Simplified Nutritional Appetite Questionnaire Score Research Articles

Anorexia assessment using the Simplified Nutritional Appetite Questionnaire and its association with activities of daily living in patients with stroke

ObjectiveThis study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire. MethodsThis cross-sectional observational study assessed appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment – Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes. ResultsAmong the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13–16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (β = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R2 = 0.662). ConclusionsThis study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.

Appetite-inducing effect and safety evaluation of Habb-e-Hilteet in patients with Ḍu‘f al-Ishtihā (anorexia): An open prospective clinical trial

Objectives: Anorexia is one among the most prevalent conditions triggering malnutrition, drastic weight loss and serious health issues in people especially older adults. Habb-e-Hilteet is commonly prescribed Unani pharmacopoeial formulation for anorexia. However, no scientific data is available as to its safety and efficacy. The current study assessed the appetite-inducing effect and safety of Habb-e-Hilteet in Ḍu‘f al-Ishtihā (anorexia) patients.
 Methods: An open prospective clinical trial was carried out in 95 clinically diagnosed anorexia patients of either gender (19-65 yrs old). The study was approved by Institutional ethic committee and conducted in accordance with the GCP guidelines. Habb-e-Hilteet, 1 pill (500mg) was administered orally in patients twice daily for 14 days. The safety of the formulation was assessed by important pathological and biochemical indices and monitoring adverse events. The efficacy was assessed on the basis of improvement in the Simplified Nutritional Appetite Questionnaire (SNAQ) score.
 Results: Out of 95 patients recruited, 78 completed the trial and 17 patients lost to follow-up. The mean age of patients was 29.8 yrs, with the majority (59.0%) being female. Overall therapeutic response was found to be 96%. A significant (P<0.05) increase in the mean SNAQ score was observed after 7 and 14 days of treatment when compared to baseline. No significant difference before and after treatment was observed in pathological and biochemical indices. No adverse events were reported during the entire study period.
 Conclusion: The study results indicate that Habb-e-Hilteet could be a viable treatment option for anorexia with no safety concerns.
 Keywords: Ḍu‘f al-Ishtihā; Buṭlān al-Shahwa; Anorexia; Habb-e-Hilteet; Unani pharmacopoeal formulation.

Dynamic Scoring of Appetite Predicts Inpatient Survival in Patients with Acute-on-Chronic Liver Failure

Background and Aim: Decreased appetite is common in patients with liver disease and may be mediated by inflammatory cytokines. Acute-on-chronic liver failure (ACLF) is associated with raised inflammatory cytokines. The aim of this study was to evaluate appetite scoring as a predictor of inhospital survival in patients with ACLF. Methods: In a prospective observational study, consecutive hospitalized patients with ACLF were recruited. Appetite was assessed daily using Simplified Nutritional Appetite Questionnaire (SNAQ). The total SNAQ score ranged from 4 to 20, and a change in SNAQ score ≥1 was considered significant. Patients received standard medical care. Outcome was defined as good when patient was discharged in a stable condition and as poor if patient died or was discharged in terminal state. Results: Seventy-five ACLF patients (mean age 44 years; 66 males) were recruited. The median length of hospital stay was 5 (range: 1–20) days. Outcome was good in 50 and poor in 25 patients. Patients with good outcome had higher Day 1 SNAQ score (median: 12, range: 7–16) than patients with poor outcome (median: 10, range: 5–16) (P < 0.001). The area under receiver operating characteristic curve to predict poor outcome was 0.71 (95% confidence interval [CI]: 0.56–0.86) for Day 1 SNAQ score and 0.90 (95% CI: 0.82–0.98) for SNAQ δ. When divided into tertiles based on Day 1 SNAQ score, the outcome was good for all patients whose appetite improved and poor for all patients whose appetite worsened on Day 3. Conclusion: Appetite (SNAQ) scores on Day 1 and change on Day 3 predict inhospital survival in ACLF patients. SNAQ is a simple bedside tool which may help in guiding therapeutic decisions in ACLF patients. Further larger studies are required to validate these findings.

The influence of olfactory dysfunction on risk of malnutrition is mediated by depressive symptoms in cancer patients undergoing chemotherapy.

