious complications, duration of ICU stay and mechanical ventilation, the total hospital expenses and in-hospital mortality were recorded. Results Of the 1 183 cases, 134 children(11.3%) had low nutritional risk, 746 children(63.1%) had moderate nutritional risk and 303 children(25.6%) high nutritional risk.The prevalence of severe malnutrition, moderate malnutrition and mild malnutrition was 8.1% (96/1 183 cases), 8.2% (97/1 183 cases), and 12.8% (151/1 183 cases) respectively.The severe malnutrition group had a higher incidence of high nutritional risk than other groups [74.0%(71/96 cases) vs.67.0%(65/97 cases), 40.4%(61/151 cases), 12.6%(106/839 cases)], and the differe-nce was statistically significant (P<0.001). The incidence of high nutritional risk in the CCU was higher than that than that in the PICU and SICU, and the difference was statistically significant [36.5%(96/263 cases), 23.8%(125/524 cases) and 20.7%(82/396 cases) respectively, P<0.01]. And the incidence of high nutritional risk was higher in infants[37.6%(198/527 cases)] than those in the other age groups[18.4%(52/282 cases), 12.0%(21/175 cases), 16.0%(32/199 cases)], and the difference was statistically significant (χ2=68.90, P<0.000 1). Children with a high nutritional risk had increased incidence of infectious complications [8.6%(26/303 cases) vs.4.7%(35/746 cases), 3.7%(5/134 cases)], incidence of mechanical ventilation[66.0%(200/303 cases) vs.41.4%(309/746 cases), 38.8%(52/134 cases)] and total hospital expenses (￥52 500 vs.￥39 700 and ￥48 700 RMB) compared with those with the moderate or the low nutritional risk, and the differences were statistically significant(all P<0.05). There were 16 deaths and 8 deaths (2.7%) in the high nutrition risk group, which was significantly higher than those in the moderate nutrition risk group [8 cases (1.1%)] and the low nutrition risk group[0 case(0)] (χ2=7.60, P=0.02). Conclusions Moderate or high nutritional risk is seen in the critically ill children, especially in infants and the children with congenital heart disease.Nutritional risk score is correlated with clinical outcomes.Nutritional risk screening and standard nutritional support are recommended so as to improve clinical treatment outcomes. Key words: Nutritional risk screening; Critically ill; Clinical outcome; Child

Preoperative skeletal muscle index vs the controlling nutritional status score: Which is a better objective predictor of long-term survival for gastric cancer patients after radical gastrectomy?

Skeletal muscle index (SMI) and the controlling nutritional status (CONUT) score are useful for evaluating nutritional status, which is closely associated with cancer prognosis. This study compared the prognostic value of these indicators in patients with gastric cancer (GC) after radical gastrectomy (RG). We retrospectively enrolled 532 patients between 2010 and 2011. SMI was measured via CT images to determine low SMI. The CONUT score was calculated based on serum albumin, total lymphocyte count, and cholesterol. Patients were grouped according to SMI and the CONUT score based on previous research. Spearman's correlation coefficient, the Kaplan‐Meier method, and Cox regression were used. There was no significant correlation between SMI and the CONUT score. Five‐year overall survival (OS) and recurrence‐free survival (RFS) in patients with low SMI were significantly worse than those in patients with high SMI (P < .001). The normal nutrition group had better OS and RFS than did the light and moderate or severe malnutrition groups (P < .05), but the OS and RFS were not significantly different between the light and moderate or severe malnutrition groups (P = .726). Univariate analysis showed that SMI and the CONUT score were associated with OS and RFS, but only SMI remained prognostic in multivariate analysis. Preoperative SMI based on CT images is a more objective predictor than the CONUT score of long‐term survival in GC after RG, but this finding must be confirmed by prospective trials.

Comparison of creatinine index and geriatric nutritional risk index for nutritional evaluation of patients with hemodialysis.

