Severity Of Malnutrition In Patients Research Articles

Evaluation of Hand Grip Strength Test: As a Reliable, reproducible, Costeffective Tool to Assess the Nutritional Status and Outcomes of Cirrhotic Patients Awaiting Liver Transplant

Abstract Background Malnutrition is common comorbidity in patients with cirrhosis. Its prognostic value is indisputable as it greatly affects the evolution of liver disease. It has a major impact on both morbidity and mortality before and after liver-transplantation. Being now integrated in the definition of malnutrition and recognized as new entity in the international classification of disease, physicians have taken great interest in sarcopenia. Its negative impact on survival of cirrhotic patients is well demonstrated, particularly those on wait-list of liver-transplantation (LT). Aim of the Work The aim of this study is twofold; first, to assess the effect of malnutrition on mortality in patients awaiting Liver transplantation and, second, to evaluate hand grip strength HGS as a reliable, non-invasive, and inexpensive tool that can be used in routine clinical practice for early diagnosis and stratification of severity of malnutrition in patients awaiting Liver transplantation. Patients and Methods This is a prospective observational study, which was conducted at Ain- Shams specialized Hospital, liver transplantation department. The study was conducted after obtaining institutional ethics committee approval. Nutritional status assessment will be made by dominant hand grip strength (HGS) and all patients undergo a detailed nutrition assessment by a qualified Clinical Dietitian and nutritional intervention was recommended based on severity of malnutrition. Disease severity was classified according to the criteria proposed by Child-Pugh and the Model for End stage Liver Disease (CTP and MELD). The scores were noted during liver transplantation evaluation. Results We found in this study that 15 of the 29 included patients (51.7%) were 50-65 years old and 21 were males (72%) and 8 were females (27.6%). Six of the included patients were diagnosed as cryptogenic cirrhosis (21%) while 18 were diagnosed as post0viral cirrhosis (62%). Malnutrition was diagnosed in 25 out of the 29 included patients (86.2%) and only 4 patients were well- nourished (13.9) by SGA. In all included patients HGS was reduced and mean HGS was (21.9 ± 3.85 Kg), reflecting sarcopenia (reduced muscle strength). There was also reduction in MAMC (mean 18.7 ± 4.12 cm) with correlation between MAMC and HGS reflecting reduction in muscle mass and strength. Conclusion Malnutrition as assessed by SGA is very frequent in cirrhotic patients on wait-list for liver transplantation. This malnutrition in negatively affecting survival and should be managed by intensive nutritional intervention to improve post-transplant survival. HGS is reduced in most cirrhotic patients waiting for LT, this can worsen the prognosis independent of other confounders and should be assessed as predicted in all cirrhotic patients. HGS by dynamometer is a simple, cost effective and reasonably reliable to be used as screening tool to diagnose sarcopenia in patients with ESLD and can be followed by more confirmatory methods if needed as CT on Lumber 3 and determination of LMI (Lumber mass index)

Association of Malnutrition Diagnosed Using Global Leadership Initiative on Malnutrition Criteria with Severe Postoperative Complications After Gastrectomy in Patients with Gastric Cancer.

Background: The purpose of this study was to investigate the relationship between malnutrition assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the occurrence of severe postoperative complications (SPCs) after gastrectomy in patients with gastric cancer. Methods: A total of 220 patients with gastric cancer were included in this retrospective study. According to the GLIM criteria, the first step was to use the Nutrition Risk Screening Score 2002 to conduct nutritional risk screening for patients and the second step was to diagnose and grade the severity of malnutrition in patients at risk of malnutrition. According to the Clavien-Dindo classification system, SPCs were defined as C-D Grade IIIa or higher. Results: Overall, 66 (30.0%) patients were diagnosed with malnutrition, including 32 (14.5%) with moderate malnutrition and 34 (15.5%) with severe malnutrition. The incidence of SPCs was 14.5%, and the most frequent postoperative event was anastomotic leakage. In the multivariate regression analysis, malnutrition was considered an independent risk factor for SPCs (P < .001). After adjusting for various factors, the grading association remained statistically significant. Compared with patients with normal nutrition, patients with moderate and severe malnutrition have a nearly 15-fold (OR = 15.682, 95% CI: 4.481-54.877, P < .001) and 20-fold (OR = 20.554, 95% CI: 5.771-73.202, P < .001) increased risk of developing SPCs, respectively. Conclusions: Malnutrition assessed by GLIM was an independent risk factor for SPCs in gastric cancer patients. Therefore, early identification of malnourished patients is crucial for timely implementation of nutritional treatment and reducing the occurrence of postoperative complications.

