SGA Scores Research Articles

Evaluation of five nutritional scores as predictors of postoperative outcome following pancreatic resection: A prospective, single-center study

Background and aimsPatients undergoing pancreatic resection are commonly malnourished. It is still unclear whether nutritional scores reliably predict postoperative outcomes after pancreatic resection. This study evaluated whether five commonly used preoperative nutritional screening scores predicted severe complications and length of stay. MethodsPatients scheduled for pancreatic resection (pancreatoduodenectomy, distal and total pancreatectomy) at a national referral center for pancreatic surgery from September 2022 to June 2023 were prospectively screened for malnutrition with MNA, MUST, SGA, SNAQ, and NRS2002 scores. Postoperative complications were classified using the Clavien-Dindo classification. #NCT05608538. ResultsThree hundred patients were enrolled, including 168 pancreatoduodenectomies (56%), 102 distal pancreatectomies (34%), and 30 total pancreatectomies (10%). Final pathology revealed malignancy in 203 cases (67.7%). When applying the scores, the proportion of patients malnourished or at risk of malnutrition ranged from 21.7% for SGA to 79.3% for NRS2002. After adjusting for selected confounders, only an MNA <17 was associated with severe postoperative complications (OR 8.39, 95%CI[1.95 – 32.31], p=0.01). MNA, SGA, and SNAQ predicted the length of stay (all p<0.01), while MNA and SGA also correlated with a higher probability of having a greater heterogeneity in the length of stay (p=0.04 and 0.002, respectively). DiscussionWe promote using MNA to detect malnourished patients at risk of severe postoperative complications and longer hospitalization after pancreatic surgery. SGA and SNAQ may also have value in predicting patients who will be hospitalized longer. More prospective studies will be needed to corroborate these findings.

Screening and assessment of nutritional status and some related factors in patients who have laparoscopic surgery for colon cancer

Background: Preoperative malnutrition is a significant problem for cancer and colon cancer patients, so screening, monitoring, and supporting this condition becomes increasingly essential in the surgical field. In colorectal cancer, malnutrition is significantly associated with several consequences, including mortality and increasing the length of hospital stay after surgery. The NRS 2002 and SGA scores are practical malnutrition assessment tools widely used in clinical practice today. Materials and methods: A cross-sectional descriptive study was performed on 53 patients undergoing laparoscopic surgery due to colon cancer at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital. The NRS-2002 tool was used for risk screening, and the SGA was used to assess the patient’s nutritional status. Information about the disease and related factors are referenced from medical records combined with asking the patient. Results: The average age was 61.5±14.5, of which 50.9% were male. ASA 1 accounted for the majority at 66.0%. Complications of surgical site infection accounted for 11.3%. Two patients with subcutaneous emphysema accounted for 3.8%, and one with urinary retention accounted for 1.9% were treated with conservative treatment. One patient had early postoperative small bowel obstruction due to abdominal drainage and was successfully treated medically, accounting for 1.9%. There were no major complications requiring reoperation and short-term mortality. The average hospital stay was 7.4 ± 2.1 days. According to the 2002 NRS score, there were 19 (35.8%) cases of nutritional at-risk; the SGA rating had 1.9% SGA-C and 15.1% SGA-B cases. There was a relationship between NRS-2002 and the patient’s blood albumin concentration. Conclusion: The prevalence of patients at nutritional risk and malnutrition is quite common. It is necessary to carry out routine screening and nutritional risk assessment to support colon cancer treatment. Key words: malnutrition, colorectal cancer, NRS 2002, SGA score.

Impact of Oral Nutritional Supplementation in Chronic Kidney Disease Patients on Maintenance Hemodialysis: An Open-label, Single-arm Study among Indian Patients.