Malnutrition is prevalent in hemodialysis (HD) patients, and the risk of mortality is strongly correlated with malnutrition. Current methods of nutritional evaluation are mostly subjective, time-consuming, and cumbersome. Creatinine index (CI) and geriatric nutritional risk index (GNRI) are very simple and objective methods to assess the nutritional status of HD patients. The present study compares the performance of CI and GNRI as nutritional risk assessment tools. Eighty-eight patients with end-stage renal disease on HD were recruited from a single tertiary center. A clinical dietitian carried out individual interviews of all patients and made nutritional diagnosis. Demographic and clinical data were also used to derive GNRI and CI over 4 months. Thirty-eight out of 88 patients (44%) were diagnosed with normal nutritional status. Twenty-two patients (25%) were diagnosed with severe malnutrition and 27 (31%) had moderate malnutrition. Compared with patients with severe malnutrition, the normal group and those with moderate malnutrition showed significantly higher levels of body mass index and GNRI. Even though GNRI was associated with CI, protein intake, uric acid, and normalized protein nitrogen were not significantly correlated with GNRI, whereas the markers were highly associated with CI (P = 0.000). GNRI enable the identification of the severe malnutrition group but not the normal and moderate-malnutrition groups. However, based on CI, the normal group was distinguished while those with severe and moderate malnutrition were not. Either CI or GNRI was a valid tool for longitudinal observation of nutritional status of patients on chronic HD and facilitated the screening of cases with malnutrition. Compared with GNRI, CI ranked higher in performance for the assessment and monitoring of nutritional status in HD patients.

Assessing nutritional status of severe malnutrition patients by bioelectrical impedance technique: a multicenter prospective study

To assess the nutritional status of severe malnutrition patients with anorexia nervosa by multi-frequency bioelectrical impedance technique, and to provide the basis for nutritional support therapy. A prospective study was conducted. Twenty-six severe malnutrition patients with anorexia nervosa, body mass index (BMI) ≤ 16 kg/m2 admitted to intensive care unit (ICU) of Peking University Third Hospital and general three ward of Peking University Sixth Hospital from June 1st to September 30th, 2017 were enrolled. The extracellular water (ECW), intracellular water (ICW), ECW/ICW ratio, adipose tissue mass (ATM), lean tissue mass (LTM), total body water/body weight (TBW/WT), ATM/WT, and LTM/WT were measured by multi-frequency bioelectrical impedance meter. Thirty-eighty healthy volunteers with normal nutritional status (23.0 kg/m2 > BMI > 18.5 kg/m2) matched by gender and height were enrolled as healthy control group. The predictive value of main body composition for nutritional status were analyzed by receiver operating characteristic (ROC) curve. All the patients were female. There was no significant difference in height between two groups, but WT and BMI in the severe malnutrition group were significantly higher than those in the healthy control group [WT (kg): 38.1±4.9 vs. 54.2±3.3, BMI (kg/m2): 13.6±2.5 vs. 21.2±1.1, both P < 0.01]. Compared with the healthy control group, the ECW, ICW, ATM, LTM, ATM/WT and LTM/WT were significantly decreased in the severe malnutrition group [ECW (L): 9.02±0.42 vs. 10.19±0.77, ICW (L): 12.6±0.9 vs.19.1±1.3, ATM (kg): 9.3±1.1 vs. 16.6±1.9, LTM (kg): 16.5±1.5 vs. 26.1±1.7, ATM/WT: 0.26±0.02 vs. 0.30±0.02, LTM/WT: 0.22±0.02 vs. 0.26±0.01, all P < 0.01], the ECW/ICW and TBW/WT were significantly increased in the severe malnutrition group (ECW/ICW: 0.72±0.06 vs. 0.54±0.06, TBW/WT: 0.58±0.02 vs. 0.52±0.02, both P < 0.01). It was shown by ROC curve analysis that the area under ROC curve (AUC) of TBW/WT, ATM/WT, LTM/WT for evaluating severe malnutrition were 0.999, 0.919, 0.954 respectively; when the cut-off of TBW/WT, ATM/WT, LTM/WT were 0.58, 0.28, 0.24 respectively, the sensitivity were 100%, 85%, 80% respectively, and the specificity were 95%, 80%, 91% respectively. Main body composition of severe malnutrition patients with anorexia nervosa changed significantly. Bioelectrical impedance technology can be an effective assessment tool for the nutritional status of such patients.

The Prognostic Impact of Controlling Nutritional Status (CONUT) in Intrahepatic Cholangiocarcinoma Following Curative Hepatectomy: A Retrospective Single Institution Study.

