Significant Risk Of Malnutrition Research Articles

Malnutrition and Fall Risk in Older Adults: A Comprehensive Assessment Across Different Living Situations.

Malnutrition among older adults is associated with numerous adverse effects, including increased morbidity, mortality, prolonged hospital stays, and a heightened risk of falls. This study aims to investigate the prevalence of malnutrition in different groups of older adults using the F-MNA, anthropometry, and s-albumin and the association between nutritional status and fall risk. A total of 228 participants aged 60 years and older were divided into three groups: (1) patients in an internal medicine ward, (2) individuals living in family homes, and (3) residents of care homes. Disease profiles, nutritional status (assessed using the F-MNA and SNAQ), body composition, fall risk, and biochemical markers were evaluated. The results indicated the highest prevalence of malnutrition among hospitalized individuals. Fall risk was associated with age, calf circumference, the F-MNA, the SNAQ, serum albumin levels, residence in a care home, comorbidities, and the number of medications taken daily. Regression analysis revealed that age, calf circumference, and residence in a care home were independent predictors of fall risk in older adults. Older adults are at significant risk of malnutrition, with the risk notably increasing during hospitalization and long-term stays in care homes. Hospitalized individuals had the poorest nutritional status and were at significant risk of further weight loss, underscoring the importance of post-discharge care and rehabilitation.

Enteric Tube Placement and Management: Tips for Interventional Radiologists

AbstractThere is a significant risk of malnutrition and aspiration among hospitalized patients, particularly the elderly, patients with head and neck malignancy, and those with a chronic debilitating disease. Enteral feeding is preferred over parenteral feeding for patients with functional gastrointestinal tracts but who have impaired swallowing due to its cost-effectiveness, lesser complications, and theoretical benefits such as preserving mucosal architecture and gut-associated lymphoid tissue. While nasogastric and nasojejunal tubes address short-term feeding needs, long-term enteral feeding tubes are crucial for patients requiring nutritional support beyond 4 weeks. Enteric tube placement can be performed surgically, endoscopically, or radiologically, with radiologically inserted gastrostomy emerging as a safe and effective method. This review article discusses various interventional radiological techniques for enteral feeding, including percutaneous gastrostomy, gastrojejunostomy, jejunostomy tube placement, and gastrointestinal tract decompression procedures like cecostomy. It covers procedural considerations, patient selection criteria, technical aspects, and outcomes, drawing on current evidence and clinical experience. The review also addresses emerging trends, advancements, and future directions in interventional radiology for enteral feeding and gastrointestinal tract decompression, aiming to contribute to the ongoing evolution of clinical practice and patient care. Key recommendations from international guidelines are summarized, emphasizing individualized risk assessment for optimal enteral feeding strategies.

Anticancer restrictive diets and the risk of psychological distress: Review and perspectives.

The most studied anticancer restrictive diets include fasting, fasting-mimicking diets (FMDs) and ketogenic diets (KDs). Besides the current lack of established clinical benefit and the significant risk of malnutrition and micronutrient deficiencies, dietary restrictions in cancer patients might have relevant psychological effects. We reviewed the randomized and non-randomized controlled clinical trials (CCTs) reporting data on the psychological impact of fasting, FMDs and KDs in cancer patients. We excluded trials on restrictive diets performed for weight reduction in obese or overweight patients, studies on dietary restrictions lasting less than 24 h, and studies on fasting related to cultural or religious beliefs. Three CCTs on fasting or FMDs and eight CCTs on KDs in cancer patients were included. In terms of diet-related distress, emotional, social, and family well-being, none of these studies showed a detrimental impact of fasting, FMDs and KDs. However, clinical trials specifically assessing the psychological aspects in the long term are lacking. In the absence of a conclusive evidence on the clinical benefits of restrictive diets, which carry significant risks especially if unsupervised, further studies are needed to clarify their psychological impact in cancer patients. Multidisciplinary approaches including psychological evaluations should be used to ameliorate patient selection for clinical trials, identify early distress symptoms, and increase patient compliance to dietary recommendations.