Protein-energy wasting (PEW) affects about 50-75% of patients with chronic kidney disease (CKD), particularly those who are on maintenance hemodialysis (MHD). This study evaluated the efficacy and tolerability of an oral nutritional supplement in Indian patients receiving MHD. This was a 3-month, prospective, open-label, and single-centered study. Eligible participants supplemented their regular diet with one sachet (40 gm) of oral nutritional supplement powder twice daily for 90 days. The study efficacy endpoints were mean change in acute phase proteins (albumin and prealbumin), anthropometric measurements [weight, body mass index (BMI), and triceps skin fold thickness], handgrip strength, hemoglobin, total iron binding capacity (TIBC), potassium, and phosphorus levels, malnutrition score (MS)-modified subjective global assessment (modified SGA), malnutrition inflammation score (MIS), and nutritional status. The study population comprised 36 (42.9%) men and 48 (57.1%) women with a mean age of 54.85 ± 15.50 years. A paired sample t-test was used to compare the baseline with end-of-study values for continuous variables. Serum albumin, prealbumin, hemoglobin, and phosphorus levels remained stable throughout the study period. The mean change in weight, BMI, triceps skin fold thickness, handgrip strength, and TIBC for the overall study population was 1.11 kg (1.82%, p < 0.0001), 0.46 kg/m2 (1.98%, p < 0.0001), 3.47 mm (30.78%, p < 0.0001), 6.05 kg (44.98%, p < 0.0001) and 11.80 µg/dL (6.06%, p < 0.0001), respectively. At the end of the study period, there was a significant (p < 0.0001) improvement in the SGA and MIS scores. Further, there was a significant improvement in nutritional status as demonstrated by the overall intake of calories (p < 0.001), proteins (p < 0.0001), carbohydrates (p = 0.003, and fats (p < 0.0001). Protein-energy malnutrition is a strong predictor of morbidity, mortality, and poor outcomes in CKD patients. A scientifically designed formula in accordance with KDOQI standards was able to improve the nutritional status, overall body composition, sarcopenia, and quality of life in CKD patients on MHD.

Impact of nutritional intervention on concurrent chemoradiotherapy outcomes in locally advanced esophageal cancer: A pharmacological perspective

Purpose: To determine the pharmacological implications of nutritional intervention and the occurrence of toxic side effects in patients with locally advanced esophageal cancer undergoing concurrent chemoradiotherapy.&#x0D; Methods: An extensive retrospective analysis of clinical data was carried out on individuals who received concurrent chemo-radiotherapy. 150 patients were included in the study, with 85 patients receiving nutritional management (intervention group) and 65 patients without nutritional support (control group). Assessments were conducted for Nutritional Risk Screening-2002 (NRS-2002) and patient-generated subjective global assessment (PG- SGA) scores, serum nutritional parameters, toxic side effects and treatment completion rates at 2, 4, and 6 weeks before and during chemo-radiotherapy.&#x0D; Results: After concurrent chemo-radiotherapy, intervention group exhibited significantly lower NRS2002 and PG- SGA scores compared to control group (p = 0.002 and 0.001, respectively). Intervention group had a statistically significant increase in PALB (p = 0.001) and ALB, while control group experienced a significant decline in ALB (albumin) and PALB (pre-albumin) levels. Grip strength also significantly decreased in control group compared to intervention group (p = 0.003). Intervention group showed a significantly lower incidence of radiation esophagitis. Moreover, a smaller proportion of patients in intervention group experienced interruptions or delays in radiotherapy compared to control group (95 % vs. 83.3 %).&#x0D; Conclusion: Nutritional intervention has a pharmacological impact on maintaining nutritional status, reducing treatment toxicities and improving the completion rates of chemo- radiotherapy in patients with locally advanced esophageal cancer. Further investigations and longer-term studies are warranted to shed more light on the potential impact of nutritional interventions on the overall survival rates of these patients

Subjective Global Assessment as a Pre-Operative Nutrition Status Screening Tool for Head and Neck Cancer Patients of a Tertiary Health Care Setting

Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between Subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: Subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.