Several studies have examined controlling nutritional status (CONUT), which is one of the useful biomarkers for predicting patients' prognosis following cancer treatment. The aim of this study was to evaluate the value of CONUT as a postoperative prognostic marker in patients with intrahepatic cholangiocarcinoma (ICC) following curative hepatectomy. We retrospectively analyzed 71 patients who underwent curative hepatectomy for ICC between May 2002 and November 2016. Patients were divided into two groups according to their preoperative CONUT score (i.e., CONUT≧2 or CONUT<2). The number of patients assigned to the normal, mild, moderate, or severe malnutrition groups was 40, 28, two, and one, respectively. The high CONUT group (CONUT≧2) consisted of 31 patients (43.7%) and had a poor prognosis with regard to overall survival (OS) (p=0.0149). A high CONUT score is also identified as one of the independent predictors of poor prognosis in OS (hazard ratio 3.02; 95% confidence interval 1.4-6.8; p=0.007). However, in the current study, a high CONUT score was not associated with postoperative complications (Clavien-Dindo classification≧III or more). CONUT may be useful for the preoperative assessment of prognosis in patients with ICC who have undergone curative hepatectomy.

Cysteine, Malondyaldehide (MDA) and Glutathione (GSH) Levels in Marasmic Type Malnutrition

Micronutrien deficiency in severe malnutrition will reduce antioxidant capacity that needed for oxidative stress defense. Cysteine, a non-essential amino acid, is one of an important component for reduced glutha-tione (GSH). This study aims to prove the difference between the levels of cysteine, MDA and GSH levels in children with marasmic malnutrition and well-nourished children and prove whether there is a relationship between those parameters. Fiftysix patients participated in this study were grouped into two groups of sam-ples that were marasmic type malnutrition group (28 patients) and control groups that were well nourished group (28 patients). Examination begins with a complete laboratory screening, followed by examination of cysteine, MDA and GSH level. Of the 28 patients included in marasmic type malnutrition group consisting of 15 male patients (53.6%) and 13 female patients (46.4%), while the well-nourished group consisted of 13 male patients (46.4%) and 15 female patients (53.6%). The average age is 54.61±56.35 months in the group of ma-rasmic type malnutrition and 48.25±45.34 months in the well-nourished group. By using the Mann Whitney test, there were significant difference between the levels of cysteine and GSH in marasmic malnutrition and control group (p = 0.000 and p = 0.000 respectively). Spearman correlation test between cysteine and GSH levels, cysteine and MDA levels, MDA and GSH levels in marasmic malnutrition children shows no significant correlation (R = -0.206, p = 0.294; R = -0.036, p = 0.856; R = 0.210, p = 0.284 respectively). In well-nourished group Spearman correlation test between cysteine and GSH levels, cysteine and MDA levels, MDA and GSH levels also shows no significant correlation (R = -0.053, p=0.789; R = -0.146, p = 0.458; R = -0.079, p = 0.688 re-spectively). From this study it can be concluded that there are significant differences of the levels of cysteine and GSH between severe malnutrition groups compared with the control one. But this study shows no signif-icant correlation between the levels of cysteine and GSH levels in marasmic type malnutrition and well-nourished children.

Preoperative Nutritional Assessment by Controlling Nutritional Status (CONUT) is Useful to estimate Postoperative Morbidity After Esophagectomy for Esophageal Cancer

A nutritional indicator suitable for predicting complications after esophagectomy has not been confirmed. The nutritional screening tool CONUT is a potential candidate. We retrospectively analyzed 352 patients who underwent elective esophagectomy with lymphadenectomy for esophageal cancer between April 2005 and December 2014. Patients were divided into three groups according to the malnutrition degree in controlling nutritional status (CONUT): normal, light malnutrition, moderate or severe malnutrition. The numbers of patients assigned to the normal, light malnutrition, and moderate or severe malnutrition groups were 205, 126, and 21, respectively. One hundred forty-seven (41.8%) patients were considered malnourished. Patients with moderate or severe malnutrition had a significantly high incidence of any morbidity, severe morbidities, and surgical site infection. Hospital stay in patients with moderate or severe malnutrition was significantly longer. Logistic regression analysis suggested that moderate or severe malnutrition was an independent risk factor for any morbidity [hazard ratio (HR) 2.75, 95% confidence interval (CI) 1.081-7.020; p=0.034] and severe morbidities (HR 3.07, 95% CI 1.002-9.432; p=0.049). CONUT was a convenient and useful tool to assess nutritional status before esophagectomy. Patients with moderate or severe malnutrition according to CONUT are at high risk for postoperative complications.

