Undernutrition In Patients Research Articles

Concomitant sarcopenia and undernutrition: Impact on clinical outcomes in patients undergoing hemodialysis

BackgroundSarcopenia and undernutrition are crucial in the cycle of frailty in patients requiring hemodialysis therapy, and their deleterious clinical consequences are well documented. However, little attention has been directed towards examining their combined impact on clinical outcomes. ObjectiveThis study aimed to elucidate the effects of concomitant sarcopenia and undernutrition on clinical outcomes in patients undergoing hemodialysis. MethodsThis prospective cohort study recruited outpatients undergoing hemodialysis from four facilities. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia, 2019. Undernutrition was determined using the Geriatric Nutritional Risk Index, with a score of < 92 classified as undernutrition. Patients were classified into four groups according to the presence or absence of sarcopenia and undernutrition. Cox proportional hazards analysis was used to assess the independent association between concomitant sarcopenia and undernutrition, all-cause mortality, and cardiovascular (CV) events after adjusting for baseline characteristics. ResultsWe included 450 patients in this analysis. Of the 450 patients, 69 (15.3%) had concomitant sarcopenia and undernutrition. The mean follow-up period was 1,067 days, and there were 61 deaths and 60 CV events. The cumulative survival rate was significantly lower in the sarcopenia with undernutrition group (P=0.011). The overlap of sarcopenia and undernutrition was significantly associated with a risk of mortality (hazard ratio 2.10; 95% confidence interval 1.05-4.21; P=0.037). However, no association was observed between the co-occurrence of sarcopenia and undernutrition and the risk of CV events. ConclusionsConcomitant sarcopenia and undernutrition were significantly associated with an increased mortality risk among patients undergoing hemodialysis. This finding reaffirms the importance of managing sarcopenia and undernutrition in patients undergoing hemodialysis in daily clinical practice.

Combined effect of inflammation and malnutrition for long-term prognosis in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a cohort study

BackgroundInflammation is a key driver of atherosclerotic diseases and is often accompanied by disease-related malnutrition. However, the long-term burden of dysregulated inflammation with superimposed undernutrition in patients with acute coronary syndrome (ACS) remains unclear. This study sought to investigate the double burden and interplay of inflammation and malnutrition in patients with ACS undergoing percutaneous Coronary Intervention (PCI).MethodsWe retrospectively included 1,743 ACS patients undergoing PCI from June 2016 through November 2017 and grouped them according to their baseline nutritional and inflammatory status. Malnutrition was determined using the nutritional risk index (NRI) with a score lower than 100 and a high-inflamed condition defined as hs-CRP over 2 mg/L. The primary outcome was major adverse cardiovascular events (MACEs), compositing of cardiac mortality, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization. Long-term outcomes were examined using the Kaplan-Meier method and compared with the log-rank test. Multivariable Cox proportional hazards regression analysis was applied to adjust for confounding. The reclassification index (NRI)/integrated discrimination index (IDI) statistics estimated the incremental prognostic impact of NRI and hs-CRP in addition to the Global Registry of Acute Coronary Events (GRACE) risk score.ResultsDuring a median follow-up of 30 months (ranges 30–36 months), 351 (20.1%) MACEs occurred. Compared with the nourished and uninflamed group, the malnourished and high-inflamed group displayed a significantly increased risk of MACEs with an adjusted hazard ratio of 2.446 (95% CI: 1.464–4.089; P < 0.001). The prognostic implications of NRI were influenced by patients’ baseline inflammatory status, as it was only associated with MACEs among those high-inflamed (P for interaction = 0.005). Incorporating NRI and hs-CRP into the GRACE risk score significantly improved its predictive ability for MACEs (NRI: 0.210, P < 0.001; integrated discrimination index; IDI: 0.010, P < 0.001) and cardiac death (NRI: 0.666, P < 0.001; IDI: 0.023, P = 0.002).ConclusionsAmong patients with ACS undergoing PCI, the double burden of inflammation and malnutrition signifies poorer outcomes. Their prognostic implications may be amplified by each other and jointly improve the GRACE risk score’s risk prediction performance.