Nutritional Assessment Using Modified SGA Score and Its Correlation with Biochemical Profile Among Maintenance Hemodialysis Patients: A Cross Sectional Study at Multiple Hemodialysis Centers in Dhaka

Patients on maintenance hemodialysis are vulnerable to multitude of health-related issues, malnutrition being one ofthem. It is a key predictive factor for morbidity and mortality among patients on maintenance hemodialysis. Theprimary objective of the study was to assess the severity of malnutrition in patients undergoing maintenancehemodialysis, using modified subjective global assessment score and correlate it with biochemical parameters likeblood hemoglobin, serum creatinine, serum albumin, serum pre-albumin, serum triglyceride and serum totalcholesterol. Cross-sectional study from July 2016 to June 2017 was conducted at hemodialysis unit of SSMC &amp; MH,BSMMU, BIRDEM hospital and NIKDU, Dhaka, among 80 maintenance hemodialysis patients. Adult patients overthe age of 18 years and on regular (&gt;_2 sessions per week) hemodialysis for more than 3 months without any acuteinfection were enrolled. Nutritional status of the patients was evaluated using modified subjective global assessmentscore and compared with biochemical parameters for any correlation between them. Based on the modified SGAscores, of the 80 patients, 10% were well nourished and the rest were mildly malnourished, showing a high degree ofmalnutrition among respondents. There was strong positive correlation between modified subjective globalassessment score and age. Modified SGA score also showed statistically significant negative correlation with serumcreatinine, serum albumin and serum pre-albumin. Data obtained from this study confirm that modified subjectiveglobal assessment score can be used as a reliable index for identifying patients at risk for malnutrition and itcorrelates well with some of the biochemical profile. Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):14-19

Characteristics of malnutrition according to Global Leadership Initiative on Malnutrition criteria in non-surgical patients with inflammatory bowel disease

Objective: Malnutrition is common in patients with inflammatory bowel disease (IBD). The Global Leadership Initiative on Malnutrition (GLIM) was proposed to assess the severity and characteristics of malnutrition. Thus, we aimed to use the latest consensus on the diagnosis of malnutrition, GLIM criteria, to evaluate malnutrition in patients with IBD.Methods: We performed a retrospective cohort study of 73 adult patients with IBD (48 with Crohn disease and 25 with ulcerative colitis). Demographic data, clinical characteristics, and nutrition status defined by Nutritional Risk Screening (NRS) 2002 and GLIM criteria were recorded at enrollment.Results: According to the GLIM criteria, 43 (58.90%) patients were identified with malnutrition, and the incidence of mild to moderate malnutrition and severe malnutrition was 28.77% (21 of 73 patients) and 30.14% (22 of 73 patients), respectively. The severity of malnutrition in patients with IBD increased with the cumulative number of phenotypic criteria they met (P < 0.01). The difference in the number of etiologic indicators was only identified between patients with severe malnutrition and those without malnutrition (P < 0.05). Patients with Crohns disease had a significantly higher rate of muscle mass loss than patients with ulcerative colitis (P = 0.038) but a lower incidence of reduced food intake or assimilation (P = 0.039).Conclusion: The prevalence of malnutrition according to the GLIM criteria was high in non-surgical patients with IBD, and as the degree of malnutrition worsened, more phenotypes and etiologic types appeared. The phenotypic and etiologic characteristics of GLIM were different in patients with Crohn disease than in those with ulcerative colitis.

Diagnosis of malnutrition in patients with intestinal insufficiency or failure using GLIM-criteria

Rationale: Due to lack of global consensus in diagnosing malnutrition (MN), Global Leadership Initiative on Malnutrition has suggested the GLIM-criteria based on etiological and phenotypical criteria. The aim of this study was to investigate the frequency and severity of MN in patients with intestinal insufficiency (INS) or failure (IF) and to validate GLIM-criteria

The Effect of Using Nutritional Guideline by Nurses on the Incidence and Severity of Malnutrition in Patients Admitted to the Intensive Care Units