Malnutrition is common and detrimental in cancer patients undergoing chemotherapy. There are close associations between olfactory dysfunction, depression, and malnutrition, but how they correlate in cancer patients undergoing chemotherapy remains unclear. Two hundred and one cancer patients undergoing chemotherapy were recruited to this study. Their risk of malnutrition was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ); odor identification was assessed by Sniffin' Sticks test; self-measurement of olfaction was assessed by Self-reported Mini Olfactory Questionnaire (Self-MOQ); and depressive symptoms were assessed using the Beck Depression Inventory (BDI). Correlation analyses and mediation analyses were used to explore the relationships between olfaction, depression, and risk of malnutrition. The SNAQ score was negatively correlated with the Self-MOQ score and BDI score, and positively correlated with body mass index (BMI) scores and odor identification. The Self-MOQ score was negatively correlated with odor identification and positively correlated with BDI scores, and the duration of chemotherapy was negatively correlated with odor identification. Mediation analyses suggested that BDI scores exhibited a partial mediation effect on the relationship between Self-MOQ score and SNAQ scores. The influence of olfactory dysfunction on risk of malnutrition is mediated by depressive symptoms in cancer patients undergoing chemotherapy. Early intervention of olfactory dysfunction and depressive symptoms may be helpful in reducing the risk malnutrition in cancer patients undergoing chemotherapy.

Accuracy of the Simplified Nutritional Appetite Questionnaire for Malnutrition and Sarcopenia Screening among Older Patients Requiring Rehabilitation.

This cross-sectional study aimed to examine the accuracy of the Simplified Nutritional Appetite Questionnaire (SNAQ) and the SNAQ for Japanese Elderly (SNAQ-JE) for the Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition and sarcopenia screening in older persons. We included 380 inpatients aged ≥65 years (mean age, 79.3 ± 7.9; 60.0% women) and admitted to rehabilitation units. Undernutrition and sarcopenia were diagnosed based on GLIM criteria and the Asian Working Group for Sarcopenia, respectively, using bioimpedance analysis. Poor appetite was defined as an SNAQ score of <14 points and an SNAQ-JE score of ≤14 points. The sensitivity, specificity, and accuracy of these tools for detecting poor appetite for GLIM-defined malnutrition and sarcopenia were assessed. The rates of GLIM-defined malnutrition and sarcopenia were 56.8% and 59.2%, respectively. The number of patients with poor appetite was 94 (24.7%) for the SNAQ and 234 (61.6%) for the SNAQ-JE. The sensitivity and specificity of the SNAQ measured against GLIM-defined malnutrition were 32.9% and 73.1%, respectively, and against sarcopenia were 29.8% and 70.2%, respectively. The sensitivity and specificity of the SNAQ-JE measured against GLIM-defined malnutrition were 82.6% and 51.0%, respectively, and against sarcopenia were 86.0% and 53.7%, respectively. The SNAQ-JE showed fair accuracy for GLIM-defined malnutrition and sarcopenia in older patients admitted to rehabilitation units.

A retrospective study on the efficacy of Ninjin’yoeito on fatigue in patients with interstitial pneumonia

IntroductionFatigue, caused by dyspnea associated with progression of interstitial pneumonia (IP), can negatively affect patients' quality of life (QOL). Ninjin’yoeito (NYT), a Chinese herbal medicine, is prescribed for general symptoms of fatigue and for fatigue associated with various respiratory diseases. However, there is a lack of integrated research on the effects of NYT in patients with IP. Therefore, we retrospectively investigated the efficacy of NYT in patients with IP and fatigue. Materials and methodsFrom the IP patients who had taken NYT, 19 who met the following inclusion criteria were included: (1) age of ≥20 years, (2) fatigue, and (3) history of NYT administration. The primary endpoint was fatigue, which was assessed using the Chalder Fatigue Scale (CFS). The secondary endpoints were loss of appetite and dyspnea, which were evaluated using the Simplified Nutritional Appetite Questionnaire (SNAQ) and modified Medical Research Council (mMRC) scores, respectively. All items were measured before and after 12 weeks of NYT administration. ResultsIn the enrolled 19 patients (male, 12; female, 7; mean age, 65.8 ± 12.7 years), the underlying diseases were idiopathic pulmonary fibrosis (n = 8), idiopathic pleuroparenchymal fibroelastosis (n = 5), connective tissue disease-related interstitial pneumonia (n = 2), chronic hypersensitivity pneumonitis (n = 3), and nonspecific interstitial pneumonia (n = 1). The CFS score decreased from 17.1 ± 6.8 before administration to 13.4 ± 5.7 after administration of NYT (p = 0.0389). The SNAQ score did not change markedly. The median mMRC score decreased from 3 to 2, however, the difference was not significant. ConclusionMany subtypes of IP are progressive, and a cure cannot be expected in cases of irreversible lung fibrosis. Therefore, a multifaceted approach to improve and maintain the QOL is needed in addition to the standard of care. This study showed that NYT can improve fatigue and help maintain the QOL in IP patients.

