Subjective Global Assessment Score Research Articles

Relevance of plasma lipoproteins and small metabolites in assessment of nutritional status among patients with severe injuries

BackgroundThis study aimed to identify plasma lipoproteins and small metabolites associated with high risk of malnutrition during intensive care unit (ICU) stay in patients with severe injuries. MethodsThis observational prospective exploratory study was conducted at two level-1 trauma centers in the Netherlands. Adult patients (aged ≥18 years) who were admitted to the ICU for more than 48 h between July 2018 and April 2022 owing to severe injuries (polytrauma, as defined by Injury Severity Scores of ≥16) caused by blunt trauma were eligible for inclusion. Overall, 51 patients were included; partial least squares discriminant analysis was used to analyze the relationship of 112 lipoprotein-related components and 23 small metabolites with the risk of malnutrition (modified Nutrition Risk in Critically Ill score). Malnutrition was diagnosed based on Subjective Global Assessment scores. The relationship of lipoprotein properties and small metabolite concentrations with malnutrition (during ICU admission) was evaluated using mixed effects logistic regression. ResultsLower (very) low-density lipoprotein ([V]LDL) (free) cholesterol and phospholipid levels, low particle number, and higher levels of LDL triglycerides were associated with a higher risk of malnutrition (variable importance in projection [VIP] value >1.5). Low levels of most (V)LDL and intermediate-density lipoprotein subfractions and high levels of high-density lipoprotein Apo-A1 were associated with the diagnosis of malnutrition (VIP value >1.5). Increased levels of dimethyl sulfone, trimethylamine N-oxide, creatinine, N, N-dimethylglycine, and pyruvic acid and decreased levels of creatine, methionine, and acetoacetic acid were also indicative of malnutrition (VIP value >1.5). Overall, 14 lipoproteins and 1 small metabolite were significantly associated with a high risk of malnutrition during ICU admission (P <0.05); however, the association did not persist after correcting the false discovery rate (P=0.35 for all). ConclusionIncreased triglyceride in several lipoprotein subfractions and decreased levels of other lipoprotein subfraction lipids and several small metabolites (involved in the homocysteine cycle, ketone body formation, and muscle metabolism) may be indicative of malnutrition risk. Following validation in larger cohorts, these indicators may guide institution of preventive nutritional measures in patients admitted to the ICU with severe injuries.

Effect of branched-chain amino acid supplementation and exercise on quadriceps muscle quantity and quality in patients with cirrhosis as assessed by ultrasonography: A randomized controlled trial

Background/aimSarcopenia and myosteatosis are common in patients with cirrhosis. The study aimed to evaluate efficacy of ultrasound to monitor muscle status during branched-chain amino acid (BCAA) supplementation and/or muscle exercise interventional approaches. Patients & MethodsA randomized controlled study, included 220 liver cirrhosis patients with Child- Pugh B & C, randomized into a control group (55 patients) received only the standard care, and interventional groups (165 patients) equally distributed into three subgroups, in addition to standard care, they received BCAA, programmed exercise, or BCAA and programmed exercise. At baseline and after 28 days, all participants were subjected to ultrasound-measured quadriceps muscle thickness and echo-intensity, muscle strength using handgrip, performance using short physical performance battery (SPPB), MELD score and nutritional assessment using 7- subjective global assessment score (SGA) and laboratory assessment. ResultsAll interventional groups showed a significant improvement in the ultrasound detected quadriceps muscle thickness (p = 0.001) & echo intensity, in addition to muscle strength, muscle performance, and SGA. Hematological parameters (hemoglobin & platelet count), biochemical parameters (ALT, AST, bilirubin, creatinine, urea and INR) & MELD score were also improved in the interventional groups. In Child-Pugh B patients BCAA combined with exercise showed an add-on effect. ConclusionBCAA supplements, programed muscle exercise and both are useful interventional methods in improving muscle quality and quantity in cirrhosis patients, which can be monitored by ultrasound. The best results can be achieved by combined intervention in Child-Pugh B, while in Child-Pugh C single intervention may lead to an acceptable improvement. The trial was registered retrospectively in the Clinical Trials RegistryRegistration number NCT06088550).

Efficacy of oral nutritional supplement in cancer patients receiving chemotherapy: a systematic review and meta-analysis of randomized controlled trials.