Background: Malnutrition is still one of the most important and common problems in hospitals and increases the incidence, side effects, and mortality in hospitalized patients. In this regard, the Intensive Care Unit (ICU) patients are more at risk due to critical conditions. Objectives: The aim of this study was to determine the effect of nurses’ nutritional guidelines on the severity of malnutrition in ICU patients. Methods: This single-blind clinical trial was conducted on 70 patients hospitalized in the ICU of Golestan and Imam Khomeini hospitals in Ahwaz in 2012. Available patients were randomly divided into the control and intervention groups. The data collection tool was a checklist of demographic data and the Maastricht index for malnutrition assessment. Patients were evaluated based on the Maastricht index at baseline and 10 days after feeding. Results: There was no significant difference between the two groups in terms of demographic variables. Mean and standard deviation of albumin, pre-albumin, and lymphocyte parameters before the intervention were 3.13 ± 0.571, 1.28 ± 0.31, 1638.2 ± 489.59, whereas, after the intervention, they were 536 3.32 ± 3.88, 1.88 ± 0.36, 2195 ± 40.85, respectively. Also, the amount of malnutrition intensity by the Maastricht formula before and after the intervention was 4.89 ± 2.17 and 2.00 ± 2.10, at a significance level of 0.001. Regarding the normal distribution of data, using the T-test, two groups showed significant differences (P = 0.001). Conclusions: The prevalence of malnutrition is high in patients admitted to the ICUs, which is mainly due to inappropriate nutrition of patients in these sectors. Although nurses play a significant role in feeding patients, their knowledge in this field is less than needed. According to the results of this study, the use of the guideline by nurses reduced the severity of malnutrition. Therefore, it is essential to create the necessary backgrounds for increasing the knowledge of this group of treatment staff and to educate valid nutrition guides for them to improve the nutritional status, and subsequently accelerate the treatment process of the patients.

Nutritional Status in Non-Syndromic Cyanotic Congenital Heart Diseases Patients: A Single Tertiary Center Study in Iran

Background: Patients with congenital heart disease (CHD) are susceptible to mild malnutrition up to failure to thrive. The prevalence of malnutrition among patients with CHD is higher in developing countries. Many factors are considered to affect the nutritional status such as cyanosis. Objectives: This study aims to assess the prevalence and severity of malnutrition in patients with CHD prior to the surgical corrective or palliative repair. Methods: This study was performed by reviewing inpatient medical records and cardiac surgery databases of children with cyanotic CHD who underwent palliative or corrective surgery between March 2011 and March 2017. Patients’ age and height at the time of surgery, birth weight, duration of intensive care unit (ICU) stay and 30-day mortality were extracted and weight for age z score (WAZ), weight for length z score (WLZ) and length for age z score (LAZ) were calculated. Z scores above -1 were considered as normal, between -1 and -2 as mild, between -2 and -3 as moderate and below -3 as severe malnutrition. Results: In a total number of 639, the average age, weight and height were 16.688 ± 24.859 months, 7.509 ± 5.629 kilograms and 73.759 ± 95.869 centimeters, respectively. The average length of ICU stay was 8.36 ± 6.254 days and the 30-day mortality was 36 (5.7%). The average WAZ, LAZ, WLZ and BMI Z was -1.5 ± 1.69, -0.9 ± 2.38, -1.2 ± 3.97 and -1.4 ± 2.11, respectively. Regarding WAZ, LAZ, WLZ and BMI Z, 62.2%, 46.1%, 72.3% and 70.9% of patients had mild to severe forms of malnutrition, since the rate of malnutrition based on WAZ (P = 0.001), LAZ (P < 0.0001), WLZ (P < 0.0001) and BMI Z (P = 0.007), was significantly higher than normal subjects. Conclusions: The prevalence of mild to severe forms of malnutrition, based on different growth indices, for both cyanotics and acyanotics are higher than those reported in the other previous studies. These findings reflect the fact that cultural, genetic and racial differences of Iranians compared to others, cause malnutrition to be more frequent in Iranian CHD children. This calls for higher requirement of nutritional support for these patients.

Hand grip strength: A reliable, reproducible, cost-effective tool to assess the nutritional status and outcomes of cirrhotics awaiting liver transplant

Summary Background & aim Malnutrition (MN) in patients with cirrhosis awaiting liver transplant (LTx) has been shown to be an important determinant of outcomes. Hence there is an impetus on early diagnosis and stratification to guide goal directed nutritional intervention. The aim of this study was twofold; first, to assess the effect of MN on mortality in patients awaiting LTx and, second, to evaluate HGS as a reliable, non-invasive, and inexpensive tool that can be used in routine clinical practice for early diagnosis and stratification of severity of malnutrition in patients awaiting LTx. Methods Adults evaluated for LTx and accepted as suitable candidates were enrolled on a waiting list at a single centre between May 2014 and February 2016 and were prospectively included. Nutritional status was assessed by Subjective Global Assessment (SGA), anthropometry, and dominant hand grip strength (HGS). Statistical analysis was performed using Pearson correlation, t-test, and Receiver Operating Characteristic (ROC curve) in SPSS version 16.0. Results One hundred eighty patients (81% male) aged 51.6 ± 10 years, (Child's C 70.6%, B 26.1%, A 3.3%) were included and followed up till LTx or end of study. Eighty seven patients (48%) who underwent LTx were excluded from the final analysis. Of the 93 patients on the waiting list, 46 (49%) were alive and revealed a high (88%) incidence of MN as assessed by SGA. There was a significant increase in MN with increasing Model End stage Liver Disease (MELD) and Child score, and decreasing HGS (p Conclusions HGS is a reliable, non invasive and cost-effective tool to identify MN in cirrhotic patients. Low HGS (≤19.5 kg) was a strong predictor of mortality in wait-listed patients and indicated a 7.8 times higher mortality than HGS >19.5 kg. The cut-off of HGS to stratify severity of MN and guide goal directed nutrition intervention was lower in our patient population than recommended by normative standards and likely represents the standard for the Indian population with ESLD.