OGC P24 The impact of early enteral feed composition on the rate of chyle leak post-oesophagectomy

Abstract Background Patients undergoing oesophagectomy are at significant risk of malnutrition and benefit from peri-operative enteral feeding. Chyle leak presents in up to 20% of patients undergoing an oesophageal resection and is associated with immunosuppression, malnutrition and increased complications. Early enteral feeding can increase the rate of chyle leak in these patients. Enteral feed with a high percentage of fat as medium chain triglycerides (MCT) is more easily absorbed and can reduce chyle production. We evaluated the impact of early enteral MCT-rich feed on the prevalence and severity of chyle leak post-oesophagectomy. Secondary outcomes include length stay, and post-operative weight change. Methods Retrospective review of records from consecutive patients undergoing oesophagectomy at a single tertiary centre between January 2015 and December 2022. Following specialist dietician input, patients received enteral feed on post-operative day 1 – 5 with Nutrison Protein Plus Energy (standard; 5.8% total fat, 0.9% (MCT)) (2015-June 2021) or Nutrison Peptisorb Plus HEHP (HEHP; 5% total fat and 3% MCT) enteral feed (June 2021 to Dec 2022). All patients transitioned to standard feed on post-operative day 6 onwards and were discharged on IDDSI level 4 diet and supplemental jejunal feeding. Patients who did not commence early enteral feeding were excluded from analysis. Results A total of 329 patients were included. Patients who received early enteral HEHP feed had fewer chyle leaks (5/52; 9.6%) compared to patients who received early enteral standard feed (68/277; 24.5% p=0.017). The proportion of ECCG grade I and II leaks was similar between groups. No patients required surgical intervention for a chyle leak during the study period. The HEHP group had a shorter critical care (p<0.001) and total length of hospital stay (p=0.011). Weight change from pre-operative baseline was equivalent in both groups at 6 weeks (standard; -4.5%, HEHP; -2.3%, P=0.066) and 3 months (standard; -5.6%, HEHP -4.0%, P=0.400). Conclusions In the context of routine jejunostomy use and early enteral feeding post-oesophagectomy, HEHP feed on post-operative day 1- day 5 was associated with a significantly lower chyle leak rate with corresponding shorter length of stay compared to standard feed. No difference was noted in post-operative weight change between groups which was relatively well preserved up to 3 months post-operatively.

Controlling Nutritional Status (CONUT) score and the risk of mortality or impaired physical function in stroke patients: A systematic review and meta-analysis

AimsThe Controlling Nutritional Status (CONUT) score is a tool for assessing the risk of malnutrition (undernutrition) that can be calculated from albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. CONUT score has been proposed as a promising prognostic marker in several clinical settings; however, a consensus on its prognostic value in patients with stroke is lacking. The aim of this systematic review and meta-analysis was to evaluate the relationship between CONUT score and clinical outcomes in patients with stroke based on all current available studies. Data synthesisSystematic research on PubMed, Scopus and Web of Science from inception to February 2023 was performed on the association between CONUT score and clinical outcomes in patients with stroke. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality was evaluated using the Newcastle-Ottawa Scale quality assessment tool. Pooled effect estimation was calculated by a random-effect model.Through the initial literature search, 15 studies (all high-quality) including 16 929 patients were found to be eligible and analysed in the meta-analysis.A significant risk of malnutrition (in most studies defined by a CONUT score ≥5) was directly associated with mortality, higher risk of poor functional outcome according to the modified Rankin Scale and total infection development. Evidence was consistent for acute ischaemic stroke and preliminary for acute haemorrhagic stroke. ConclusionCONUT score is an independent prognostic indicator, and it is associated with major disability and infection development during hospitalisation. PROSPERO IDCRD42022306560.

Стоит ли назначать малобелковую диету пожилому пациенту с хронической болезнью почек?