The use of oral nutritional supplement (ONS) is one of the modalities employed to manage cancer-associated malnutrition. However, evidence of its efficacy is limited. In 2018, a meta-analysis reported the statistical benefits of increased body weight from ONS. This study aimed to evaluate the efficacy of ONS in cancer patients receiving chemotherapy in more recent trials. All randomized controlled trials (RCTs) of adult cancer patients receiving chemotherapy, which compared ONS with standard of care and reported on body weight, nutritional status, or quality of life (QoL), were included. Eligible RCTs were identified from PubMed, OVID, and the references of previous systematic reviews up until February 2023. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool. The outcomes of interest were pooled and analyzed using the mean difference (MD) with a corresponding 95% confidence interval (CI). This study was registered in PROSPERO, number CRD42023400471. Ten RCTs comprising 1,101 patients were included. ONS did not show a significant impact on final body weight (MD -0.07 kg, 95% CI: -0.99 to 0.84, P=0.88). It tended to increase body weight (MD 0.90 kg, 95% CI: -0.48 to 2.28, P=0.20), and this benefit was particularly noticeable in elderly patients, those with low baseline body weight, females, and non-Asian patients. After adjusting for risk of bias, ONS was found to significantly increase body weight (MD 1.32 kg, 95% CI: 0.12 to 2.52, P=0.03), and it also tended to enhance Patient-Generated Subjective Global Assessment (PG-SGA) score of -2.13 (95% CI: -5.07 to 0.82, P=0.16), global domain QoL score of 4.01 (95% CI: 0.08 to 7.94, P=0.05) and fatigue domain QoL score of -7.63 (95% CI: -13.87 to -1.39, P=0.02). ONS could help to increase body weight in cancer patients receiving chemotherapy. This benefit was especially notable in those at high risk of malnutrition, including elderly patients, those with low baseline body weight, females, and non-Asian patients. It also resulted in improved PG-SGA scores and significantly improved patients' QoL during chemotherapy treatment. Future studies should explore the potential benefit of ONS on oncological outcomes or improvements of chemotherapy-related toxicity.

Enhancing Nutritional Status and Quality of Life in Hemodialysis Patients: The Impact of Internet-Based Cognitive Behavioral Therapy

This study examined the effects of internet-based cognitive behavioral therapy on the nutritional status and scores from the Knowledge, Attitude, and Practice questionnaire in maintenance hemodialysis patients. Patients in the traditional therapy group received standard health education, whereas those in the experimental group participated in three months of this therapy. Clinical and nutritional indicators, including blood biomarkers and Knowledge, Attitude, and Practice questionnaire scores, were recorded for both groups before and after the treatment. Post-treatment, the group receiving internet-based cognitive behavioral therapy exhibited higher blood calcium levels, increased upper arm circumference, and reduced levels of potassium and phosphorus. They also showed comparatively lower scores in Nutritional Risk Screening 2000 and Malnutrition Inflammation, along with higher Visual Analog Scale scores (P &lt; 0.05). The internet-based cognitive behavioral therapy group exhibited higher albumin and prealbumin levels, reduced transferrin, total cholesterol, creatinine, and urea levels, and modified quantitative subjective global assessment scores than the traditional therapy group (P &lt; 0.05). They also scored higher on the Knowledge, Attitude, and Practice questionnaire (P &lt; 0.05). These results indicate that internetbased cognitive behavioral therapy can improve the nutritional status, Knowledge, Attitude, and Practice questionnaire scores, and overall quality of life in maintenance hemodialysis patients, highlighting its potential benefit in patient outcomes.

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  

Digital health interventions to promote healthy lifestyle in hemodialysis patients: an interventional pilot study

Low physical activity has been associated with poor prognosis in hemodialysis (HD) patients. Interventions to maintain healthy lifestyle in this population are important to reduce mortality. This study aimed to evaluate the effectiveness of digital health interventions (DHIs) for improving the physical activity and health-related quality of life (HRQoL) in HD patients. The 24-week prospective study enrolled 31 clinically stable HD patients. All participants were assigned home exercises and provided with wearable devices. Dietary and exercise information was uploaded to a health management platform. Suggestions about diet and exercise were provided, and a social media group was created. Physical performance testing was performed at baseline and during weeks 4, 8, 12, 16 and 24. HRQoL and nutritional status were evaluated. A total of 25 participants completed the study. After the interventions, the daily step count increased 1658 steps. The 10-time-repeated sit-to-stand test reduced by 4.4 s, the sit-to-stand transfers in 60 s increased 12 repetitions, the distance of six-minute walk test (6MWT) increased by 55.4 m. The mental health components and burden of kidney disease of the Kidney Disease Quality of Life survey, and subjective global assessment (SGA) scores improved. By Spearman correlation, the monthly step count correlated positively with 6MWT and SGA. DHIs that combined wearable devices, a health management platform, and social media could strengthen physical activity and improve the HRQoL and nutrition of maintenance HD patients. The results outline a new model to promote healthy lifestyle behaviors in HD patients.