P1161 Prevalence of undernutrition in patients with inflammatory bowel disease and improvement after nutritional advice

Abstract Background The prevalence of undernutrition ranges from 25% to 70% and severe undernutrition from 1% to 30% among individuals with active inflammatory bowel disease (IBD). The aetiology of malnutrition is multifactorial. There are not many studies that have assessed nutrition after therapy modification and dietary advice. Aim To study the prevalence of undernutrition in IBD and the change after nutritional advice. Methods In this single-centre prospective cohort study, 218 consecutive patients with IBD were screened. Patients with associated diseases that could lead to undernutrition were excluded (N=18). Nutritional assessment was done as per the European Society for Clinical Nutrition and Metabolism (ESPEN) definition: BMI &amp;lt;18.5 kg/m2 or unintentional weight loss &amp;gt;10% were defined as undernutrition and the Malnutrition Inflammation Risk Tool (MIRT) score was calculated. Obesity was defined as per the WHO Asian BMI classification: grade 1 (BMI 25-29.9 Kg/m2) and obesity grade 2 (BMI &amp;gt;30 Kg/m2)1. Patients were given nutritional advice and therapy was optimized as per disease activity. BMI and MIRT were calculated on subsequent visits to assess response to nutritional advice. Results Of 200 patients (median age 39 [IQR 28-53] years; 96 females), 105 had ulcerative colitis (UC), 93 Crohn’s disease (CD), and 2 IBD-unclassified. Fifty-four (27%) patients had undernutrition (28 UC, 25 CD, and 1 IBD-U). Sixty-one (30.5%) patients were obese. At follow up (median duration 24 months), of 37/54 patients with BMI &amp;lt;18.5 Kg/m2, BMI increased in 24 (64.8%) and decreased in 13 (35.1%); of 17 patients with &amp;gt;10% unintentional weight loss, 5 (29.4%) had increased weight on follow-up. MIRT score decreased in 24/54 patients (44.4%), remained same in 14 (25.9%), and increased in 16 patients (29.6%). Of the 24 patients with decrease in MIRT score, 7/24 (29.1%) received only dietary advice, 10 (41.6%) received dietary advice and optimization of IBD treatment, and 7 (29.1%) received only optimization of IBD treatment. Conclusion The prevalence of undernutrition and obesity in patients with IBD was 27% and 30.5%, respectively. After dietary advice and therapy optimization, nutrition improved in 53.7% while MIRT score decreased in 43.3% of patients.

Association between nutritional risk status and health related quality of life: An investigation on the aging patients with cardiovascular disease.

Acknowledging the considerable influence of undernutrition on health outcomes and HRQOL, this study sought to appraise the nutritional risk status of elderly patients with cardiovascular diseases (CVD) through the utilization of the Nutritional Risk Screening (NRS). Additionally, the investigation aimed to evaluate the correlation between NRS status and HRQOL within the context of patients referred to a cardiac hospital in Tabriz, Iran. This cross-sectional study was conducted in Tabriz, Iran. The participants were selected randomly from patients referring to Shahid Madani Heart Hospital, a comprehensive university hospital during July to December 2018. A linear regression was used for control of confounding variables (age, gender, education level, marital status, and income levels) and predict the relationship between nutrition risk status and HQRL. Of the 200 patients with CVD participated in this study, 68 (34%) of participants had normal nutrition status, 108 (54%) were at risk for undernutrition, and 24 (12%) had undernutrition. A total of 24 aging patients with undernutrition, 13 (54%) were divorced or widowed. 86% of patients with diabetes were at risk for undernutrition and 13.9% had undernutrition. There were statistically significant relationship between undernutrition and HRQOL dimensions, age, gender, and marital status. The study revealed a correlation between elevated undernutrition scores in patients and factors such as older age, female gender, and marital status of being divorced or widowed. Furthermore, the results imply that a notable elevation in the risk score for undernutrition in patients is significantly linked to impaired HRQOL among elderly individuals with CVD.

Nutritional supplementation to prevent tuberculosis incidence in household contacts of patients with pulmonary tuberculosis in India (RATIONS): a field-based, open-label, cluster-randomised, controlled trial