There are no clear dietary recommendations for patients over 70 years of age, while stages 3-5 of chronic kidney disease (CKD) and protein-energy wasting (PEW) is common among this category of patients. Nutritional status is known to be one of the significant factors influencing the prognosis of patients receiving renal replacement therapy. The aim of the research was the analysis of the mechanisms of PEW, methods for assessing the nutritional status and effectiveness of diets with different protein content in patients with CKD based on literature data. Material and methods. The research material was the scientific literature presented in the domestic and international (eLIBRARY, PubMed, Google Scholar) databases, as well as clinical recommendations for the management of geriatric patients with CKD, dietary recommendations for patients with anorexia and other conditions. Results. The studies devoted to the mechanisms of PEW were analyzed. One of the leading causes of this condition is anorexia, in the pathogenesis of which uremic toxins, inflammation and hormonal disorders are involved (hormones such as gastrin, cholecystokinin, leptin, insulin, testosterone and others may be involved in the pathogenesis). A number of studies have shown that limiting protein to 0.6 g/kg day could significantly reduce uremic dyspepsia risk and slow CKD progression. At the same time, several researchers gave data on the ineffectiveness of a low-protein diet in patients with CKD and diabetes mellitus and a significant risk of malnutrition. Subjective global assessment, the mini nutrition assessment and the geriatric nutritional risk index can be distinguished among the methods of assessing nutritional status. Conclusion. Research data on the effectiveness of a low-protein diet in elderly patients with stage 3B-5 CKD are contradictory. PEW in CKD is common and largely determines survival; the mechanism of PEW is complex. The study of the optimal nutritional diet for elderly patients with predialysis stages of CKD still remains an urgent problem.

Malnutrition among the Elderly in Malaysia and Its Associated Factors: Findings from the National Health and Morbidity Survey 2018

Background Malaysia is predicted to become an ageing population by 2035. Malnutrition among the elderly is one of growing concern. This study aims to identify the prevalence of malnutrition and its associated factors among the elderly in Malaysia. Methods Data from the National Health and Morbidity Survey (NHMS) 2018 was analysed. This survey applied a multistage stratified cluster sampling design to ensure national representativeness. Malnutrition was identified using a validated Mini Nutrition Assessment-Short Form (MNA-SF). Variables on sociodemographic, health status, and dietary practices were also obtained. The complex sampling analysis was used to determine the prevalence and associated factors of at-risk or malnutrition among the elderly. Result A total of 3,977 elderly completed the MNA-SF. The prevalence of malnutrition and at-risk of malnutrition was 7.3% and 23.5%, respectively. Complex sample multiple logistic regression found that the elderly who lived in a rural area, with no formal or primary level of education, had depression, Instrumental Activity of Daily Living (IADL) dependency, and low quality of life (QoL), were underweight, and had food insecurity and inadequate plain water intake were at a significant risk of malnutrition (malnutrition and at-risk), while Chinese, Bumiputra Sarawak, and BMI more than 25 kgm−2 were found to be protective. Conclusions Currently, three out of ten elderly in Malaysia were at-risk or malnutrition. The elderly in a rural area, low education level, depression, IADL dependency, low QoL, underweight, food insecurity, and inadequate plain water intake were at risk of malnutrition in Malaysia. The multiagency approach is needed to tackle the issue of malnutrition among the elderly by considering all predictors identified from this study.

Acute Diverticulitis Is at Significant Risk of Malnutrition: an Analysis of Hospitalized Patients in a Medicine Department.