Nutritional status in patients with chronic pancreatitis

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas, accompanied by damage to the functioning parenchyma and ducts to develop irreversible structural changes (fibrosis, calcification) and irreparable loss of the endocrine and exocrine functions of this organ. Maldigestion is a typical outcome of CP of any etiology with a long-term history. Fat malabsorption is considered as a basis for malnutrition in patients with CP. The severity of malnutrition in patients with CP correlates with three major pathogenetic factors: primary nutrient deficiency, pancreatic maldigestion and secondary malabsorption syndrome (nutrient loss), hypermetabolism that is caused by an inflammatory process in the pancreas and that determines the severity of the disease. Malnutrition in patients with CP is not just a complication of this disease, but has an important impact on its course. Patients with severe malnutrition are noted to have the significantly lower activity of pancreatic enzymes in the duodenal contents, feces, and blood, which is correlated with the smaller blood amount of total protein and albumin.

Determining the frequency and severity of malnutrition and correlating it with the severity of liver cirrhosis

Malnutrition is a significant problem in cirrhosis of the liver worldwide. Inadequate data is available on the nutritional status of Pakistani patients. This study aimed to determine the frequency and severity of malnutrition in patients having cirrhosis of the liver and to compare the degree of malnutrition with the severity of liver disease. Two hundred ninety-eight patients with liver cirrhosis were included in the study. Nutritional status was assessed using the Royal Free Hospital Global Assessment scheme for cirrhotics. The patients were categorized into well-nourished, and mild to moderately and severely malnourished. Various degrees of malnutrition were compared with severity of disease according to Child-Pugh staging. In the 298 patients with liver cirrhosis, hepatitis C (54,36%) and B (35,90%) were the commonest aetiologies, followed by autoimmune hepatitis (3,35%), primary billiary cirrhosis (2,34%), Wilson's disease (1,34%), haemochromatosis (1,0%), cryptogenic cirrhosis (1,0%), and alcohol being the rare cause (0,67%). 14,42% patients were well-nourished, (54,02%) were mildto moderately malnourished and (31,54%) were severely malnourished. Malnutrition is more frequent in virus-related cirrhosis, and the degree of malnutrition increases with increasing clinical severity as assessed by Child- Pugh stages with statistically significant p-value of 0.001. Moderate to severe malnutrition among diverse aetiologies of cirrhosis is quite common in Pakistan. The degree of malnutrition increases with increasing clinical severity of cirrhosis of liver.

Serum myostatin levels and malnutrition in patients with chronic obstructive pulmonary disease