In India, tuberculosis and undernutrition are syndemics with a high burden of tuberculosis coexisting with a high burden of undernutrition in patients and in the population. The aim of this study was to determine the effect of nutritional supplementation on tuberculosis incidence in household contacts of adults with microbiologically confirmed pulmonary tuberculosis. In this field-based, open-label, cluster-randomised controlled trial, we enrolled household contacts of 2800 patients with microbiologically confirmed pulmonary tuberculosis across 28 tuberculosis units of the National Tuberculosis Elimination Programme in four districts of Jharkhand, India. The tuberculosis units were randomly allocated 1:1 by block randomisation to the control group or the intervention group, by a statistician using computer-generated random numbers. Although microbiologically confirmed pulmonary tuberculosis patients in both groups received food rations (1200 kcal, 52 grams of protein per day with micronutrients) for 6 months, only household contacts in the intervention group received monthly food rations and micronutrients (750 kcal, 23 grams of protein per day with micronutrients). After screening all household contacts for co-prevalent tuberculosis at baseline, all participants were followed up actively until July 31, 2022, for the primary outcome of incident tuberculosis (all forms). The ascertainment of the outcome was by independent medical staff in health services. We used Cox proportional hazards model and Poisson regression via the generalised estimating equation approach to estimate unadjusted hazard ratios, adjusted hazard ratios (aHRs), and incidence rate ratios (IRRs). This study is registered with CTRI-India, CTRI/2019/08/020490. Between Aug 16, 2019, and Jan 31, 2021, there were 10 345 household contacts, of whom 5328 (94·8%) of 5621 household contacts in the intervention group and 4283 (90·7%) of 4724 household contacts in the control group completed the primary outcome assessment. Almost two-thirds of the population belonged to Indigenous communities (eg, Santhals, Ho, Munda, Oraon, and Bhumij) and 34% (3543 of 10 345) had undernutrition. We detected 31 (0·3%) of 10 345 household contact patients with co-prevalent tuberculosis disease in both groups at baseline and 218 (2·1%) people were diagnosed with incident tuberculosis (all forms) over 21 869 person-years of follow-up, with 122 of 218 incident cases in the control group (2·6% [122 of 4712 contacts at risk], 95% CI 2·2-3·1; incidence rate 1·27 per 100 person-years) and 96 incident cases in the intervention group (1·7% [96 of 5602], 1·4-2·1; 0·78 per 100 person-years), of whom 152 (69·7%) of 218 were patients with microbiologically confirmed pulmonary tuberculosis. Tuberculosis incidence (all forms) in the intervention group had an adjusted IRR of 0·61 (95% CI 0·43-0·85; aHR 0·59 [0·42-0·83]), with an even greater decline in incidence of microbiologically confirmed pulmonary tuberculosis (0·52 [0·35-0·79]; 0·51 [0·34-0·78]). This translates into a relative reduction of tuberculosis incidence of 39% (all forms) to 48% (microbiologically confirmed pulmonary tuberculosis) in the intervention group. An estimated 30 households (111 household contacts) would need to be provided nutritional supplementation to prevent one incident tuberculosis. To our knowledge, this is the first randomised trial looking at the effect of nutritional support on tuberculosis incidence in household contacts, whereby the nutritional intervention was associated with substantial (39-48%) reduction in tuberculosis incidence in the household during 2 years of follow-up. This biosocial intervention can accelerate reduction in tuberculosis incidence in countries or communities with a tuberculosis and undernutrition syndemic. Indian Council of Medical Research-India TB Research Consortium.

Combined use of handgrip strength and hemoglobin as markers of undernutrition in patients with stage 3–5 chronic kidney disease

Background and aimsThe early identification of undernourished patients with CKD could help instating appropriate nutritional intervention before the full development of the threatening condition known as Protein Energy Wasting (PEW). Handgrip strength (HGS) and blood hemoglobin (Hb) concentration are two parameters considered representative of nutritional status but not included among the criteria for PEW diagnosis. In the present work we investigated whether they could help identifying CKD patients at risk of undernutrition. Methods and resultsWe performed a two-step cluster analysis to classify a cohort of 71 stage 3–5 CKD patients, none of which with PEW, according to their Hb concentration and dominant-hand HGS. Two clusters were finely separated using this method. When we compared the two groups for main body composition and nutritional variables by using t-test statistics or Mann–Whitney test, as appropriate, we found significant differences in PhA, ECW/TBW, ASMI, serum iron. Then we stratified our population by gender and performed cluster analysis as well. PhA, ECW/TBW were still significantly different in the two clusters both in M and in F, while serum iron concentration only in males and ASMI only in females. ConclusionThese results suggest that either in male than in female Hb concentration and HGS may distinguish two subgroups of CKD patients with different nutritional status and disease severity. Patient belonging to either of these cluster can be easily identified by using the HGS/Hb ratio which represents the HGS normalized per gr Hb.

Undernutrition was a prevalent clinical problem among older adult patients with heart failure in a hospital setting in Northwest Ethiopia.