The composition of the gut microbiome differs among community dwelling older people with good and poor appetite.

BackgroundAnorexia of ageing is common and important in the development of sarcopenia in older individuals. Links have been proposed between the gut microbiota and sarcopenia. Disordered gut function is also recognized in anorexia of ageing, but how this may relate to resident gut microbiota is unexplored. Understanding this relationship may provide a basis for novel interventions for anorexia of ageing and sarcopenia. This study explores compositional differences of the gut microbiota between community dwelling healthy older adults with good or poor appetite, and associated differences in sarcopenia.MethodsWe assessed appetite by the Simplified Nutritional Appetite Questionnaire (SNAQ) in members of the TwinsUK cohort aged ≥65 years. Using a pool of 776 individuals with existing microbiome data estimated from 16S rRNA sequencing data, we identified 102 cases (SNAQ score < 14) (95% female, mean age 68 years) matched to controls (SNAQ > 14) on body mass index, gender, age, diet, calorie consumption, frailty, antibiotic use, socio‐economic status, and technical variables to minimize confounding microbiota associations. Species abundance and diversity, compositional differences, and paired differences in taxa abundance were compared between cases and controls. Additionally, we compared case and controls for sarcopenia as measured by muscle mass (appendicular lean mass/height2) and strength (chair stand time in seconds).ResultsCases with poor appetite had reduced species richness and diversity of their gut microbiome (adjusted OBSERVED: beta = −0.2, P < 0.001; adjusted SHANNON: beta = −0.17, P = 0.0135), significant compositional differences (adjusted non‐parametric multivariate analysis of variance, P = 0.0095), and significant differences in taxa abundance including reduction of genus Lachnospira (logFC = −1.015, q = 0.023). In all‐female subgroup analysis, cases with poor appetite demonstrated reduction in muscle strength (11.03 s vs. 9.26 s, P = 0.02).ConclusionsThis study is the first to observe differences in the composition of gut microbiota between healthy community dwelling older individuals with good and poor appetite. We found female individuals with reduced muscle strength had poor appetite compared with those with normal strength. These associations require further examination to understand causality and mechanisms of interaction, to inform potential strategies targeting the gut microbiota as a novel intervention for anorexia of ageing and sarcopenia.

The effect of narrow-band ultraviolet B radiation on sleep, happiness, and appetite: A prospective cohort study.

The health benefits of sunlight are well documented, including the effects on happiness and sleep. However, only a few studies have investigated the benefits of artificial narrow-band ultraviolet B (NB-UVB) radiation. To investigate the effect of NB-UVB on sleep quality, happiness, and appetite. Patients from a single phototherapy unit were selected, and their epidemiological characteristics were documented. Subjects were asked to complete questionnaires including the Pittsburg Sleep Quality Index (PSQI), Subjective Happiness Scale (SHS), and the Simplified Nutritional Appetite Questionnaire (SNAQ) 4weeks before and after the initiation of the NB-UVB therapy. The sample consisted of 52 patients. Four weeks after the initiation of NB-UVB sessions, sleep quality was significantly improved (the PSQI decreased from 6.5 to 5.23 (t = -3.52, P<.01). In contrast, subjective happiness did not improve (the SHS decreased from baseline 5.5 to 5.2, P>.05). Similarly, appetite did not change (the SNAQ score increased from baseline 14.75 to 15.05, P>.05) and body mass index was not affected by phototherapy. In general, men were found to have better sleep quality before and after UV light therapy. Our data suggest that NB-UVB exposure over 4weeks improves sleep quality; however, it does not influence happiness or appetite.

Poor Appetite Is Associated with Six Month Mortality in Hospitalised Older Men and Women.

Appetite loss is common in hospitalised older individuals but not routinely assessed. Poor appetite in hospital has previously been identified as predictive of greater mortality in the six months following discharge in a single study of female patients. The present study aimed to assess this association in a larger sample including both hospitalised men and women. Longitudinal observational study with six month follow up. Acute hospital wards in a single large hospital in England. Older inpatients aged over 70 years. Appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) during hospital stay. Deaths during six month follow-up period were recorded. Association between SNAQ score during hospital admission and death 6 months post-discharge was assessed using binary logistic regression in unadjusted and adjusted analysis. 296 participants (43% female, mean age 83 years (SD 6.9)) were included in this study. Prevalence of poor appetite (SNAQ score <14) was 41%. In unadjusted analysis a SNAQ score of <14 was associated with a 2.47 increase in odds of mortality at six months (OR 2.47 (95% CI 1.27,4.82)). This association remained after adjusting for number of comorbidities (Charlson index), length of stay and gender (OR 2.62 (95% CI 1.30, 5.27)). In unadjusted continuous analysis, every one point decrease in SNAQ score led to a 1.20 fold increase in odds of mortality at six months (OR 1.20 (95% CI 1.06-1.36)). This association remained in adjusted analysis (OR 1.22 (95% CI 1.07-1.39)). Poor appetite is common in hospitalised older people. We have confirmed the association, previously reported in older women, between poor appetite during hospital stay and greater mortality at six months post-discharge but in a larger study including older men and women. Further research is needed to understand the mechanisms of poor appetite, which lead to increased mortality.