Clinical efficacy of modified Kamikawa anastomosis in patients with laparoscopic proximal gastrectomy.

With the increasing incidence of proximal gastric cancer, laparoscopic proximal gastrectomy has been applied. However, reflux esophagitis often occurs after traditional esophagogastric anastomosis. In order to solve this problem, several methods of digestive tract reconstruction have emerged, but the most satisfying method remains to be discussed. Therefore, we modified traditional Kamikawa anastomosis to investigate the appropriate digestive tract reconstruction in laparoscopic proximal gastrectomy. To discuss the clinical efficacy of modified Kamikawa anastomosis in laparoscopic proximal gastrectomy. A retrospective case series was adopted. Clinicopathological data were collected from 26 patients who underwent laparoscopic proximal gastrectomy and modified Kamikawa anastomosis at our hospital from January 2020 to September 2022. The operation conditions, postoperative recovery, postoperative complications, and follow-up data were collected and analyzed. All the patients were successfully operated on without conversion to laparotomy. The duration of operation and digestive tract reconstruction were 203.500 (150-224) min and 87.500 (73-111) min, respectively. The intraoperative amount of bleeding was 20.500 mL ± 0.696 mL. The time of postoperative first flatus, the first postoperative fluid intake, and the postoperative length of stay were 2 (1-3) d, 4 (3-5) d, and 9 (8-10) d, respectively. All the patients were followed up for 12-23 months. The body mass index at 6 and 12 months after surgery were 22.577 kg/m2 ± 3.098 kg/m2 and 22.594 kg/m2 ± 3.207 kg/m2, respectively. The nutrition risk screening 2002 score, the patient-generated subjective global assessment score, and the gastroesophageal reflux disease scale score were good at 6 and 12 months after surgery. Reflux esophagitis and anastomotic stenosis were not observed in any of the patients during their 12-month postoperative gastroscopy or upper gastrointestinal tract visits. All the patients exhibited no tumor recurrence or metastasis. The modified Kamikawa anastomosis is safe and feasible for laparoscopic proximal gastrectomy and has good antireflux effects and nutritional status.

Individualized Dietary Guidance can Help Improve Dietary Compliance in Chronic Renal Failure Patients Undergoing Maintenance Hemodialysis, Improve their Nutritional Status and Enhance their Quality of Life

This study aimed to examine the impact of individualized dietary guidance on the recovery of patients with chronic renal failure undergoing maintenance hemodialysis. This study included 124 patients undergoing maintenance hemodialysis at the Second Affiliated Hospital of Dalian Medical University between March 2020 and March 2023. The patients were divided into an observation group and a control group using a random number table method, with 62 patients in each group. Patients in the observation group received individualized dietary guidance, while those in the control group received conventional dietary guidance. After the intervention, patients in the observation group had higher Renal Adherence Behavior Questionnaire scores, transferrin, albumin, and prealbumin levels, Generic Quality of Life Inventory-74 scores, and fasting blood glucose levels than those in the control group. Furthermore, patients in the observation group had lower subjective global assessment scores, blood phosphorus levels, and incidence of hypoglycemia than those in the control group. Individualized dietary guidance can help improve dietary compliance in patients with chronic renal failure undergoing maintenance hemodialysis, improve their nutritional status, enhance the effectiveness of blood phosphorus and blood glucose management, and elevate their quality of life.

Geriatric Nutritional Risk Index Combined with Calf Circumference Can be a Good Predictor of Prognosis in Patients Undergoing Surgery for Gastric or Colorectal Cancer.