NUTRITION STATUS ASSESSMENT BASE ON BMI AND SGA OF HOSPITALIZED PATIENTS AT NATIONAL HOSPITAL FOR TROPICAL DISEASES IN 2020

Background: Malnutrition is a common problem in hospitalized patients. Many factors such asfatigue, loss of appetite, chronic diseases and misconceptions in nutrition can caused malnutrition. In hospitalized patients, malnutrition is associated with morbidity and mortality in the hospital.Objectives: Description of nutritional status of inpatients at the National Hospital for TropicalDiseases (NHTD) in 2020.Subjects and methods: Across sectional descriptive study with 165 patients aged 18 years or older,hospitalized within 48 hours, treated at the NHTD. All the patients were assessed nutrition status based on BMI, SGA scores and 24 - hour diet recall.Results: 18,2% of patients with chronic lack of energy (BMI &lt; 18.5). There are 47.27% patients at risk of malnutrition and 8.49% of patients at risk of severe malnutrition (according to SGA). Only 35.15% of patients consumed more than 70% of the nutritional requirements. There were 28.48% of patients whose diets met less than 30% of the recommended levels of intake.Conclusions: BMI and SGA scores could be used to assess nutrition status for the inpatients. Patient’s nutrition status should be evaluated on admission as well as during hospital stay. Through that, we can plan for nutritional care and treatment effectively.

LOW MUSCLE MASS AND SARCOPENIA IN CIRRHOSIS: PREVALENCE OF LOW PHASE ANGLE AND ASSOCIATIONS WITH NUTRITIONAL VARIABLES

Sarcopenia and malnutrition are common in cirrhosis and are associated with adverse outcomes. Bioimpedence analysis (BIA) for skeletal muscle is limited due to fluid accumulation, however low phase angle (PA) is suggestive of low muscle mass in cirrhosis. This study was performed to evaluate the prevalence of sarcopenia (low PA and handrip strength) and low muscle mass (low PA) and its association with clinical/nutritional variables. Patients with cirrhosis (n=41) were grouped into PA ≤4.9° or >4.9°. Sarcopenia was confirmed by PA≤4.9° and handgrip strength (HGS) by dynamometry < 27 and <16 kg in males and females. 20 patients presented PA ≤4.9°. 6 patients were sarcopenic. Compared with higher-PA group, patients with PA≤4.9° were older (p<0.05) and females; presented lower PA (4.2° vs. 5.8°, p <0.0001), HGS (19.7 vs 34.7 kg, p=0.001) and impaired 10-metre walk test (1.4 vs 1.1 m/sec, p=0.001). No differences were detected for BMI, NRS 2002 and SGA scores, plasma albumin and ammonia, Child-Pugh and MELDNa score. In univariate analysis (n=41) PA was positively (p≤0.002) associated with male gender, BIA-measured intracellular water, HGT and albumin and negatively (p<0.015) with walk-test and Child-Pugh score. No correlations were detected with BMI, NRS2002, SGA, BIA-determined total and extracellular water, ammonia, liver enzymes, bilirubin, and MeldNa score. In patients with cirrhosis, the prevalence of low muscle mass is high (up to 50%) and is correlated with functional variables (HGT and walk speed) and disease severity (Child-Pugh score) but not with nutritional scores and BMI. Specific tools are required to identify sarcopenia.