The Nutritional Risk Security (NRS2002) System is recommended for hospitalized patients in order to assess their nutritional status. However, studies assessing large-scale systematic screening policies are lacking. The aim of this study was to assess the feasibility of implementing a screening strategy concerning all admissions for diverticular disease (DD) of the colon in the Department of Medicine of a Tertiary Hospital. All patients suffering from acute diverticulitis (AD) and admitted to the Medicine Department from January 1st to 31 December 2017, were pre-screened by NRS2002 System by the nursing staff of the Nutritional team at the day of the admission. If the pre-screening was positive, the patients were referred to a supplementary assessment performed by a dietician. The global number of admissions in the observational period was 4,667 and 133 patients suffered from AD. A positive pre-screening test was recorded in 97 (72.9%) patients: a NRS2002 score > 3, describing a severe impaired nutritional status was found in 61 patients (62.9%). All 97 patients with a NRS2002 positive screening received initial nutritional support by oral supplements (17 patients, 17.52%) or enteral nutrition (22 patients, 22.68%) or total parenteral nutrition (58 patients, 59.8%). The mean length of hospital stay for all 133 patients was 6,9 days. However, the length of hospital stay was significantly longer for patients with a positive NRS2002, with a mean of 18 days (p= 0.01) Conclusions: A large number of hospitalized patients due to AD are at nutritional risk and have a significantly longer hospital stay.

Not just substance use: the critical gap in nutritional interventions for pregnant women with opioid use disorders

ObjectivesPregnancy is a time when optimization of nutrition is critically important, yet pregnant women with substance use disorders face unique nutritional challenges. The aim of this short communication is to summarize existing knowledge about nutritional interventions used in substance use disorders for pregnant and parenting women with opioid use disorder (OUD) and substance use disorders and to inform program development by maternity care and treatment providers. Study designWe conducted a narrative review of nutritional interventions for pregnant women with OUD and performed environmental scanning to explore current practice. MethodsTo gain knowledge about the unique nutritional needs of pregnant women with OUD, we searched the medical literature using Medical Subject Headings terms and key words combining the concepts of nutrition, pregnancy, and substance use. To explore current practice, we interviewed staff of a geographically diverse sample of 35 programs treating women with substance use disorders across the United Stated and Canada on their approach to prenatal nutrition for clients. ResultsLiterature review identified two studies evaluating the nutritional status of pregnant women with substance use disorders, but neither described nutritional interventions. Lower body mass index and folate, B12, and iron deficiencies were found in women with OUD compared with women without OUD. Two additional studies integrated nutritional interventions in substance use treatment for non-pregnant populations, resulting in significant improvements in dietary habits and psychological well-being for participants. Of 15 substance use treatment programs that responded to our query, only two incorporated longitudinal nutrition curricula for pregnant women. ConclusionsPregnancy is a time when a healthy diet is critically important for maternal, fetal, and neonatal health; however, pregnant women with OUD are at significant risk of malnutrition. There is an urgent need to address food insecurity and develop targeted nutrition education programs for pregnant women in early recovery.

Identifikasi risiko malnutrisi dan evaluasi status nutrisi pasien kanker anak dengan pengobatan kemoterapi

Identification of malnutritional risk and nutrition status evaluation of pediatric cancer patients with chemotherapy treatmentBackground: Hospitalized childhood cancer patients had a high risk for malnutrition, either caused by the disease or effects of cancer treatment. Malnutrition in cancer patients gives negative impacts on treatment outcomes in the form of increasing morbidity and mortality rates. Nutrition screening for identifying malnutrition risks could prevent malnutrition in hospitals.Objectives: Investigating the influence of malnutrition risk during hospitalization on the changes in the nutritional status of childhood cancer patients with chemotherapy treatment. Methods: This research was observational research with the nested case-control design. The research subjects were childhood cancer patients aged 2-18 years old meeting the inclusion criteria. They were 64 in number consisting of the case group involving 32 patients and a control group involving the rest. During hospitalization, analyses of nutritional intake, change in body weight, nutritional status, and hospitalization period. Furthermore, the analyses of the influence of malnutrition risk on the outcome between those two groups were then compared. Results: There was a significant influence of malnutrition risk on less energy intake (p<0.001), less protein intake (p=0.002), weight loss >2% (p<0.001), poor nutritional status based on the BMI/U (p=0.011), and longer hospitalization (p=0.034). The group of patients with malnutrition risks had risks of 15.5 (CI 95%: 3.991-63.359) times higher for less energy intake, 6.12 (CI 95%: 1.675-24.906) times higher for less protein intake, and 45.3 (CI 95%: 5.666-1940.768) times higher for weight loss > 2% than the group of patients without malnutrition risks.Conclusions: Patients with a significant risk of malnutrition had less energy and protein intake, weight loss > 2%, poor nutritional status based on BMI/U, and longer hospitalization.