Effects of Polypharmacy on Appetite and Malnutrition Risk Among Institutionalized Lebanese Older Adults - Preliminary Results

Abstract Objectives We aimed to assess the polypharmacy effect on appetite and malnutrition risk among Lebanese nursing home residents. We hypothesized that polypharmacy will be associated to lower appetite and increased of malnutrition. Methods A cross-sectional pilot study was carried out in two nursing homes in the North-Lebanon region. Fifty-three older adults (OA) aged 60 and above were recruited and were interviewed face-to-face. A general questionnaire was administered to gather information about their socio-demographics, dietary habits and physical activity routine. Appetite was evaluated by the Simplified Nutritional Appetite Questionnaire (SNAQ) validated for use with nursing homes residents. The participants' nutritional status was assessed using the Short Form of the Mini-Nutritional Assessment (MNA-SF). Polypharmacy was determined if OA were taking 5 or more medications. Information about attitudes towards the use, the number and the cost of medications was also collected. Differences in SNAQ and MNA scores based on polypharmacy were tested using Independent t-tests. Logistic regression was performed to assess the association between polypharmacy and nutritional status after adjusting for several factors. Results Our sample constituted of 49.1% females with an average age of 67.6 ± 3.8 and BMI of 22.3 ± 1.7 kg/m2. The majority were widowed (79.2%) and had a low level of education (85% elementary education). Regarding the MNA scores, 33% had a normal nutritional status while 59% were at risk of malnutrition and 8% were malnourished, with an average MNA score of 10.1 ± 2.2. The average SNAQ score was 11.0 ± 3.3, with 85% scoring ≤14, indicating an significant risk of at least 5% weight loss withing 6 months. Regarding medication use, 50.9% of OA take at least 5 drugs/d with an average of 4.3 ± 2 drugs. Independent t-tests showed that MNA scores were significantly lower in those taking 5 drugs/d vs those taking less (9.4 ± 2.5 vs 10.8 ± 1.6, P = .024) while no significant difference was observed for SNAQ scores (10.3 ± 2.9 vs 11.6 ± 3.6, P = .13). Logistic regressions did not show any significant association between polypharmacy and MNA or SNAQ categories. Conclusions Lower MNA scores were observed in OA taking ≥5 drugs/d indicating a higher risk of malnutrition with polypharmacy. This is significant since malnutrition can further worsen the aging process. Funding Sources N/A.

Combined effect of poor appetite and low masticatory function on sarcopenia in community-dwelling Japanese adults aged≥75 years: A 3-year cohort study.

This study aimed to investigate the longitudinal association of the combination of poor appetite (PA) and low masticatory function (LMF) with sarcopenia in community-dwelling older adults. In total, 173 community-dwelling Japanese adults aged≥75years participated in the 3-year cohort study. Appetite assessment using the Simplified Nutritional Appetite Questionnaire (SNAQ) and masticatory function assessment using spectrophotometric measurement of differences in gum colour before and after masticating colour-changeable chewing gum (ΔE*ab) were performed at baseline. SNAQ score of≤14 was defined as PA. The lowest tertile of ΔE*ab was defined as LMF. Follow-up examinations were administered annually over a 3-year period to determine sarcopenia incidence, which was defined by the criteria proposed by the Asian Working Group for Sarcopenia. Adjusted hazard ratios (HRs) of sarcopenia incidence according to the presence of PA and LMF were calculated using Cox proportional hazards regression models. At baseline, 81 participants (46.8%) had neither PA nor LMF, 34 (19.7%) had PA alone, 35 (20.2%) had LMF alone, and 23 (13.3%) had both PA and LMF. On follow-up, 31 participants (17.9%) developed sarcopenia. After adjusting for covariates, the adjusted HR for sarcopenia in participants with both PA and LMF was 4.4 (95% confidence interval=1.6-12.2) compared with those without PA or LMF. PA or LMF alone was not significantly associated with sarcopenia development. Coexisting PA and LMF increase the risk of sarcopenia development among community-dwelling Japanese adults aged≥75years.