SO048CREATININE INDEX AND IT'S ASSOCIATION WITH MORTALITY AND HOSPITALISATION AMONG INCIDENT HAEMODIALYSIS PATIENTS

Abstract Background and Aims Studies have suggested that higher lean body mass (LBM) is associated with increased longevity among haemodialysis (HD) patients. It has been shown that creatinine index is a surrogate marker of lean body mass and can be estimated using a simplified equation based on age, gender, serum creatinine and KT/V(sp). The present study was conducted to investigate the association between estimated creatinine index and all-cause mortality in a large racially diverse cohort of incident HD patients. We also examined the relationship between creatinine index and hospitalisation incidence in this cohort. Method Incident patients (aged≥18 years) between January, 2010 and December, 2018 who survived six months of HD were included in this retrospective observational study. Baseline demographic data was collected at study commencement, followed by clinical and laboratory data during the 6 month exposure period. Patients were followed from the index date (last day of exposure period) until first of the following – death, withdrawal or end of study (June 30, 2019). The exposure of interest was Creatinine Index (CI) estimated using a simplified formula (Canaud et al 2014) based on patient demographics (age and gender), pre-dialysis serum creatinine and KT/V(sp). Patients were stratified into 4 groups based on CI quartiles - Q1(&amp;lt;=17.48), Q2(17.49-18.91), Q3(18.92-20.54) and Q4(20.55+). Primary outcome was all-cause mortality during the overall follow-up. Adjusted hazard ratios were estimated using a Cox regression model for association between CI quartiles and mortality. Negative binomial regression models were used to assess the relationship between CI quartiles and hospitalisation. Results A total of 3172 incident HD patients (mean age 60.4±11.5 years, 56.2% male, 57.4% Chinese and 70.4% with diabetes as cause of ESRD) were included in the study. During the median follow-up of 2.8 (1.4-4.7) years, 755 (23.8%) patients died. The mean creatinine index for entire cohort was 19.1±2.3 mg/kg/day. The patients in the lowest CI quartile (Q1) were older, females, had higher incidence of diabetes and comorbidity but lower levels of albumin, haemoglobin, BMI and SGA scores compared to higher quartiles (p&amp;lt;0.001). Following multivariate analysis the adjusted hazard of death were as follows - Q4 (aHR-1, reference), Q1 (aHR-2.14, 95%CI 1.56-2.94), Q2 (aHR-1.58, 95%CI 1.21-2.05), Q3 (aHR-1.33, 95%CI 1.05-1.68), p&amp;lt;0.001. Patients in the lowest quartile of CI (Q1) had 64% higher incidence of hospitalisation (IRR 1.64, 95%CI 1.36–1.98, p&amp;lt;0.001) compared with patients in Q4 (IRR-1, reference). Conclusion Creatinine index derived from a simplified equation is useful in predicting mortality and hospitalisation among Southeast Asian incident HD patients. Low CI was associated with increased risk of all-cause mortality and hospitalisation in our cohort. The present study is limited by the lack of data on residual renal function which might confound the results.

Utility of nutritional indices in preoperative assessment of cancer patients

Malnutrition is an important but neglected predictor for outcomes and healthcare costs in cancer patients. A simple screening tool for detecting malnutrition may have clinical utility in their preoperative assessment. This study compared three validated indices, for their predictive ability for prolonged length of stay (LOS) and 30-day postsurgical complications in malignancies in a tertiary hospital in South India. 342 cancer patients admitted for elective surgery were stratified on their preoperative day using MUST - Malnutrition Universal Screening Tool, SGA - Subjective Global Assessment and NRI - Nutritional Risk Index. The postoperative LOS and 30-day morbidity as per Clavien-Dindo classification (CDC) were compared to calculate the predictive accuracy of the various nutritional indices. In our study, 44% patients were classified as malnourished by SGA. SGA was found to have maximum correlation coefficient with LOS (σ=0.410), followed by MUST (σ=0.401) and NRI (σ=0.36). On logistic regression, MUST, NRI and SGA were all found to be significant independent predictors of LOS and CDC class. Age, acute illness and comorbidities were found to have significant confounding effects. Sensitivity of MUST and SGA to predict prolonged LOS (>10d) were. Our study showed that surgical cancer population was at high risk for malnutrition. MUST and SGA were good risk-stratification tools with independent predictive ability for prolonged LOS and postoperative complications. Patients having higher MUST and SGA scores fared poorly postoperatively with significant prolongation of stay. MUST had 88% agreement with SGA, and took shorter time to administer in the in-patient setting. Routine preoperative nutritional assessment is important in cancer patients. SGA and MUST were found to be reliable tools, with MUST being the simplest and quickest tool for preoperative nutritional assessment. Patients stratified to be at risk for malnutrition may benefit with nutritional therapy.