To explore the effect of combined hematological and physical measurement indicators on the prognosis of patients undergoing surgery for gastric or colorectal cancer and to screen for the best prognostic indicators. Gastric and colorectal cancer is a widespread health concern worldwide and one of the major contributors to cancer-related death. The hematological and physical measurement indicators have been shown to associate with the prognosis of patients undergoing surgery for gastric or colorectal cancer, respectively, but it is still unclear whether the combination of the two can reflect the prognosis more effectively. Thirteen hematological indicators and 5 physical measurement indicators were selected in this study, and the most promising ones were screened using LASSO regression. Then, the best prognostic indicators were selected by time-ROC curves. Survival curves were constructed using the Kaplan-Meier method, and the effects of hematological and physical measurement indicators on the prognosis of patients undergoing surgery for gastric or colorectal cancers were evaluated by Cox proportional risk regression analysis. In addition, the relationship between hematological and physical measurement indicators on secondary outcomes, including length of stay, hospitalization costs, intensive care unit (ICU) admission, and patients' subjective global assessment scores (PGSGA), was explored. After initial screening, among the hematological indicators, the geriatric nutritional risk index (GNRI) showed the highest mean area under the curve (AUC) values. Among body measures, calf circumference (CC) showed the highest mean AUC value. Further analyses showed that the combination of combined nutritional prognostic index (GNRI) and calf circumference (CC) (GNRI-CC) had the best performance in predicting the prognosis of patients undergoing surgery for gastric or colorectal cancers. Low GNRI, low CC, and low GNRI-low CC increased the risk of death by 44%, 48%, and 104%, respectively. Sensitivity analyses showed the same trend. In addition, low GNRI-low CC increased the risk of malnutrition by 17%. This study emphasizes that a combination of blood measures and body measures is essential to accurately assess the prognosis of patients undergoing surgery for gastric or colorectal cancers. The GNRI-CC is a good prognostic indicator and can also assess the risk of possible malnutrition.

Influence of Whole-Process Nutrition Management on Nutritional Status of Patients with Esophageal Cancer Undergoing Radiotherapy

To probe the effect of whole-process nutrition management on the nutritional status of patients with esophageal cancer undergoing radiotherapy, 100 patients were allocated to the control group (n = 50) and observation group (n = 50). Patients in both groups underwent routine treatment after admission. The control group adopted conventional nutrition management, while the observation group was given whole-process nutrition management. Compared to the control group, the patient-generated subjective global assessment score in the observation group declined after intervention (P &lt; 0.05). Levels of prealbumin, albumin, transferrin, immunoglobulin A, immunoglobulin G, immunoglobulin M, CD3+, and CD4+ in the observation group were elevated compared to the control group after intervention (P &lt; 0.05). According to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, the observation group exhibited higher scores in the aspects of family understanding and cooperation, mental condition, appetite, daily life, and sleep quality than the control group after intervention (P &lt; 0.05). Furthermore, the incidence of adverse reactions in the observation group was lessened compared to the control group (P &lt; 0.05). Hence, implementing whole-process nutrition management in patients undergoing radiotherapy can promote their nutritional status and quality of life.

The correlation between serum growth differentiation factor 15 and malnutrition in patients with end-stage kidney disease on hemodialysis

Objective Malnutrition commonly occurs in patients undergoing maintenance hemodialysis. Early detection of malnutrition could allow early interventions to prevent later complications. At present, there are not many biomarkers with high predictive value of end-stage kidney disease (ESKD)-related malnutrition, especially for early malnutrition in hemodialysis patients, which needs more in-depth research. Therefore, we performed a cross-sectional study on 97 patients to identify biomarkers for malnutrition in hemodialysis patients. Research Methods & Procedures 7-point subjective global assessment (SGA) was applied to evaluate the nutritional status of patients on hemodialysis. Serum levels of growth differentiation factor 15 (GDF15), albumin, pre-albumin, c-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), hemoglobin, low density lipoprotein-cholesterol, and high density lipoprotein-cholesterol were detected before hemodialysis. Logistic analysis and linear regression were used to analyze the association between GDF15 levels and the SGA score after adjustment for basic characteristics and laboratory findings. Results Among the 97 patients on hemodialysis, 51 had malnutrition (SGA < 6). There was no difference between the malnourished and well nourished (SGA ≥ 6) groups for dialysis duration, cholesterol, CRP, TNF-α, and hemoglobin. The malnutrition group had significantly lower grip strength (p < 0.05). GDF15 levels correlated negatively with the SGA score after adjustment for possible confounding factors [rho (male) = -0.312, rho(female)= -0.437;P(male) = 0.0181, P(female) = 0.005], and might contribute to the malnutritional status, the AUCs of GDF15 for malnutrition was 0.697 (p = 0.011) in male and 0.828 (p < 0.001) in female. Conclusions GDF15 is associated with malnutrition according to the SGA score in patients with ESKD on hemodialysis, suggesting that GDF15 might be involved in the pathogenesis of malnutrition patients with ESKD in this setting. Furthermore, GDF15 is likely to be a potential diagnostic biomarker for malnutrition according to the SGA score.