108 Poor Appetite is Common in Hospitalised Older People and Associated with Subclinical Low Mood

Abstract Introduction Appetite loss in older people -anorexia of ageing (AA) - is common. Recognised consequences include undernutrition, sarcopenia, frailty, and increased mortality after discharge from hospital. Identification and management of AA may prevent onset of these health burdens. Whilst appetite can be assessed, this is often not routine. Methods Cross-sectional data from three studies (carried out 2010-2017), with comparable data collection methods and drawn from the same population, were combined. Participants were over 70 years, admitted to acute wards within a large UK hospital. Appetite was assessed using the simple 4 item Simplified Nutritional Appetite Questionnaire (SNAQ); a score of ≤14/20 defines poor appetite. Correlates of SNAQ scores were evaluated. Results The dataset included 474 participants (64% female) with mean age 84 (6.5), median Barthel 78 (IQR 53-91), mini-mental state exam (MMSE) 27 (IQR 23-29) and comorbidity index 5 (IQR 4-7). The median GDS for the population was 4 (IQR 4-6). The mean SNAQ score was 13.9 (SD 2.6), and 265 (56%) participants scored ≤14 indicating poor appetite. There was no significant difference between mean SNAQ scores of men and women (P=.26), or those living alone and with others (P=.62). Age, MMSE, comorbidity index, and total number of medications were not related to SNAQ score in continuous analyses but geriatric depression score (GDS-15) was (adjusted coefficient -.248; P&amp;lt;.001); such that lower mood was associated with poorer appetite. Conclusions These findings highlight the importance of assessing appetite in hospitalised older people, as poor appetite is very common. Appetite can be assessed in hospital using the simple 4 item SNAQ tool. Subclinical low mood, measured by GDS-15, had the strongest association with SNAQ score whilst in hospital. Therefore, for those with poor appetite in hospital, clinicians should have a low threshold to evaluate and treat low mood.

Validity and Reliability of Korean Version of Simplified Nutritional Appetite Questionnaire in Patients with Advanced Cancer: A Multicenter, Longitudinal Study

PurposeMalnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. Nutrition risk screening aims to increase awareness and allow early recognition and treatment of cancer cachexia. Therefore, screenings should be brief, inexpensive, highly sensitive, and have good specificity. Simplified Nutritional Appetite Questionnaire (SNAQ) is a simple screening tool including four questions, and validated to predict weight loss within 6 months in community-dwelling adults and nursing home residents. Our study aimed to translate the SNAQ into Korean, and to assess the validity and reliability of the translated screening tool in advanced cancer patients.Materials and MethodsThe SNAQ was translated into Korean according to linguistic validation. The internal consistency of the SNAQ was evaluated by Cronbach’s alpha coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient. Concurrent validity was evaluated by measuring the Pearson’s correlation coefficient between the SNAQ and Mini-Nutritional Assessment (MNA) and Patient-Generated Subjective Global Assessment (PG-SGA).ResultsIn the 194 patients included in full analysis set, cancer stage was predominantly metastatic (98.5%), the mean age was 60 years (range, 23 to 81 years), and the mean body mass index was 24 kg/m2 (range, 15.6 to 39.6 kg/m2). According to MNA score ≤ 11, 57 patients (29.4%) were malnourished. The mean score (±standard deviation) of the Korean version of the SNAQ was 13.8±2.5 with a range of 6-19. Cronbach’s alpha coefficient was 0.737, and intraclass correlation coefficient was 0.869. The SNAQ was moderately correlated with MNA (r=0.404, p < 0.001) and PG-SGA (r=–0.530, p < 0.001). A significant weight loss of > 5% of the original bodyweightwithin 6 months occurred in 46 of the 186 patients (24.7%). SNAQ score ≤ 14 predicted > 5% weight loss with a sensitivity of 56.5% and a specificity of 44.3%.ConclusionThe Korean version of the SNAQ had high validity and reliability. SNAQ is useful for the screening tool for advanced cancer patients. The SNAQ had a limitation to predict impending weight loss in advanced cancer patients.