SAT-036 ERYTHROPOIESIS STIMULATING AGENT HYPORESPONSIVENESS AND ITS ASSOCIATION WITH MORTALITY AND HOSPITALISATION

In patients with CKD, higher erythropoiesis stimulating agents (ESA) dose might cause higher mortality and increased cardiovascular complications. Hyporesponsiveness to ESA treatment is a known predictor of poor clinical outcomes in haemodialysis (HD) patients. Poor outcomes could be the result of high ESA dosage required in these groups or patient related cause of hypo-responsiveness or a combination of both. We sought to examine whether high erythropoietin resistance index (ERI) was associated with increased all-cause mortality and hospitalisation among incident HD patients. Incident HD patients between January 2010 and December 2016, who completed six months of HD were included in this retrospective observational cohort study. Patients were followed up for one year from the index date (last day of 6 months exposure period) until first of the following – death, withdrawal or end of study (Dec 31, 2017). The main predictor variable was ESA responsiveness measured by ERI (IU/kg/week/g/dl) which was defined as average weekly weight-adjusted EPO dose per average haemoglobin concentration. Patients were divided into 2 groups based on ERI quartiles - ESA hyporesponsive (4th quartile, ERI >15.25+) and ESA responsive group (1st, 2nd and 3rd quartile combined, ERI < 15.25). ESA responsiveness was also assessed by a combination of ESA dosage (high: ≥ median value of ESA dose or low: < median value of ESA dose) and haemoglobin levels (high: ≥ 10 g/dl or low: <10 g/dl). Patients were then divided into 4 groups with low-dose ESA therapy and high haemoglobin (Hb) level as reference category.Primary outcomes were all-cause mortality and hospitalisation during the one year follow-up. Cox regression and Negative binomial regression models were used to determine associations with mortality and hospitalisation among the ERI groups. Binary logistic regression model was used to define the predictors of high ERI. A total of 2302 incident HD patients (mean age 60.1 ± 11.4 years, 56.2% male, 59% Chinese and 69.9% with diabetes as cause of ESRD) were included in the study. During the mean follow-up time of 0.95 ± 0.16 years, 113 (4.9%) patients died. The median EPO dose and mean ERI were 113.9 (IQR, 77.8 to 154.8) IU/kg/week and 12.1± 6.4 IU/kg/week/g/dl respectively. The ESA hyporesponsive group (ERI >15.25+) were more likely to be females, have low albumin, low BMI, low SGA scores and low transferrin saturation % levels but higher KT/V and ferritin levels compared to the ESA responsive group (p<0.001). ESA hyporesponsive group (ERI>15.25+) had 83% higher risk of all-cause mortality (aHR 1.83, 95% CI 1.20 – 2.79, p=0.005) after adjusting for potential confounders. HD patients with high-dose EPO and low Hb levels (ESA hyporesponsive) had significantly higher risk of mortality (aHR 2.42, 95% CI 1.41 – 4.19, p=0.001). The high ERI group also had 36% higher incidence of hospitalisation (IRR 1.36, 95% CI 1.20 – 1.54, p<0.001) compared to low ERI group. The independent predictors of high ERI were female gender, low albumin, high ferritin, low transferrin saturation %, low BMI, high KT/V, high acuity status and increased hospital admissions in the exposure period.View Large Image Figure ViewerDownload Hi-res image Download (PPT) High ERI levels are associated with increased risk of all-cause mortality and hospitalisation in incident HD patients. Lack of data on inflammatory markers is a study limitation.

Prognostic Importance of Multiple Nutrition Screening Indexes for 1-Year Mortality in Hospitalized Acute Decompensated Heart Failure Patients.

Background: The purpose of the study was to evaluate the impact of nutritional status on 1-year mortality in hospitalized patients with acute decompensated heart failure (ADHF). Methods and Results: We enrolled 457 hospitalized ADHF patients. Previously established objective nutritional indexes (controlling nutritional status [CONUT], prognostic nutritional index [PNI], geriatric nutritional risk index [GNRI], and subjective global assessment [SGA]) were evaluated at hospital admission. Malnutrition was defined as CONUT score ≥5, PNI score <38, GNRI score <92, and SGA scores B and C. The frequencies of malnutrition based on CONUT, PNI, GNRI, and SGA were 31.5%, 21.4%, 44.9%, and 27.8%, respectively. All indexes were related to the occurrence of 1-year mortality on univariate Cox regression analysis (P<0.05). We constructed a reference model using age, body mass index, systolic blood pressure, sodium concentration, and renal function on multivariable Cox regression analysis. Adding SGA to the reference model significantly improved both net reclassification improvement (NRI) and integrated discrimination improvement (0.344, P=0.002; 0.012, P=0.049; respectively). Other indexes (CONUT, PNI, and GNRI scores) significantly improved NRI (0.254, P=0.019; 0.273, P=0.013; 0.306, P=0.006; respectively). Conclusions: Nutritional screening assessed at hospital admission was appropriate for the prediction of 1-year mortality in hospitalized patients with ADHF.