Undernutrition is a frequently noticed medical problem in patients with heart failure. It is caused by poor nutrient intake, malabsorption, systemic inflammation, neurohumoral activation, oxidative stress, and hypermetabolic state. Undernutrition results in a decrease in the quality of life and the survival rate in patients with heart failure. There is a paucity of documentation on undernutrition among patients with heart failure in sub-Saharan African countries. The study aimed to determine the magnitude and associated factors of undernutrition among older adult patients with heart failure in the hospital setting in Northwest Ethiopia. An institutional-based cross-sectional study was conducted at the University of Gondar Hospital, Northwest Ethiopia, between 1 June 2021 and 31 October 2021. A consecutive sampling method was used to recruit 262 study subjects. A Mini-nutritional assessment-full form (MNA-FL) Questionnaire was used to extract nutritional information among patients with heart failure. Patients with heart failure, who scored MNA-FL score <17, were declared to have undernutrition. The data were entered into EPI Info version 4.6.0.0 and then exported to SPSS version 26 for analysis. Explanatory variables associated with undernutrition in patients with heart failure were analyzed by applying a logistic regression model. A P-value of <0.05 was used to declare a significant association. A total of 262 patients with heart failure were included in the study. The mean age (± SD) of the study subjects was 64.6 (± 9.2) years. Hypertensive heart disease (111/262, 42%) was the most common cause of heart failure. Hypertension was the frequently observed comorbid disease. Based on the MNA-FL score for nutritional status, 75 out of 262 (28.6%, 95% CI: 22.9-34.4%) were undernourished (MNA-FL < 17), while 124 out of 262 (47.3%, CI: 41.5-53.1%) were at risk of undernutrition (MNA-FL = 17-23.5). The remaining 63 out of 262 (24.1%, 95% CI: 18.2-29.8%) study subjects were well nourished (MNA-FL > 24). On a multivariate analysis, patients with severe heart failure (New York Heart Association (NYHA) functional class III/IV) (AOR = 4.287, CI: 2.012-9.134, P-value < 0.001), with a duration of illness of 3-5 years (AOR = 3.225, CI: 1.138-9.137, P-value = 0.028), with a duration of illness of >5 years (AOR = 4.349, CI: 1.592-11.879, P-value = 0.001), presence of comorbidities (AOR = 2.29, CI: 1.06-4.96, P-value = 0.036), who underwent treatment with loop diuretics (AOR = 2.983, CI: 1.407-6.326, P-value = 0.040), and who reside in a rural area (AOR = 5.119, CI: 2.481-10.560, P-value < 0.001) were at risk of developing undernutrition. Undernutrition was a significant clinical problem in older patients with heart failure. Nutritional interventions should be prioritized for patients with chronic and severe heart failure.

Assessement of nutritional status and dietary habits among the elderly inpatients at two departments of internal medicine, Hue University of Medicine and Pharmacy Hospital

Introduction: Undernutrition is popular among inpatients. According to estimates of National institute of Nutrition, the prevalence of undernutrition accounts for 40% to 50% among inpatients. Undernutrition has a significant effect on complication, mortality, hospital stay as well as quality of life... Therefore, screening and evaluating the nutritional status is important in the treatment process. Objectives: 1. To assess nutritional status of elderly inpatients at two departments of Internal medicine, Hue University of Medicine and Pharmacy Hospital. 2. To find out dietary habits and its relation to nutritional status. Methodology: A cross-sectional study was conducted on 389 inpatients in two departments of Internal medicine. Body Mass Index (BMI) and Subjective Global Assessment (SGA) were applied to assess nutritional status, and questionnaire was used to understand dietary habits and its relation to nutritional status. Results: The prevalence of undernutrition among elderly inpatients by BMI and SGA were 38.8% and 35.0 % respectively. The was a relationship between the habit of using food after cooking for more than 2 hours, the selection of food suitable for diseases and the nutritional status assessing by BMI. There was a relationship between the eating at a fixed time, using food within 30 minutes after cooking, eating after 9:00 PM, drinking over 1.5 liters of water per day and the nutritional status assessing by SGA. Conclusion: The prevalence of undernutrition among elderly inpatients at two departments of Internal medicine was quite high. Therefore, it is important to consider assessing nutritional status as a routine procedure and design nutritional intervention plan with undernutrition inpatients. Key words: nutritional status, dietary habits