Abstract 16800: Sarcopenia in Advanced Systolic Heart Failure Patients Receiving Left Ventricular Assist Devices

Introduction: Sarcopenia is the age-related deterioration in skeletal muscle mass and function, which can be accelerated by chronic comorbidities. The prevalence in advanced systolic heart failure (HF) and impact on HF health status are currently uncertain. Sarcopenia diagnostic criteria from the Foundation for the National Institutes of Health (FNIH) and European Working Group on Sarcopenia in Older People (EWGSOP) have not been applied to HF cohorts. Hypothesis: We hypothesized that at the time of left ventricular assist device (LVAD) implantation systolic HF patients have prevalent sarcopenia, and that sarcopenia is associated with poorer nutritional and HF health status. Methods: We recruited 18 adults with systolic HF ±21 days from LVAD implantation. All underwent whole-body dual X-ray absorptiometry (DXA) to calculate appendicular lean mass (ALM). Subjects also underwent a 3-day food recall, Simplified Nutritional Appetite Questionnaire (SNAQ), Kansas City Cardiomyopathy Questionnaire (KCCQ) for HF health status, handgrip strength and blood testing. Sarcopenia was defined by 2 ALM criteria: FNIH – males &lt;19.75kg, females &lt;15.02kg; EWGSOP – males &lt;7.26kg/m 2 , females &lt;5.5kg/m 2 . Linear regression determined relationships between appendicular lean mass and age, weight, handgrip strength, KCCQ summary score, SNAQ score, 24-hour protein intake, and key blood variables, without/with adjustment for sex and height. Results: Sarcopenia was diagnosed in 5 subjects (28%) by FNIH criteria and an additional 5 (10 total, 56%) by EWGSOP criteria (Figure). There were unadjusted associations between lower appendicular lean mass and lower handgrip strength; higher SNAQ score (higher malnutrition risk); lower sodium; and lower hemoglobin. After adjustment for sex and height, lower lean mass remained associated with lower hemoglobin. Lower appendicular lean mass was also independently associated with higher (more favorable) KCCQ scores. Conclusions: As many as half of advanced systolic HF patients meet standard DXA criteria for sarcopenia. Lower appendicular lean mass is independently associated with lower hemoglobin but does not appear to be associated with poorer HF status.

Usefulness of Simplified Nutritional Appetite Questionnaire (SNAQ) in Appetite Assessment in Elder Patients with Liver Cirrhosis.

Appetite has received little attention in health care and researches in liver cirrhosis. The Simplified Nutritional Appetite Questionnaire (SNAQ), a self-assessment nutritional screening tool, could be used to screen the risk of malnutrition and weight loss. Our objective was to assess the usefulness of SNAQ in appetite assessment in patients with liver cirrhosis. Seventy patients were enrolled. Appetite assessment was applied in the enrolled patients by completing SNAQ. Weight, hemoglobin, albumin, pro-albumin and Child-Pugh class were evaluated and recorded. The correlation between SNAQ score and these indexes was also evaluated. The most discriminating SNAQ value was calculated, which separated the participant at risk of weight loss. In participants with SNAQ < 14, the BMI, hemoglobin, albumin and pro-albumin were significantly less than those in participants with SNAQ ≥ 14. The correlation between SNAQ and these indexes were also observed (hemoglobin: r = 0.334, p = 0.005; albumin: r = 0.384, p = 0.001; pro-albumin: r = 0.342, p = 0.004; BMI: r = 0.550, p = 0.000). The SNAQ scores reduced along with the increase of Child-Pugh class. An SNAQ score under 11.5 was the best clinical indicator of elder people at risk of weight loss. SNAQ can be used to evaluate the appetite loss and predicting the weight loss in patients with liver cirrhosis. The SNAQ tool also can be used by clinicians and nurses to identify patients with a poor appetite who are at risk of weight loss.

Reliability and validity of Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ).

We aimed to investigate reliability and validity of the Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ) in geriatric outpatients. A cross-sectional study was designed through 2013-2016 years. At first, translation and back translation processes of the SNAQ from English to Turkish languages were done consecutively. Then construct validity was performed. They were recruited among the outpatients aged >=60 years that were consecutively admitted to the geriatric outpatient clinic of the Istanbul University hospital. Demographic data was recorded. SNAQ, Mini Nutritional Assessment (MNA), six-item Katz activities of daily living (ADL) and eight-item Lawton instrumental activities of daily living (IADL) scales were applied. 442 participants consisted of 305 women and 137 men with a mean age of 77.1 ± 6.8 years. The SNAQ identified 21.5% (n=95) of the participants with poor appetite. Reliability analysis showed good inter-rater reliability (r= 0.693, p< 0.05) and test-retest stability (r= 0.654, p< 0.05). Cronbach's alpha coefficient was 0.522. In terms of construct validity of SNAQ, Cohen's kappa analysis showed fair to moderate agreement between SNAQ and MNA (κ=0,355, p<0.001). Female gender, being illiterate, functional dependency in IADL were significantly associated with poor appetite. The SNAQ score was weakly correlated with scores of MNA-SF and MNA-LF (r=0.392 and r=0.380, respectively, p<0.0001 for both). There was statistically significantbut negligible correlation between the SNAQ and Katz ADL index, Lawton IADL index, and age. Turkish version of the SNAQ is a simple measurement with sufficient reliability and validity to screen poor appetite in community-dwelling older adults.