Comparison of Nutrition Parameters and MNA and SGA Scores of Geriatric and Non-Geriatric Chronic Liver Parenchymal Patients

Comparison of Nutrition Parameters and MNA and SGA Scores of Geriatric and Non-Geriatric Chronic Liver Parenchymal Patients

Endobronchial ultrasound transbronchial needle aspiration in elderly patients: safety and performance outcomes EBUS-TBNA in elderly

Aim Complication rates are low and endobronchial ultrasound guided needle aspiration (EBUS-TBNA) is generally regarded as a safe procedure, but there is a very limited number of studies evaluating the efficacy and safety of the procedure in advanced ages. The aim of this study is to assess the safety and performance outcomes of EBUS-TBNA in elderly. Methods It was a retrospective observational study; patients who received EBUS-TBNA between September 2016 and January 2018 were evaluated. We analyzed patient’s characteristics, doses of midazolam, and lidocaine used, regions of lymph node biopsies, and complications. Also, functionality and general physical status of patients over 65 years of age were evaluated. Results During study period 132 cases of EBUS-TBNA were evaluated. 39 (29.5%) cases were aged 70 years, and over. There were more comorbidities in older group. Performance status of older group was worse. Furthermore, when evaluated according to American College of Cardiology (ACC)/American Heart Association (AHA) and American Society of Anesthesiologists (ASA), the older group was found to be composed of the riskier patients. When patients aged between 65 and 69, and over 70 compared, older patient’s Barthel, EQ 5-D, SGA, and G8 scores were found to be worse. Despite that, there was no difference in the frequency, and types of complications between both groups. Diagnostic performance was not different between age groups. Conclusions Independent from comorbidities, general health status, and functionality EBUS-TBNA procedure in 70-year-old and over patients is a safe minimally invasive procedure.

Nutrition assessment and its relationship with performance and Glasgow prognostic scores in Vietnamese patients with esophageal cancer.

To determine the nutritional status of patients with esophageal cancer, and to investigate its relationship with performance status and prognosis. This clinical, cross-sectional study was conducted from August 2014 to February 2015 at National Cancer Hospital, Hanoi, Vietnam. Stage III/IV esophageal cancer patients were assessed for their nutritional status (patient-generated subjective global assessment (PG-SGA) and SGA scores, BMI, mid-arm circumference (MAC), energy and protein intakes, weight changes, Karnofsky and Eastern cooperative oncology group performance scores (KPS/ECOG), and Glasgow prognostic score (GPS). Sixty-four male patients were enrolled. The mean ± standard deviation of PG-SGA score was 9.88±4.41. SGA revealed 44% as class B and 6.2% as class C. The BMI revealed 43.8% of patients were underweight. MAC measurement revealed 29.7% of undernourished patients. Patients with an energy intake <25 kcal/kg/d comprised 54.7%, and 48.4% with <1 g/kg/day of protein. Totally, 68.8%, 84.4% and 92.2% patients exhibited weight loss past 2-weeks, one-month and six-months, respectively. The PG-SGA and SGA strongly correlated with the KPS (r=-0.717 and 0.632, both p<0.001) and ECOG (r=0.672 and 0.626, both p<0.001), but were weakly correlated with the GPS (r=0.332 and 0.278, p<0.01 and 0.05). The KPS, ECOG, BMI, MAC, energy and protein intakes, and weight change were not correlated with the GPS. Malnutrition, weight change, and insufficient intake were noteworthy in esophageal cancer patients. The PG-SGA and SGA were strongly correlated with the performance status, but weakly correlated with prognostic indices.