MO568: The Relationship Between Oxidative Stress and Undernutrition in CKD Patients

Abstract BACKGROUND AND AIMS Undernutrition is frequent in patients with chronic renal failure. It affects 35% of patients at the start of dialysis and represents one of the causes of morbidity and mortality. The objective of this work is to determine the relationship between oxidative stress and undernutrition in patients at different stages of chronic renal failure. METHOD A descriptive longitudinal study of 162 patients with chronic renal failure at different stages (2, 3, 4, 5 and 5D). We have studied the biological and anthropometric nutritional parameters in CKD patients at different stages as well as markers of oxidative stress, and we have studied their correlations with undernutrition in these patients. RESULTS The mean age of the patients is 56.5 ± 17 years with a sex ratio of 1.43. Regarding markers of oxidative stress, MDA, MPO and AOPP were studied. The means of which are respectively (6.1 ± 0.12 μmol/L, 59 0.89 ± 1.98 IU and 61.89 ± 1.4 μmol/L). The average body mass index, albumin and pre-albumin levels are respectively: (21.98 ± 0.28), (37.84 g/L ± 0.47) and (302.93 mg/L ± 5.4). All three parameters decrease significantly (P &amp;lt;0.05) with degradation of renal function (from stage 2 to stage 5D) and increase in markers of oxidative stress with a negative correlation (P &amp;lt; 0.05). The most undernourished patients are found in stage 5 and 5D with high levels of oxidative stress markers. Undernutrition is greater in patients with severe CKD and in hemodialysis patients with high levels of oxidative stress markers. CONCLUSION Chronic renal failure represents a real public health problem. Undernutrition is one of the causes of morbidity and mortality in these patients, especially after extra renal treatment, hemodialysis, oxidative stress worsens undernutrition and cardiovascular morbidity.

COVID-19 management in a UK Tertiary Centre with High Consequence Infectious Diseases Centre: Nutritional status, intervention and outcome

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension have been shown to have a higher risk of hospitalization, severe disease, and mortality.1 To date, little data has been published on the timely identification and correction of undernutrition in patients hospitalised with COVID-19.

Nutritional Status of Children and Adolescents with Type1 Diabetes Mellitus in Basra

Background: Growth problems represent an important complication in children and adolescent with Type1 diabetes mellitus and poor metabolic control seems to impact their growth velocity. Aim: to assess the nutritional status in children with type 1 diabetes mellitus, in relation to selected patients' variables. Methods: a case-control study has been carried out to assess the nutritional status of sixty-one patients with type 1 diabetes mellitus; and eighty-two age and sex matched healthy children as control group; their ages ranged from 3-14 year, from the 1st of October 2016 till 15th of March 2017. Results: The mean age of diabetic patients was (10.3±3.02) years; (60.66%) belong to large family size with low education. Diabetic patients significantly belong to families with poor financial support and income in (45.9%) compared to the control group (26.8%) (p value 0.02), as well as those undernourished diabetic children significantly belongs to families with poor income than those with normal nutritional status (75%, 38%) respectively. Body mass index was significantly below 5th percentile in diabetic patients than the controls (19.68 %, 2.4 %) respectively; P value 0.001. History of inadequate dietary intake was recorded in 66.67% of patients; significantly related to undernutrition in diabetics patients than controls (P value 0.002). Undernutrition in diabetic children significantly associated with poor glycemic control with significantly high level of HbA1c (13.9±9.57) than those without undernutrition (10.6±5.28) respectively. Conclusions: Frequent evaluation of diabetic children is required to overcome the problem of undernutrition in patients with type 1 diabetes mellitus. Keywords: Type1diabetes; Nutritional status; Children; Basra

Multiple Antihyperglycemic Drug Use is Associated with Undernutrition Among Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