Association between plasma endocannabinoids and appetite in hemodialysis patients: A pilot study

Uremia-associated anorexia may be related to altered levels of long chain n-6 and n-3 polyunsaturated fatty acid (PUFA) derived circulating endocannabinoids (EC) and EC-like compounds that are known to mediate appetite. Our study's hypothesis was that such molecules are associated with appetite in patients with end-stage renal disease. A cross-sectional observational study was performed in 20 chronic hemodialysis patients (9 females, 11 males) and 10 healthy female controls in whom appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) and blood drawn in the fasting (and when applicable) pre-dialysis state. Blood levels of PUFA and EC were also measured. Higher blood levels of the long chain n-6 fatty acid 20:4n6 (arachidonic acid) and lower levels of the long chain n-3 fatty acid 20:5n3 (eicosapentaenoic acid) were observed in female hemodialysis patients compared to controls. No differences were observed between male and female patients. In female study participants strong correlations between specific EC-like compounds and total SNAQ scores were noted, including with the n-6 PUFA derived linoleoyl ethanolamide (L-EA; ρ=−0.60, P<.01) and the n-3 PUFA derived docosahexaenoyl ethanolamide (DH-EA; ρ=0.63, P<.01). The L-EA:DH-EA ratio was most strongly associated with the SNAQ score (ρ=−0.74, P≤.001), and its questions associated with appetite (ρ=−0.69, P≤.01) and satiety (ρ=−0.81, P≤.001). These findings support a link between circulating EC and appetite in hemodialysis patients.

Pain May Lead to Malnutrition in Nursing Home Patients

Pain may be a factor in malnutrition in nursing home residents, according to a recent study published in Clinical Nutrition. The report points to a need for prompt assessment and treatment of pain to prevent appetite loss in this population, and consideration of the nutritional impact of drugs when selecting analgesics. In an analysis of data on individuals in 12 nursing homes, Austrian researchers looked at relationships between pain, appetite, and other factors that may have influenced malnutrition. The population assessed, in a secondary analysis from the OSiA (Optimiertes Schmerzmanagement in Altenpflegeheimen, or “optimized pain management in nursing homes”) Study, was 243 nursing home residents 60 or older who had mild or no cognitive impairment (Clin Nutr 2015;34[Suppl 1]:557). Baseline information was drawn from standardized questionnaires and medical documentation. Pain was detected with a verbal rating scale, and a Simplified Nutritional Appetite Questionnaire (SNAQ) was used to detect risk of malnutrition in the patients. A SNAQ score of at least 14 indicates that an individual is at risk of weight loss of at least 5% in the next 6 months. Cross-sectional and single-case analyses showed that overall, 66% of the nursing home residents had pain at rest or in action, 22% had no appetite because of pain, and 25% were at risk of malnourishment. Of the patients in the latter group, 30% reported pain. Pain was reported as the cause of loss of appetite by 43% of those who were at risk for both malnutrition and pain. Looking at use of analgesics in the population, the authors found that 64% of patients at risk of malnutrition, pain, and pain-associated loss of appetite were given analgesics with known adverse effects that included appetite loss, nausea, and vomiting. The drugs in this “inadequate” category that were most commonly prescribed were oral hydromorphone and transdermal fentanyl, and they were given in higher quantity than other drugs. The diagnoses that triggered use of analgesics in the study population included disorders of spine/extremities, injuries, arthrosis, and gastritis/gastralgia, and did not differ whether treatment was considered adequate or inadequate. There were also no differences in use of additional analgesics, such as local diclofenac and oral metamizol (also known as dipyrone, a non-NSAID analgesic and antipyretic not available in the United States), in patients on hydromorphone or fentanyl vs. other pain medications. Presenting the results at the 37th Congress of the European Society for Clinical Nutrition and Metabolism in Lisbon, Portugal, Maria Magdalena Schreier of the Institut of Nursing Science and Practice at Paracelsus Medical University said that screening and assessment of malnutrition should consider pain as a favoring factor for poor appetite. “Nearly two-thirds of the selected residents received analgesics with nutritional side effects. Those analgesics may play an important role in the context of malnutrition.” She encouraged clinicians caring for nursing home residents to assess them for pain systematically and to provide adequate pain treatment to prevent malnourishment in these patients. The appetite-reducing potential of drugs, too, should be considered. Judith M. Orvos, ELS, is a freelance medical writer and president of Orvos Communications in Washington, DC. In this study, 243 residents 60 years or older with no or mild cognitive impairment from 12 nursing homes were screened for pain and assessed for appetite using SNAQ (Short Nutritional Assessment Questionnaire). The results of this study indicated that pain was reported as the cause of loss of appetite by 43% of residents at risk for both malnutrition and pain. Additionally, the researchers investigated the use of analgesics in this population and reported that some of the medications used for pain — oral hydromorphone and fentanyl patches — caused side effects including appetite loss, nausea, and vomiting. The researchers concluded that pain should be evaluated for all nursing home residents using a systematic pain assessment tool and that analgesics provided should be considered for potential nutritional side effects. This study validates and quantifies the impact of pain as a risk factor for malnutrition in older adults in long-term care. In addition to other physical causes of malnutrition including impaired oral status, physical limitations, chronic disease, early satiety, and changes in taste and smell, the presence of pain should be considered when evaluating a resident's risk for malnutrition. Although medications can be helpful to control pain, there are potential side effects of medications which can have negative impacts on nutrition status, including loss of appetite, nausea, vomiting, and constipation, among others. An interdisciplinary approach including the physician, registered nurse, and dietitian should be considered when evaluating and treating pain in the institutionalized older adult. —Phyllis Famularo, DCN, RD Senior Manager, Nutrition Services, Sodexo