MP67-11 NUTRITIONAL PREDICTORS OF PERIOPERATIVE COMPLICATIONS AND MORTALITY FOLLOWING RADICAL CYSTECTOMY: A POPULATION-BASED ANALYSIS

INTRODUCTION AND OBJECTIVES: The standard of care for patients with muscle-invasive urothelial carcinoma of the bladder (UC) is radical cystectomy (RC). Many patients undergoing RC are at significant risk of malnutrition due to a combination of age, comorbidity, and disease-factors. Our objective was to assess the prevalence of markers of malnutrition among a population-based sample of patients treated with RC, and to evaluate the impact of nutritional-features on 30-day complications and mortality rates. METHODS: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database identified 2055 patients who underwent RC for UC from 2006-2012. Preoperative albumin ( 10% weight loss within 6 months of surgery, and body mass index (BMI, categorized as underweight, normal weight, overweight, class I, II, and III obesity as 10% was observed in 3.5% and preoperative albumin 40kg/m: OR 4.1, p1⁄40.004). CONCLUSIONS: Low serum albumin and increasing degrees of obesity independently predict an increased risk of complications within 30 days of RC. BMI appears to demonstrate a U-shaped relationship with 30-day death, such that the highest risk of postoperative mortality exists in those patients who are underweight or morbidly obese.

MP67-12 THE MODIFIED FRAILTY INDEX AS A MARKER OF ADVERSE OUTCOMES DURING CYSTECTOMY FOR UROTHELIAL CANCER

INTRODUCTION AND OBJECTIVES: The standard of care for patients with muscle-invasive urothelial carcinoma of the bladder (UC) is radical cystectomy (RC). Many patients undergoing RC are at significant risk of malnutrition due to a combination of age, comorbidity, and disease-factors. Our objective was to assess the prevalence of markers of malnutrition among a population-based sample of patients treated with RC, and to evaluate the impact of nutritional-features on 30-day complications and mortality rates. METHODS: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database identified 2055 patients who underwent RC for UC from 2006-2012. Preoperative albumin ( 10% weight loss within 6 months of surgery, and body mass index (BMI, categorized as underweight, normal weight, overweight, class I, II, and III obesity as 10% was observed in 3.5% and preoperative albumin 40kg/m: OR 4.1, p1⁄40.004). CONCLUSIONS: Low serum albumin and increasing degrees of obesity independently predict an increased risk of complications within 30 days of RC. BMI appears to demonstrate a U-shaped relationship with 30-day death, such that the highest risk of postoperative mortality exists in those patients who are underweight or morbidly obese.

PTH-121 The Burden Of Poor Nutrition In Chronic Pancreatitis: What Are The Impact Of Behavioural And Socioeconomic Factors?

IntroductionNutrition centred research in pancreatitis has largely focused on acute pancreatitis. There is limited nutritional data in patients with Chronic Pancreatitis (CP), a condition that predisposes to endocrine and exocrine...

OC-074 Nutritional Optimisation And Pancreatic Enzyme Supplementation In Chronic Pancreatitis: Are We Giving Our Patient’s Enough Advice?

IntroductionThere is a significant risk of malnutrition in patients with Chronic Pancreatitis (CP) with evidence to suggest that good dietary counselling for a balanced homemade diet is as good as...