IntroductionUndernutrition is prevalent in older age. Current management of type 2 diabetes mellitus (T2DM) requires modified diet patterns; however, older adults with diabetes may also be at the risk of undernutrition due to age, disease, and medication-related factors. Our objectives in this study were to examine the proportion and associations of undernutrition among community-dwelling older adults with T2DM.MethodsThis prospective, cross-sectional study involved older outpatient adults (≥ 65 years) with and without T2DM. We assessed the nutritional status using the Mini Nutritional Assessment-Short Form. Undernutrition referred to being either at risk of malnutrition or malnourished. Variables independently associated with undernutrition were evaluated by logistic regression analysis.ResultsFive hundred forty-six older adults [n = 215 with T2DM and n = 331 control; mean (SD) age, 74.9 (6.3) years; 388 (71.1%) female] were included in the study. The frequency of undernutrition was 31.1%, which was higher in patients with T2DM than in those without (36.7% vs. 27.5%, p < 0.05). However, the difference was no longer significant after adjustment for covariates (gender, lower education, lower body mass index, cardiovascular disease, multimorbidity, cognitive performance, functional performance, depressive symptoms, and polypharmacy). In the T2DM group, the ratio of multiple antihyperglycemic drug use (≥ 2) was higher in those with undernutrition compared with normal nutritional status (78.5% vs. 59.6%, p = 0.005). On multivariable analysis, decreased functional performance, depressive symptoms, and use of multiple antihyperglycemic drugs were associated with undernutrition in patients with T2DM.ConclusionsUndernutrition was more common among older adults with T2DM compared with the control group. Undernutrition was further dependent on chronic conditions and diabetes management.

Controlling Nutritional Status Score is Associated with All-Cause Mortality in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

PurposeThe controlling nutritional status (CONUT) score was developed to detect undernutrition in patients. Here, we investigated whether the CONUT score estimated at diagnosis could help predict poor outcomes [all-cause mortality, relapse, and end-stage renal disease (ESRD)] of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Materials and MethodsWe retrospectively reviewed and collated data, including baseline characteristics, clinical manifestations (to calculate AAV-specific indices), and laboratory results, from 196 newly diagnosed AAV patients. Serum albumin, peripheral lymphocyte, and total cholesterol levels (at diagnosis) were used to calculate CONUT scores.ResultsIn total, 111 patients had high CONUT scores (≥3), which showed higher frequency of myeloperoxidase-ANCA and ANCA positivity, and demonstrated higher AAV-specific indices. The optimal cut-offs of CONUT score (at diagnosis) for predicting all-cause mortality and ESRD were ≥3.5 and ≥2.5, respectively. Patients with CONUT scores higher than the cut-off at diagnosis exhibited lower cumulative and ESRD-free survival rates compared to those with lower scores than the cut-off. In multivariable analyses, diabetes mellitus [hazard ratio (HR): 4.394], five-factor score (HR: 3.051), and CONUT score ≥3.5 (HR: 4.307) at diagnosis were independent predictors of all-cause mortality, while only serum creatinine (HR: 1.714) was an independent predictor of ESRD occurrence.ConclusionCONUT score at diagnosis is associated with all-cause mortality in AAV patients.

Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis

Undernutrition in cirrhotic patients is often poorly recognised until late-stages. The current UK screening tool, the Malnutrition Universal Screening Tool, can miss undernutrition in patients with ascites/fluid retention. A 6-question Liver Disease Undernutrition Screening Tool (LDUST) has been developed in America. We sought to compare LDUST with MUST in the detection of undernutrition in 50 inpatients and 50 outpatients with liver cirrhosis in a secondary care setting. This was then validated by a dietitian assessment. Similar patient demographics and liver disease aetiologies were found in the two cohorts. Mean Child-Pugh scores were higher for inpatients, 8.3 (SD 1.9) vs 5.9 (SD 1.2). LDUST detected undernutrition in 45/50 inpatients (90%) and 34/50 outpatients (68%). MUST scores ≥2 were present in 19/50 (38%) inpatients and 9/50 (18%) outpatients. In those with a MUST score <2, LDUST detected undernutrition in 26/31 (84%) inpatients and 27/41 (66%) outpatients. 26 inpatients had undernutrition using LDUST but had a MUST score <2, 20 (76%) of these were deemed to be undernourished by dietetics assessment. LDUST was mostly completed independently or with minimal assistance (80% inpatients, 100% outpatients), with mean completion times of 4 and 3min for in- and outpatients respectively. LDUST is a quick and easy screening tool, which appears better able than MUST to detect undernutrition in cirrhotic patients, including undernutrition missed by MUST. Importantly the tool was validated against dietitian assessments. The high rates of undernutrition among cirrhotic inpatients suggest that screening this cohort is unnecessary, and instead all should undergo dietitian review, with LDUST utilised in an outpatient setting.