To investigate the prevalence and severity of malnutrition in patients with stable chronic obstructive pulmonary disease (COPD), analyze serum levels of myostatin, tumor necrosis factor alpha (TNFα) and C reactive protein (CRP), and investigate the relationship between serum myostatin and malnutrition in COPD. Seventy-one patients with stable COPD and 60 age-matched healthy volunteers were recruited in this study. Pulmonary function was tested in all of the subjects and the severity of malnutrition was evaluated by a multiple-parameter malnutritional index (MNI). Based on the MNI scores, patients with COPD were divided into group I (MNI ≥ 5 score) and group II (MNI < 5 score), the former represents the patients with severe or very severe malnutrition while the latter represents the patients with mild or without malnutrition. Serum concentration of myostatin, TNFα and CRP were measured by enzyme-linked immunosorbent assay. The MNI score was significantly elevated in patients with COPD [(7.75 ± 3.86) score] compared with the controls [(1.13 ± 0.96) score; P < 0.001], and 55 patients (77%) in COPD group I showed MNI ≥ 5 (9.30 ± 3.01) score. Serum myostatin concentration was significantly elevated in COPD group I [(12.18 ± 4.76) µg/L] than in COPD group II [(9.73 ± 2.85) µg/L] and controls [(7.93 ± 2.35) µg/L], with each P < 0.001. Serum TNFα concentration was also significantly elevated in patients with COPD compared with the controls (P < 0.001). Pearson correlation analysis showed that serum myostatin levels were significantly correlated with MNI scores (r = 0.438, P = 0.000) and TNFα levels (r = 0.234, P = 0.041) in COPD group (combined group I and II) while MNI scores were correlated inversely with BMI in COPD group (r = -0.530, P = 0.000). After stratified with subgroups, the correlation between myostatin levels and MNI scores was more significant and the correlation coefficient was higher (r = 0.464, P = 0.000) in COPD group I patients. Moreover, myostatin levels were inversely correlated with BMI (r = -0.287, P = 0.034) and forced expiratory volume in one second of the predicted value (r = -0.264, P = 0.049) in COPD group I patients. Malnutrition commonly and substantially exists in patients with COPD; serum myostatin concentration is significantly elevated and is correlated with the severity of malnutrition in the patients. The elevation of serum myostatin may contribute to malnutrition in COPD patients.

Prediction of malnutrition using modified subjective global assessment-dialysis malnutrition score in patients on hemodialysis

Malnutrition is widely prevalent among patients on hemodialysis. Malnutrition can be estimated using a fully quantitative scoring system Subjective Global Assessment-Dialysis Malnutrition Score which is simple, reliable and dynamic. The primary objective of the study was to assess the severity of malnutrition in patients with end stage renal disease and undergoing hemodialysis in a tertiary care teaching hospital in Chennai, using Subjective Global Asses sment-Dialysis Malnutrition Score and correlate it with standard indicators of malnutrition like anthropometric and biochemical parameters of the study population by Pearson's correlation. Anthropometric assessment included height, body weight, triceps skin fold thickness, mid arm circumference, mid arm muscle circumference % and biochemical parameters included serum albumin, transferrin, ferritin, total protein, total cholesterol, blood urea nitrogen and creatinine. Based on the scores, of the 66 patients, 91% were moderately malnourished. There was a significant negative correlation between modified Subjective Global Assessment-Dialysis Malnutrition Score and anthropometric measures such as triceps skin fold thickness, mid arm circumference, mid arm muscle circumference; biochemical markers such as albumin, transferrin and ferritin. The data obtained from this study confirm that a high degree of malnutrition was prevalent in patients on hemodialysis, as shown by anthropometric assessment, biochemical markers of malnutrition and Subjective Global Assessment-Dialysis Malnutrition Score. Nutritional status as determined by Subjective Global Assessment-Dialysis Malnutrition Score is a useful and reliable index for identifying patients at risk for malnutrition and it correlates well with anthropometric and biochemical assessment. may be integrated in regular assessment of malnutrition in patients on maintenance hemodialysis.

Cholesterol metabolism in patients with diabetes mellitus type 1 and the impact of weight reduction

Cholesterol metabolism in patients with diabetes mellitus type 1 and the impact of weight reduction

Comparison of three methods of nutritional assessment in liver cirrhosis: subjective global assessment, traditional nutritional parameters, and body composition analysis

Liver cirrhosis affects the results of many of the traditional techniques currently used to evaluate nutritional status. Our aim was to compare the traditional two-compartment model (subjective global assessment and anthropometry and blood tests) of nutritional assessment with a multicompartmental model (body composition analysis) in patients with cirrhosis. Seventy-nine patients and 17 control subjects were studied. Subjective global assessment, anthropometry and blood tests, and body composition analysis were performed for each. The two most important compartments were body cell mass and total body fat. The subjects were classified by each method as well nourished or moderately or severely malnourished. Twenty-five patients (31.6%) were malnourished according to the subjective global assessment, 2 (6.3%) with Child's class A cirrhosis, 10 (34.5%) with class B, and 13 (72.2%) with class C, whereas 24 (30.4%) were malnourished according to the traditional model, 5 (15.6%) in the Child's A group, 8 (27.6%) in B, and 11 (61.1%) in C. According to the multicompartmental model, 48 patients (60.1%) were malnourished, 11 (34.4%) in Child's A, 20 (69%) in B, and 17 (94.4%) in C. The use of the multicompartmental model increased the prevalence of malnutrition by more than 60% in Child's classes A and B patients and by more than 20% in Child's class C patients. Traditional nutritional assessment, although easier, underestimated the prevalence and severity of malnutrition in patients with cirrhosis. The underestimation was more pronounced in Child's class A and B patients.