Interrelationship of elevated serum Advanced Glycation End-product levels and malnutrition (Subjective Global Assessment) scores with the severity of retinopathy in type II diabetes

Hyperglycemia in diabetes causes endogenous formation of Advanced Glycation End-products (AGEs) which accumulate in various body parts including retina causing diabetic retinopathy. AGEs also originate from exogenous dietary sources contributing to the body's AGE pool. Currently, curing of diabetic retinopathy is mainly focused on medication, surgical or laser interventions and not much emphasis is given on preventing or halting its occurrence or advancement to more severe stages, nutritionally. Planning a 'low glycemic index-lowAGE' diet therapy for diabetic subjects can reduce endogenous and exogenous origin AGEs in the body and help in controlling retinopathy. Sound and accurate assessment of nutritional status is a crucial step for planning a therapeutic diet for this condition. As this aspect has not gained sufficient attention till now we are assessing the association of serum Advanced Glycation End-product (AGE) levels with the severity of diabetic retinopathy and for the first time estimating the nutritional status of subjects with this eye disorder for long term patient care. This was a tertiary care centre-based, case-control study involving sixty three consecutive cases with diabetes divided as 21 cases with diabetes but no retinopathy, 21 cases with non proliferative diabetic retinopathy (NPDR), 21 cases with proliferative diabetic retinopathy (PDR) along with 21 healthy controls. Serum AGE levels of all the cases and controls were evaluated by Enzyme Linked Immuno Sorbent Assay (ELISA) and nutritional status was assessed by anthropometric measurements and SGA scores. Serum AGE levels were found significantly elevated in PDR group when compared with no retinopathy (p<0.05) and control (p<0.001) group. Control group was also significantly different from (p<0.05) from NPDR group. Increase in SGA scores was statistically significant amongst the four study groups though other indices of nutritional status showed no definite trend with the increasing severity of retinopathy. Our study shows that serum AGE levels are potential risk markers of diabetic retinopathy and SGA can be used as a regular tool for the assessment of nutritional status of diabetic retinopathy subjects which will help planning a 'low glycemic index-low AGE' therapeutic diet for halting this morbidity.

Graft function and nutritional parameters in stable post renal transplant patients

Abstract Bioelectrical Impedance Analysis (BIA) is a noninvasive and bedside tool for assessment of nutritional status. It is expected that patients who have undergone successful renal transplant will have good nutritional intake and steadily the patient will return to normal health and have good nutritional status. Objective The aim of the study was to evaluate effect of graft function on nutritional status in post renal transplant patients with borderline to good allograft function using BIA. Material and methods For this study, 45 post-renal transplant patients with mean serum creatinine 1.42 ± 0.42 mg% and glomerular filtration rate (GFR) 45.1 ± 14.1 ml/min were subjected to bioimpedance analysis. Several parameters were evaluated. Based on BIA derived GFR, patients were divided into two groups (group 1: borderline graft function GFR Results There was significant difference between healthy controls and the post transplant patients. Based on GFR, there was significant difference in patient groups in body weight ( p = 0.01), serum creatinine ( p = 0.005), BMI ( p = 0.000), fat free mass ( p = 0.003), fat mass ( p = 0.003), body cell mass ( p = 0.000), dry weight ( p = 0.001). Patients with borderline GFR had higher serum creatinine but significantly lower body weight, BMI, FFM, FM, and dry weight, indicating poorer nutritional status as compared to those with good graft function. Based on phase angle, there was significant difference between groups A and B in GFR ( p = 0.000), extracellular water ( p = 0.015), intracellular water ( p = 0.002), plasma fluid ( p = 0.016), interstitial fluid ( p = 0.016), body cell mass ( p = 0.024). SGA scores showed that transplant patients had normal nutritional status, but when compared with healthy individuals, there was significant difference in the fat mass, fat free mass and body cell mass as assessed by BIA. Conclusion Compared to patients with good graft function, patients with borderline GFR showed evidence of early nutritional depletion as picked up by BIA implying nutritional deficiency sets in with reduction in GFR (