Fortified synbiotic dessert for improving malnutrition in hemodialysis patients: A randomized, double-blind, controlled trial.

As dysbiosis of gut microbiota is recognized as a major risk factor for malnutrition in hemodialysis (HD) patients, we aimed to assess the effects of fortified synbiotic dessert on malnutrition, oxidative stress, inflammation, and quality of life in patients undergoing hemodialysis. A total of 50 hemodialysis patients were randomized into two groups of intervention and control to consume either 50 g of synbiotic dessert fortified with vitamin D (1000 IU) and calcium (500 mg) (FSD) or 50 g of control dessert (CD) for 8 weeks, respectively. Changes in nutritional status [Subjective Global Assessment (SGA)], anthropometric measures, malondialdehyde (MDA), total antioxidant capacity (TAC), high-sensitivity C-reactive protein (hs-CRP), ferritin, biochemistry [serum albumin, vitamin D, creatinine, blood urea nitrogen (BUN), complete blood count (CBC), and electrolytes], and quality of life were assessed before and at the end of the trial. The SGA scores and serum ferritin levels decreased significantly in the FSD group compared to the control group (p = .01 and p = .03, respectively). Regarding other markers, no statistically significant changes were found comparing the two groups. This novel fortified synbiotic dessert as a functional food may be effective in reducing the severity of malnutrition by improving SGA score in short term in hemodialysis patients. Thus, it is suggested to do further studies to elucidate the possible mechanisms related to the effects of this dessert on microbiota, skeletal muscle mass, and inflammation in HD in long term.

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

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

Expression of Concern: Effect of the Omega-3 Fatty Acid Plus Vitamin E Supplementation on Subjective Global Assessment Score, Glucose Metabolism, and Lipid Concentrations in Chronic Hemodialysis Patients.

Expression of Concern: Effect of the Omega-3 Fatty Acid Plus Vitamin E Supplementation on Subjective Global Assessment Score, Glucose Metabolism, and Lipid Concentrations in Chronic Hemodialysis Patients.

Comparison of diagnosis-related group based reimbursement and case-mix index within hospitalized patients before and after modified malnutrition diagnosis.

Lack of professional and accurate diagnosis of malnutrition led to a reduction in Diagnosis Related Group (DRG) payment and a decrease in Case-Mix Index (CMI). The aim of this study was to explore the effects of adding a proper nutritional diagnosis and modifying complication groups on DRG payment and CMI. Retrospective analysis was performed on patients ad-mitted to the hospital from January to June 2022 who had received a nutritional assessment. Patients were diagnosed as well-nourished, mild malnutrition, moderate malnutrition or severe malnutrition according to patient-generated subjective global assessment (PG-SGA) scores within 24 hours of admission. CMI and DRG hospital internal control standards were recalculated and compared with the original values. A total of 254 patients were enrolled, including 40 patients with mild malnutrition, 74 patients with moderate malnutrition and 122 patients with severe malnutrition. Of all subjects, 111 changed complication groups. The median of the DRG hospital internal control standard (12006.09 vs. 13797.19, p=0.01) and the median of CMI (0.91 vs. 1.04, p=0.026) were significantly higher than those before the diagnostic change. In patients with inflammatory bowel disease (IBD), the CMI value, hospital control standard of DRG, and the classification of DRG were significantly different from those before diagnosis revision (p<0.001). Fully identification and correct coding of malnutrition cases are conducive for hospitals to receive appropriate DRG compensation, and further contribute to the improvement of medical quality and the economic sustain-ability of hospitals.