P322: Simplified Nutritional Appetite Questionnaire (SNAQ): an alternative test for geriatric nutritional assessment

Introduction: Nutrition is affected negatively in the old age due to physiological changes, acute-chronic diseases, oral-dental health problems, polypharmacy, economical factors, difficulties in food supply, difficulties in preparing and eating food. In this study we aim to evaluate nutritional status of community-dwelling older people by using Simplified Nutritional Appetite Questionnaire (SNAQ) and Mini Nutritional Assessment – Short Form (MNA-SF). Methods: Patients over 75 years of age admitted to outpatient clinic between 3 January 2013 and 31 December 2013 were enrolled. According to comprehensive geriatric assessment; height-weight measurements, weight loss, special diets and difficulty swallowing asked. The participants were evaluated with Katz Activities of Daily Living (ADL) and Lawton-Brody Instrumental Activities of Daily Living scores (IADL), Simplified Nutritional Appetite Questionnaire, Mini Nutritional Assessment Short-Form. Results: A total of 203 elders were included in the study. 33% were male and 67% were female. Mean age was 80.9 years. As a result of MNA-SF scores 5.4% had malnutrition and 22.7% had malnutrition risk. In our study group mean SNAQ score 15.5±2.4. Due to SNAQ scores total 20.7% (women 25.7%, men 10.4%) were at risk of weight loss (Table 1). We observed that a positive advanced correlation between SNAQ and functionality by ADL, IADL, the hand grip, physical activity and ambulation status (Table 2). Conclusions: Nutrition and appetite status of the elderly is an important part of a comprehensive geriatric assessment. It should be performed routinely. SNAQ form can be preferred as a alternative and a quick method for screening nutrition.

Evaluation of ghrelin level and appetite regulation in patients with acute exacerbations of chronic obstructive pulmonary disease.

BackgroundAppetite reduction is a major cause of cachexia in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study tested the correlation of appetite and circulating levels of acylated ghrelin in patients with AECOPD.MethodsThirty-six patients with AECOPD and 23 healthy adults were enrolled in this study. Circulating total ghrelin, acylated ghrelin, and obestatin levels, Simplified Nutritional Appetite Questionnaire (SNAQ) score, and caloric intake were compared in patients and healthy controls. Additionally, the above parameters were compared between admission and discharge in the patients with AECOPD.ResultsCompared with healthy controls, SNAQ scores and caloric intake were significantly lower in patients with AECOPD, but there were no significant differences in total ghrelin, acyl ghrelin, or obestatin levels. In patients with AECOPD, the total ghrelin level was significantly higher at admission than on discharge, the SNAQ score and caloric intake were significantly increased at discharge when compared with admission, and there was no significant difference in acylated ghrelin level between admission and discharge.ConclusionWe demonstrated lower appetite scores and caloric intake in patients with AECOPD, but could not confirm that these effects were caused by insufficient levels of the orexigenic peptide, acyl ghrelin. Further studies are needed to confirm our findings and to determine the mechanism regulating appetite in patients with AECOPD.