Pub Date : 2024-10-11DOI: 10.1016/j.clnesp.2024.10.003
Sabrina Wielsøe , Anna Sundberg , Thomas S. Kristensen , Jan Christensen , Martin Sillesen , Carsten P. Hansen , Stefan K. Burgdorf , Bente K. Pedersen , Charlotte Suetta , Jesper F. Christensen , Casper Simonsen
Background and aims
The association between sarcopenia and postoperative complications has been widely reported in patients with cancer. Yet, the lack of standardized population-specific diagnostic cut-off points and assessments of muscle strength is hampering prospective clinical utilization. Therefore, we aimed to examine the impact of sarcopenia, defined by both regional and international cut-off points, along with various methods of measuring skeletal muscle and muscle strength, on the risk of postoperative complications following pancreatic resection.
Methods
The present prospective observational study enrolled patients scheduled for pancreatic resection. Body composition was assessed by DXA and CT prior to surgery. We applied the algorithm and cut-off points suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) as well as cut-off points from a Danish normative reference population to classify patients as sarcopenic. Physical performance was assessed by usual gait speed while muscle strength was assessed by handgrip strength, leg extensor power, and 30-s sit-to-stand. Postoperative complications within 30 days following surgery were classified according to the Clavien-Dindo classification and the American College of Surgeons National Surgical Quality Improvement Program. Complications graded ≥3 according to Clavien-Dindo were considered major complications.
Results
A total of 134 patients with a mean age of 67 years (SD: 9) were enrolled of whom most underwent pancreaticoduodenectomy (64 %). Using international cut-off points, eight patients (7 %) were classified as sarcopenic using CT scans and sarcopenia was associated with an increased risk of major postoperative complications (RR 2.14 [1.33–3.43]). Using DXA, four patients (3 %) were classified as sarcopenic, all of whom experienced a major complication. With regional cut-off points, 16 patients (13 %) were classified as sarcopenic using CT scans, but sarcopenia was not associated with major complications (RR 1.39 [0.80–2.42]). Nine patients (7 %) were classified as sarcopenic using DXA, but sarcopenia was not associated with major complications (RR 1.15 [0.54–2.48]). Across the different muscle strength assessment methods, handgrip strength consistently demonstrated a stronger association with postoperative complications.
Conclusion
Sarcopenia defined according to the EWGSOP criteria and with international cut-off points is associated with an increased risk of postoperative complications following pancreatic resection. Using regionally based cut-off points, the prevalence of sarcopenia is higher, but it does not confer a higher postoperative complication risk. The use of different muscle strength assessment methods results in vastly different estimates of prevalence of low strength and associations with postoperative outcomes.
{"title":"Impact of sarcopenia and muscle strength on postoperative complication risk following pancreatic resection","authors":"Sabrina Wielsøe , Anna Sundberg , Thomas S. Kristensen , Jan Christensen , Martin Sillesen , Carsten P. Hansen , Stefan K. Burgdorf , Bente K. Pedersen , Charlotte Suetta , Jesper F. Christensen , Casper Simonsen","doi":"10.1016/j.clnesp.2024.10.003","DOIUrl":"10.1016/j.clnesp.2024.10.003","url":null,"abstract":"<div><h3>Background and aims</h3><div>The association between sarcopenia and postoperative complications has been widely reported in patients with cancer. Yet, the lack of standardized population-specific diagnostic cut-off points and assessments of muscle strength is hampering prospective clinical utilization. Therefore, we aimed to examine the impact of sarcopenia, defined by both regional and international cut-off points, along with various methods of measuring skeletal muscle and muscle strength, on the risk of postoperative complications following pancreatic resection.</div></div><div><h3>Methods</h3><div>The present prospective observational study enrolled patients scheduled for pancreatic resection. Body composition was assessed by DXA and CT prior to surgery. We applied the algorithm and cut-off points suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) as well as cut-off points from a Danish normative reference population to classify patients as sarcopenic. Physical performance was assessed by usual gait speed while muscle strength was assessed by handgrip strength, leg extensor power, and 30-s sit-to-stand. Postoperative complications within 30 days following surgery were classified according to the Clavien-Dindo classification and the American College of Surgeons National Surgical Quality Improvement Program. Complications graded ≥3 according to Clavien-Dindo were considered major complications.</div></div><div><h3>Results</h3><div>A total of 134 patients with a mean age of 67 years (SD: 9) were enrolled of whom most underwent pancreaticoduodenectomy (64 %). Using international cut-off points, eight patients (7 %) were classified as sarcopenic using CT scans and sarcopenia was associated with an increased risk of major postoperative complications (RR 2.14 [1.33–3.43]). Using DXA, four patients (3 %) were classified as sarcopenic, all of whom experienced a major complication. With regional cut-off points, 16 patients (13 %) were classified as sarcopenic using CT scans, but sarcopenia was not associated with major complications (RR 1.39 [0.80–2.42]). Nine patients (7 %) were classified as sarcopenic using DXA, but sarcopenia was not associated with major complications (RR 1.15 [0.54–2.48]). Across the different muscle strength assessment methods, handgrip strength consistently demonstrated a stronger association with postoperative complications.