Effect of probiotics on nutritional status, biochemical parameters, and disease severity in cirrhotic patients referred for liver transplantation–A randomised double blind, placebo-controlled trial

Probiotics have been shown to be effective in many diseases. However, their effects on the nutritional status in patients with cirrhosis is uncertain. We aimed to study the effect of probiotics on nutritional status, biochemical parameters, and liver disease severity in patients with cirrhosis referred for liver transplantation. A randomised, double-blind, placebo-controlled study was conducted from July 2021-October 2022. A total of 215 patients with cirrhosis referred for liver transplantation were enrolled and randomised to two groups to receive either probiotics (VSL#3, Sun Pharma, India, 112.5 billion colony-forming units (cfu) containing eight strains of bacteria) or placebo (corn starch filled capsules), two capsules/day for six weeks. Nutritional assessment was done, and biochemical parameters were measured before and after the intervention. Nutritional assessment parameters like body mass index (p=0.001), triceps skin fold thickness (p=0.011), muscle strength (p=0.007) and subjective global assessment scores (p<0.000) showed a positive trend in the probiotic group. Probiotic intake also significantly downregulated direct bilirubin levels (p=0.043) and increased albumin levels compared to baseline, but other biochemical parameters remained unchanged. Child Turcotte Pugh score also decreased significantly compared to pre therapy (p=0.0001). These changes were not observed in the placebo group. Moreover, probiotic VSL#3 supplementation was safe and well-tolerable without any adverse events in patients with cirrhosis. Probiotic VSL#3 supplementation improved the nutritional status, reduced the severity of liver disease and was safe and tolerable in patients with cirrhosis. www.ctri.nic.in (CTRI/2021/07/034917).

Parenteral nutrition after cytoreductive surgery for peritoneal malignancy: Should it be administered routinely?

Purpose/backgroundCytoreductive surgery (CRS) is complex abdominal surgery that is used to treat peritoneal malignancy. CRS is associated with major morbidity and efforts to address this include optimisation of perioperative care. There is variation in international protocols on the nutritional management after CRS, in particular whether parenteral nutrition (PN) should be routinely or selectively administered. Hypothesis/aimThis study assessed parenteral nutrition use, factors associated with PN requirement and nutritional outcomes in a centre that selectively uses PN after CRS. Methods/interventionsA retrospective analysis was undertaken on patients who underwent cytoreductive surgery ± hyperthermic intraperitoneal chemotherapy (HIPEC) at Peter MacCallum Cancer Centre between 1st January 2015 and 31st December 2020 using data entered into a prospectively maintained database. Patient characteristics, nutritional status, oncological parameters, operative details and postoperative outcome data were retrieved. Categorical variables were compared using the chi-squared test and continuous data was compared using a non-parametric Mann–Whitney U-test. A p-value <0.05 was considered statistically significant. Cox regression analysis was performed to identify independent predictors of requiring PN and postoperative weight change over admission. ResultsA total of 222 patients who had CRS between were included (mean age 56 years; female 61.3%). Preoperative nutritional characteristics of participants included a mean body mass index (BMI) of 27.6 kg/m2 and the majority (77.9%) were not at nutritional risk pre-operatively with a Patient Generated Subjective Global Assessment (PG-SGA) score of category A. A high proportion of patients had surgery for colonic adenocarcinoma (58.1%), received HIPEC (87.4%) and achieved complete cytoreduction (82%). Postoperative parenteral nutrition was required for 65 patients (29.3%). The most frequent indication for PN was postoperative ileus (63.1%) with the mean (SD) time to commencing PN being postoperative day 5. Factors associated with the requirement for postoperative PN included preoperative albumin (OR 0.89; p = 0.015), weight loss >5% of body weight in the 6 months prior to admission (OR 2.2; p = 0.05), higher PCI score (OR 1.048; p = 0.005), number of anastomoses completed (OR 1.766; p = 0.017) and development of any postoperative complication (OR 2.71; p = 0.009). PN use was not associated with postoperative weight change. ConclusionMost patients undergoing CRS did not require post-operative PN. Nutritional and operative factors may identify patients who are likely to need PN after surgery. Selective use of PN did not impact on postoperative weight change.