HANDGRIP STRENGTH AS A SIMPLE INDICATOR OF MALNUTRITION IN HEMODIALYSIS PATIENTS

Handgrip strength is a simple, easily performed bedside test that has been shown to correlate with lean body mass in patients close to inception of dialysis. To assess the usefulness of handgrip strength (HGS) as a simple screening instrument for assessing malnutrition among patients on Maintenance Hemodialysis and correlate it with Subjective Global Assessment score (SGA). 50 subjects on Maintenance Hemodialysis were randomly assessed using SGA scores and their Hand Grip Strength using the HGS instrument once after the dialysis. The study comprised of subjects in 3 different stages of CKD, stage III (22%), stage IV (44%), stage V (34%) among which 78% (39) were men with mean age of 51.46±13.21yr and 22% (11) were women with mean age of 60.36±14.62yr. The SGA classification showed that all the subjects (6) in severely malnourished category were of stage V whereas Very mild risk to well nourished category (15) comprised of stage III and IV. Similarly, the HGS scores were found to be 25.18±5.036 kg and 18.87±5.365 kg in CKD stage III and CKD stage V respectively. HGS was found to be directly correlated with SGA score, with statistical significance of p<0.01. HGS is a complementary tool for screening malnutrition in patients on Maintenance Hemodialysis.

Adipokines and Nutritional Status for Patients on Maintenance Hemodialysis

The aim of this study was to investigate the serum concentration of adipokines, such as leptin, adiponectin, and resistin, and assess its relation to nutritional and inflammatory parameters in both overweight and normal weight patients on maintenance hemodialysis. A total of 36 hemodialysis patients (27 M, 9 F; mean age 55.3 +/- 12 yr.) were examined and 23 additional healthy volunteers were recruited as the control group. The concentrations of leptin, leptin receptor, adiponectin, resistin, IL-6, TNFa and CRP were measured by ELISA. Assessment of nutritional status was determined by the levels of albumin, BMI, percentage of body fat (%F), lean body mass (LBM), and Subjective Global Assessment Score (SGA). According to the SGA 7-points score and the albumin level, 20 patients were of good nutritional status (6-7 points), while 16 patients were mildly malnourished (4-5 points). The concentrations of CRP, resistin, adiponectin, and TNFa were statistically higher in hemodialysis patients than in the control group (p pound 0.05). The adiponectin level was inversely correlated with %F (R Spearman=-0.3; p pound 0.05). The level of leptin was positively correlated with %F as well as with BMI and SGA scores (R Spearman=0.4; p pound 0.05). Although there was no significant difference in the nutritional status between the nonoverweight (BMI 18.5-24.99) and overweight (BMI (3)25.0) groups of patients, in the nonoverweight group there were 12 patients (54.5%) with signs of mild malnutrition compared to 4 malnourished patients (28.5%) in the overweight group. Nonoverweight patients presented significantly lower leptin concentration (12.7 vs 27.8 ug/l) and higher adiponectin level (38.9 vs 32.5 ng/ml) when compared to overweight patients. The levels of IL-6 and TNFa were higher in the nonoverweight group of patients. Overweight patients also had shorter durations of stay in the hemodialysis program (30.5 vs. 87.6 months). The results of our study indicate that lean hemodialysis patients are more prone to malnutrition and inflammation. The increased levels of leptin and decreased levels of adiponectin in the overweight hemodialysis patients support the idea of a reverse epidemiology phenomenon in this group of patients.

Comparision of nutritional status of hemodialysis patients with different ages and its nursing strategy

Objective To explore the nutritional status of hemodialysis patients with different ages, and analyze the reasons of differences of nutritional status. Methods 109 hemodialysis patients were divided into the young-age group (n=26), the middle-age group (n=49) and the old-age group (n=34). The body indices, blood biochemical parameters, dietary assessment, handgrip strength and subjective global assessment were measured. The nutritional indices and relationship were compared among patients in the three groups. Results Leg circumstance, prealbumin, creatinine, handgrip strength and SGA scores were different among the three groups (P<0.05 or P<0.01). And those five factors were all statistically associated with age (P<0.05). Conclusions With the increase of age, the hemodialysis patients' nutritional status has a descending trend. It's necessary for nursing staff to timely monitor and intervene the nutrition of elderly patients so as to prevent the incidence of malnutrition. Key words: Renal dialysis; Nutritional status; Nutrition assessment; Age factors; Nursing care