Perioperative nutrition interventions for women with ovarian cancer

Women with ovarian cancer have been shown to be at significant risk of malnutrition with incidence rates described as being between 28% to 67%. Nutrition interventions may improve clinical outcomes positively, nutritional status or quality of life measures in this patient group. This review was conducted to assess the effects of nutrition interventions during the perioperative period for women with ovarian cancer. Electronic searches were conducted of the Cochrane Gynaecological Cancer Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 7), Medline (1946 to July week 4 2012), Embase (1980 to 2012 week 31), DARE (to 7th August 2012) AMED (1985 to April 2012), BNI (1992 to April 2012), CINAHL (to April 2012). We also searched trials databases, conference proceedings and related citation lists. Reference listings were handsearched. No restrictions were applied on language or date. Randomised controlled trials (RCTs) in which women 18 years and over with any stage of ovarian cancer, including recurrent cancer, were in the perioperative phase of treatment and received any type of nutrition intervention. Titles and abstracts were screened by two review authors with study selection discussed by a team. Pairs of review authors worked independently on data collection and compared findings. A total of 4092 titles were screened and 14 full text reports reviewed; a single small study met the inclusion criteria. In the included RCT, 40 women (35 with ovarian cancer) had extensive elective surgery including bowel resection for treatment of gynaecological malignancy. Randomisation was made to either early oral feeding (oral fluids in the first 24 hours, solid foods on the following day) or to a 'traditional' feeding regimen where oral fluids and foods were delayed until there was evidence of bowel function. Most women in the early feeding group (14/18) were able to resume eating solid food one day after surgery. This resulted in a significantly shorter hospital stay with no increase in postoperative complications or change in quality of life measures in comparison with the women on the 'traditional' feeding regimen. The incidence of nausea and vomiting during the postoperative stay was similar in both groups and was noted in slightly more than half of the women. Overall survival was evaluated until 30 days following discharge from hospital; in this period, there was one death of a woman who had been in the 'traditional oral feeding' group, cause of death was not noted. We assessed risk of bias and found no high risk of bias was identified in the methodology and reporting of the included study, although there was an increased risk of bias due to the small size of the study in which not all of the women had ovarian cancer. Although women with ovarian cancer have been shown to be at risk of malnutrition, there is a lack of evidence derived from RCTs evaluating the identification, assessment and treatment of malnutrition during the perioperative phase of treatment. There is evidence from one small study that some women with ovarian cancer undergoing surgery with associated bowel resection may safely commence oral fluids within 24 hours of surgery and solid foods on the following day. Further research is required, including a RCT, to generate guidance concerning the treatment of malnutrition in this patient group.

Acute pancreatitis: Practical considerations in nutrition support

Acute pancreatitis is a clinical syndrome defined by a discrete episode of abdominal pain and elevations in serum enzyme levels. Seventy-five percent to 85% of all pancreatic episodes are considered mild and self-limiting and do not require intervention with nutrition support. Considering the significant risk of malnutrition in moderate to severe forms of pancreatic injury, enteral nutrition has more recently been documented in its benefit as an adjunct to management. In addition, it may play a role in obviating the systemic inflammatory response syndrome and in modifying the course of the disease. This paper reviews practical considerations in feeding patients with severe acute pancreatitis, including discussion of gastric versus post-pyloric feeding, choice of enteral product, and relative role and optimization of parenteral nutrition support.

Nutritional screening and assessment in cancer-associated malnutrition

Up to 85% of all patients with cancer develop clinical malnutrition, which negatively affects patients' response to therapy, increases the incidence of treatment-related side effects and can decrease survival. Early identification of patients who are malnourished or at risk of malnutrition can promote recovery and improve prognosis. In addition, early nutritional intervention is cost effective, as it reduces complication rates and length of hospital stay. The development and use of screening and assessment tools is essential for effective nutritional intervention and management of patients with cancer. Nutritional screening aims to identify patients who are malnourished or at significant risk of malnutrition. Patients identified through screening require referral to a dietician or specialist in nutrition for an in-depth nutritional assessment, involving examination of medical, dietary, psychological and social history, physical examination, anthropometry and biochemical testing. Interventions initiated after nutritional assessment should be tailored to the individual and take into consideration the patient's prognosis. Nutritional care is a fundamental aspect of nursing practice and nurses are ideally placed to play an essential role in the early detection and screening of malnutrition in patients with cancer.