Longitudinal observations of the prevalence of nutritional risk and undernutrition in patients with head and neck cancer during radiotherapy

Objective To investigate the changes in prevalence of nutritional risk and undernutrition in patients with head and neck cancer during radiotherapy. Methods In this longitudinal observational study, a convenience sampling method was used to recruit patients with head and neck cancer who were receiving radiotherapy in Beijing Cancer Hospital. Nutritional Risk Screening 2002 (NRS 2002) was applied to assess the prevalence of nutritional risk in the patients, and Patient-Generated Subjective Global Assessment (PG-SGA) and body composition test to determine the prevalence of malnutrition (undernutrition) before, during and after radiotherapy. Results 56 patients finished the three follow-up exams. Along with the progress of radiotherapy, the scores of NRS 2002 increased gradually (1.64±1.09 vs. 2.30±1.06 vs. 3.14±1.07, χ2=46.639, P<0.001), and the prevalence of nutritional risk also increased gradually (21.43% vs. 37.50% vs. 71.43%, χ2=29.700, P<0.001); the total scores of PG-SGA [1 (1-13) vs. 6 (1-15) vs. 12 (1-18), χ2=63.206, P<0.001] and dimensions of weight [0 (0-4) vs. 1 (0-4) vs. 3 (0-6), χ2=40.798, P<0.001], intake [0 (0-2) vs. 1 (0-2) vs. 2 (0-4), χ2=64.707, P<0.001] and symptoms[0 (0-7) vs. 2 (0-10) vs. 6 (0-11), χ2=61.562, P<0.001] all increased gradually with statistical significance. The prevalence of malnutrition in different stage of radiotherapy were significantly different (χ2=64.999, P<0.001). The body composition analysis in 40 patients showed that all the indicators of body composition decreased significantly along with the progress of radiotherapy. There was a great loss in patients' body weight during radiotherapy, especially the fat-free mass. Conclusions The prevalence of nutritional risk and undernutrition may increase in patients with head and neck cancer during radiotherapy. Lean body mass accounted for most of the weight loss. We should pay more attention to those patients' nutritional status during radiotherapy. Key words: Head and neck neoplasms; Radiotherapy; Nutritional status; Nutritional risk

Diagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: a systematic review

BACKGROUND Effective nutritional screening, nutritional care planning and nutritional support are essential in all settings, and there is no doubt that a health service seeking to increase safety and clinical effectiveness must take nutritional care seriously. Screening and early detection of malnutrition is crucial in identifying patients at nutritional risk. There is a high prevalence of malnutrition in hospitalized patients undergoing treatment for colorectal cancer. OBJECTIVES To synthesize the best available evidence regarding the diagnostic test accuracy of nutritional tools (sensitivity and specificity) used to identify malnutrition (specifically undernutrition) in patients with colorectal cancer (such as the Malnutrition Screening Tool and Nutritional Risk Index) compared to reference tests (such as the Subjective Global Assessment or Patient Generated Subjective Global Assessment). INCLUSION CRITERIA Types of participants: Patients with colorectal cancer requiring either (or all) surgery, chemotherapy and/or radiotherapy in secondary care. Focus of the review: The diagnostic test accuracy of validated assessment tools/instruments (such as the Malnutrition Screening Tool and Nutritional Risk Index) in the diagnosis of malnutrition (specifically under-nutrition) in patients with colorectal cancer, relative to reference tests (Subjective Global Assessment or Patient Generated Subjective Global Assessment). Types of studies: Diagnostic test accuracy studies regardless of study design. SEARCH STRATEGY Studies published in English, German, Danish, Swedish and Norwegian were considered for inclusion in this review. Databases were searched from their inception to April 2014. METHODOLOGICAL QUALITY Methodological quality was determined using the Quality Assessment of Diagnostic Accuracy Studies checklist. DATA COLLECTION Data was collected using the data extraction form: the Standards for Reporting Studies of Diagnostic Accuracy checklist for the reporting of studies of diagnostic accuracy. DATA SYNTHESIS The accuracy of diagnostic tests is presented in terms of sensitivity, specificity, positive and negative predictive values. In addition, the positive likelihood ratio (sensitivity/ [1 – specificity]) and negative likelihood ratio (1 - sensitivity)/ specificity), were also calculated and presented in this review to provide information about the likelihood that a given test result would be expected when the target condition is present compared with the likelihood that the same result would be expected when the condition is absent. Not all trials reported true positive, true negative, false positive and false negative rates, therefore these rates were calculated based on the data in the published papers. A two-by-two truth table was reconstructed for each study, and sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio and negative likelihood ratio were calculated for each study. A summary receiver operator characteristics curve was constructed to determine the relationship between sensitivity and specificity, and the area under the summary receiver operator characteristics curve which measured the usefulness of a test was calculated. Meta-analysis was not considered appropriate, therefore data was synthesized in a narrative summary. RESULTS 1. One study evaluated the Malnutrition Screening Tool against the reference standard Patient-Generated Subjective Global Assessment. The sensitivity was 56% and the specificity 84%. The positive likelihood ratio was 3.100, negative likelihood ratio was 0.59, the diagnostic odds ratio (CI 95%) was 5.20 (1.09-24.90) TRUNCATED AT 500 WORDS

Diagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: a systematic review

Diagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: a systematic review

Nutritional profile of pediatric cancer patients at Cancer Institute, Chennai.

Malnutrition is widely prevalent in the pediatric population in India. There is paucity of data on the prevalence of malnutrition in pediatric cancer patients and the impact of cancer treatment on nutritional status of Indian children. The study was conducted to look at the prevalence of malnutrition and assess the impact of treatment on nutritional status of pediatric cancer patients. This was a retrospective study. Data on the weight of pediatric cancer patients <16 years of age treated at Cancer Institute, Chennai, from January 2013 to May 2014 were analyzed at systematic time points in therapy. Patients' weight were plotted on the Centre for Disease Control (CDC) growth charts. Patients were defined to be undernourished if their weight for age was ≤3rd centile in CDC growth charts and obese if their weight for age was ≥97th centile on CDC growth charts. A total of 295 patient case records were analyzed. Acute lymphoblastic leukemia was the most common malignancy. At diagnosis, under-nutrition was seen in 44% patients, this increased to 46% midway during treatment (end of induction in acute leukemia and completion of 50% of planned treatment in solid tumors) and decreased to 27% at the end of treatment (beginning of maintenance in acute leukemia and completion of planned treatment in solid tumors) (P = 0.0005). There was no significant difference in nutritional status between patients with hematological malignancies and solid tumors (P = 0.8). Under-nutrition is present in close to half of the pediatric cancer patients presenting to our institute. Active nutritional intervention and education were able to significantly reduce the prevalence of under-nutrition in patients at the end of treatment.

Malaria and helminth co-infection and nutritional status of febrile patients in Southern Ethiopia

Because the mechanisms by which Plasmodium and helminth parasites affect nutritional status are different, these parasites likely have additive effects when they co-exist in a host. This study aimed to compare the prevalence of undernutrition in patients infected with either Plasmodium or helminths and those co-infected with the two types of parasites. Acute febrile patients suspected of having malaria who attended the outpatient clinic at Dore Bafeno Health Center between December 2010 and February 2011 were examined for Plasmodium parasites using Giemsa-stained thick and thin blood smears and for helminths using the thick Kato-Katz method. Nutritional status was determined using anthropometric indices generated from height and weight measurements. Of the 702 patients examined, 34.5% were infected with helminths alone, 12.3% were infected with Plasmodium alone, and 19.4% co-infected with Plasmodium and intestinal helminths. Out of the patients examined, 44.9% were undernourished. The prevalence of undernutrition was not significantly different between those patients not infected with Plasmodium or helminth species and those infected with Plasmodium or helminth species. The differences in the odds of undernutrition were also not significant between patients who were co-infected with different Plasmodium and helminth species and those with single infections with Plasmodium or helminth species in our multivariable logistic regression model adjusted for the confounding effects of age and sex. The prevalence of undernutrition was comparable in patients infected with Plasmodium or helminths alone and those co-infected with Plasmodium and helminths in Dore Bafeno Health Center, Southern Ethiopia. However, further studies are needed in areas of intense transmission where both parasites are endemic to elucidate whether the impact of Plasmodium and helminth co-infection on undernutrition is additive or multiplicative.

ENTERAL BESLENME: BAKIMDA GÜNCEL YAKLAŞIMLAR

Enteral Nutrition: current approaches in the care The most common complications developed in patients with enteral nutrition by nasogastric or nasoenteric are gastrointestinal, mechanical and metabolic. These complications can be simple or can reach life-threatening levels. It may cause under-nutrition of patients, diverse effects on healing process and prolonged hospitalization. Success of nutrition and reduction in complication rate can be obtained by patient care approaches in accordance with evidence-based guidelines and recommendations. In this paper, current approaches to enteral nutrition are presented.