Effects of pre-existing undernutrition on treatment-related complications and treatment outcomes in children with acute lymphoblastic leukemia: A tertiary care center experience

Background: Our study aimed to assess the influence of undernutrition on treatment tolerance, treatment-related complications, and treatment outcomes in acute lymphoblastic leucomia (ALL) patients during induction and maintenance phase of chemotherapy and subsequent follow-up visits. Materials and Methods: This retrospective, cohort study was conducted between January 2005 and September 2012 in the Departments of Pediatrics and Radiation Oncology in a tertiary care Medical College and Hospital of Eastern India. Using weight-for-age Z scores (WHO), we divided the 159 ALL patients into 4 groups: Group 1 without malnutrition, Group 2 with mild undernutrition, Group 3 with moderate undernutrition, and Group 4 with severe malnutrition. Data regarding blood counts, hematological support, bone marrow remission status and complications during treatment, and follow-up records were analyzed and compared to find out the impact of undernutrition on treatment tolerance and outcomes in different groups. Results: During the intensive phase of chemotherapy treatment, tolerance was assessed by the nadir of absolute neutrophil count and hemoglobin which fell significantly in moderate and severe malnutrition group. Significantly, more packed red blood cell support and platelet transfusions were required by those two groups P < 0.002 and P < 0.001, respectively. The incidence of febrile neutropenia was significantly more in severe malnutrition group (P < 0.001). Ninety-eight (61.63%) patients could not complete chemotherapy within the specified 145-day period of which 23 (76.67%) patients was of severe malnutrition group (P < 0.002). Remission after induction has shown declining trend with more undernutrition. A total of 24 patients relapsed in spite of bone marrow remission which was proportionately more from moderate and severe malnutrition group. During the 5-year follow-up, 20 patients died which was proportionately more in Group 3. Conclusion: Undernutrition adversely affect the final outcome, treatment tolerance, and treatment complications in children with ALL. So, baseline malnutrition should be considered as an important prognostic factor in therapeutic decision of ALL.

EVALUATION OF NUTRITIONAL ASSESSMENT IN ELDER PATIENTS WITH CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: COMPARING THE MINI NUTRITIONAL ASSESSMENT (MNA) WITH THE SUBJECT GLOBAL ASSESSMENT (SGA)

The DOQI 2000 recommends the subjective global assessment(SGA)for the nutritional evaluation in patient with continuous ambulatory peritoneal dialysis(CAPD). In 1990s, the mini nutritional assessment (MNA)has been used successfully in the evaluation of the nutrition status in the flail elder person. Is it more suitable for MNA than SGA in assessment the nutrition of elder CAPD patient? In this study, we compared the MNA method with the traditional SGA in the evaluating the nutritional status in elder CAPD patients. We used the cross-sectional study with selection of the patient. Forty-five elder CAPD patients 21 male and 24 female with more than 60 years old, were enrolled in this study. SGA and MN questionnaire, anthropometric parameters and laboratory test were investigated in those patients. The normalized protein equivalent of total nitrogen appearance (nPNA) was calculated. The result were: 1)These patients were classified into three nutritional classes according to the SGA (i.e. normal nutrition SGA considered as A, mild to moderate malnutrition SGA as B, and severe malnutrition SGA as C). The corresponding, classification according to the MNA was normal nutrition(MNAl), at risk of malnutrition(MNA2), and severe malnutrition(MNA 3). In the SGA classification, 49% were assessed as A, 31% in B and 20% in C, while the corresponding figures in MNA Was 40% in MNA 1, 38% in MNA 2 and 22% in MNA 3. Either in SGA or in MNA assessment . the dietary protein intake (DPI), dietary energy intake (DEI), serum albumin(Alb), nPNA, months On CAPD, residual renal function(RRF), and the adequacy indices(Kt/v, Ccr) were significantly different among three groups(P 0.05). Only in severe malnutrition group, both in SGA and MNA, the abnormal rates of all measures were above 80% for DEI or DPI and Alb, except for Prealbumin. 2) There were no significant differences between the classes, irrespective of methods. The kappa test, was used to compare the result of two methods, and the kappa value was 0.545 5(P