Son dönem renal yetmezlikli hastalarda vasküler kalsifikasyon, ateroskleroz ve inflamasyon ilişkisi

Introduction: This study aims to determine the relationship between vascular calcification, carotid artery intima-media thickness (CIMT) and malnutrition with inflammatory parameters in dialysis patients.&#x0D; Materials and Methods: 140 CKD patients and 44 healthy controls were included in the study. CIMT was measured by ultrasonography. Valvular calcification was assessed by echocardiography and vascular calcification scores (VCS) were done based on the radiograms. Biochemical parameters were assessed using routine laboratory methods. Subjective global assessment (SGA) was used to evaluate malnutrition.&#x0D; Results: In the study, VCS showed no differences between hemodialysis (HD) and peritoneal dialysis (PD) patients (1.84±2.35 for HD, 1.77±1.64 for PD; p:0.83). CIMT, Osteopontin (OPN), interleukin-6 (IL-6) and homocysteine were significantly different in both dialysis groups compared to healthy controls. The Mean carotid intima-media thickness (m-CIMT) was higher in HD patients compared to PD group. CIMT, vascular calcification and SGA scores showed positive correlation with age, dialysis duration and valvular calcification grades, and negative correlation with albumin levels. A positive correlation between SGA scores and high-sensitive C-reactive protein (hs-CRP) levels was also noted. On multiple regression analysis, m-CIMT was independently associated with age, VCS and albumin levels. VCS was found to be independently associated with only albumin levels.&#x0D; Conclusion: Vascular and valvular calcification, an indicator of cardiovascular mortality and morbidity in dialysis patients, was found to be significantly associated with malnutrition. We found higher rates of valvular calcification in patients with vascular calcification. Malnutrition was more prominent in these patients.

A quality control circle process to improve enteral nutrition feeding support in discharged patients with colorectal cancer.

Correct usage and maintenance of the enteral nutrition feeding pump system is always a challenge in nutrition support for patients with colorectal cancer (CRC). However, there are few studies on the sustained accuracy improvement of the enteral nutrition feeding system in discharged CRC patients. Here, we established a seven-month quality control circle (QCC) activity with the theme of improving the performance of home enteral feeding pumps (EFP) and examined the effect of QCC activity on the nutritional state and quality of life in discharged CRC patients. We enrolled 100 discharged CRC patients treated with home enteral nutrition from Zhejiang Cancer Hospital between March 2020 and December 2021. The patients were randomly split into two research groups: one participated in the QCC activity (n = 50) and the other did not (n = 50). QCC analysis indicated that the top 3 causes of EFP inaccurate usage are the simple and boring contents of training, various types of pumps, no examination rules, and lack of management. Furthermore, both intra- and inter-group comparisons showed that QCC significantly improved the patients' pass rate of nutrition pump operation from 52 to 70% after 1-month of activity, which gradually improved and got the highest (90%) after 3 months (p < 0.05). Interestingly, the established QCC activity significantly increased the patient-generated subjective global assessment (PG-SGA) and Barthel index (BI) scores, body fat mass (BFM) and superior longitudinal muscle (SLM) by intra- and inter-group comparisons. In this study, we clarified the main causes of inaccurate EFP usage and established a QCC process to improve the pass rate of EFP usage. It finally leads to the improvement of nutritional state and quality of life in CRC patients.

Topical Spironolactone in the Treatment of Evaporative Dry Eye Disease.

Meibomian gland dysfunction (MGD) is associated with evaporative dry eye syndrome, which is characterized by a reduction in meibum secretion and tear film instability. Present treatments provide only temporary relief, thereby necessitating the exploration of novel therapeutic strategies for chronic treatment. This study aims to evaluate topical spironolactone, a medication with anti-mineralocorticoid, anti-androgenic, and anti-inflammatory properties, in treating dry eye. A retrospective observational study was performed on the medical records of 102 patients diagnosed with dry eye disease. These patients were categorized into two groups based on their Schirmer's tear test scores. Various clinical indicators, including subjective global assessment scores, visual acuity, keratitis, conjunctival staining scores, and lid margin health, were evaluated prior to and following treatment with topical spironolactone eye drops. The group with higher Schirmer's scores exhibited improvement in self-reported global assessment scores after treatment. Significant improvements were also observed in keratitis and conjunctival staining scores, visual acuity, and lid margin inflammation. Similarly, the group with lower Schirmer's scores demonstrated improvements in self-reported global assessment scores and visual acuity after treatment. Topical spironolactone may improve tear film quality and address the inflammatory processes associated with MGD and evaporative dry eye. Moreover, the topical administration of spironolactone in an ocular vehicle appears to be well tolerated and may mitigate the risk of systemic adverse effects. Further studies are warranted to explore the long-term effects of topical spironolactone in the treatment of evaporative dry eye disease.