</div></div><div><h3>Conclusion</h3><div>Sarcopenia defined according to the EWGSOP criteria and with international cut-off points is associated with an increased risk of postoperative complications following pancreatic resection. Using regionally based cut-off points, the prevalence of sarcopenia is higher, but it does not confer a higher postoperative complication risk. The use of different muscle strength assessment methods results in vastly different estimates of prevalence of low strength and associations with postoperative outcomes.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 263-273"},"PeriodicalIF":2.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.clnesp.2024.09.028
Loris Pironi , Cristina Cuerda , Palle Bekker Jeppesen , Francisca Joly , Simon Lal , Georg Lamprecht , Manpreet S. Mundi , Kinga Szczepanek , André Van Gossum , Tim Vanuytsel , Geert Wanten , Arved Weimann , Stephan C. Bischoff
{"title":"Corrigendum to “Operational recommendations for the implementation of home parenteral nutrition program of care according to the guidelines of the European society for clinical nutrition and metabolism” [Clin Nutr ESPEN 63 (2024) 668–675]","authors":"Loris Pironi , Cristina Cuerda , Palle Bekker Jeppesen , Francisca Joly , Simon Lal , Georg Lamprecht , Manpreet S. Mundi , Kinga Szczepanek , André Van Gossum , Tim Vanuytsel , Geert Wanten , Arved Weimann , Stephan C. Bischoff","doi":"10.1016/j.clnesp.2024.09.028","DOIUrl":"10.1016/j.clnesp.2024.09.028","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Page 202"},"PeriodicalIF":2.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-08DOI: 10.1016/j.clnesp.2024.09.030
Jie Qin, Xueli Zheng, Juanjuan Huang, Yan Feng, Bei Feng
{"title":"Letter to the editor - “Dietary and lifestyle inflammation scores in relation to colorectal cancer recurrence and all-cause mortality: A longitudinal analysis”","authors":"Jie Qin, Xueli Zheng, Juanjuan Huang, Yan Feng, Bei Feng","doi":"10.1016/j.clnesp.2024.09.030","DOIUrl":"10.1016/j.clnesp.2024.09.030","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 198-199"},"PeriodicalIF":2.9,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.clnesp.2024.09.027
Erika Vanesa Cadena-Burbano, Ana Elisa Toscano, Joaci Pereira dos Santos-Junior, Danielle da Fonseca Dourado, Isla Ariadny Amaral de Souza Gonzaga Paz, Eulália Rebeca da Silva-Araújo, Paula Brielle Pontes
{"title":"Letter to the editor: Comment on “Maternal hemoglobin and iron status in early pregnancy and childhood cardiac outcomes”","authors":"Erika Vanesa Cadena-Burbano, Ana Elisa Toscano, Joaci Pereira dos Santos-Junior, Danielle da Fonseca Dourado, Isla Ariadny Amaral de Souza Gonzaga Paz, Eulália Rebeca da Silva-Araújo, Paula Brielle Pontes","doi":"10.1016/j.clnesp.2024.09.027","DOIUrl":"10.1016/j.clnesp.2024.09.027","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 203-204"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-08-07DOI: 10.1016/j.clnesp.2024.07.1055
Mette M Berger, Elisabeth De Waele, Leah Gramlich, Jennifer Jin, Olivier Pantet, Claude Pichard, Ashlee Jean Roffe, Lindsey Russell, Pierre Singer, Paul E Wischmeyer
Evidence is growing that the individual adjustment of energy targets guided by indirect calorimetry (IC) can improve outcome. With the development of a new generation of devices that are easier to use and rapid, it appears important to share knowledge and expertise that may be used to individualize nutrition care. Despite the focus of this tutorial being on one contemporary device, the principles of IC apply across existing devices and can assist tailoring the nutrition prescription and in assessing response to nutrition therapy. The present tutorial addresses its clinical application in intubated mechanically ventilated and spontaneously breathing adult patients (canopy), i.e. it covers the range from critical illness to outpatients. The cases that are presented show how the measured energy expenditure (mEE), and the respiratory quotient (RQ), i.e. the ratio of expired CO2 to consumed O2, should be applied in different cases, to adapt and individualize nutrition prescription, as it is a good marker of over- or underfeeding at the different stages of disease. The RQ also informs about the patient's body's capacity to use different substrates: the variations of RQ indicating the metabolic changes revealing insufficient or excessive feeding. The different cases reflect the use of a new generation device as a metabolic monitor that should be combined with other clinical observations and laboratory biomarkers. The tutorial also points to some shortcomings of the method, proposing alternatives.
越来越多的证据表明,在间接热量计(IC)的指导下对能量目标进行个体化调整可以改善治疗效果。随着更易于使用和快速的新一代设备的开发,分享可用于个体化营养护理的知识和专业技术显得尤为重要。尽管本教程的重点是当代的一种设备,但 IC 的原理适用于现有的各种设备,可以帮助定制营养处方和评估对营养治疗的反应。本教程介绍了其在插管机械通气和自主呼吸成人患者(天幕)中的临床应用,即涵盖了从危重病人到门诊病人的范围。所介绍的病例展示了如何在不同病例中应用测量的能量消耗(mEE)和呼吸商(RQ),即呼出的二氧化碳与消耗的氧气之比,以调整和个性化营养处方,因为它是疾病不同阶段过量或不足喂养的良好标志。RQ 还能反映病人身体使用不同底物的能力:RQ 的变化表明新陈代谢的变化,显示喂养不足或喂养过度。不同的病例反映了新一代设备作为代谢监测仪的使用情况,它应与其他临床观察和实验室生物标志物相结合。教程还指出了该方法的一些不足之处,并提出了替代方法。
{"title":"How to interpret and apply the results of indirect calorimetry studies: A case-based tutorial.","authors":"Mette M Berger, Elisabeth De Waele, Leah Gramlich, Jennifer Jin, Olivier Pantet, Claude Pichard, Ashlee Jean Roffe, Lindsey Russell, Pierre Singer, Paul E Wischmeyer","doi":"10.1016/j.clnesp.2024.07.1055","DOIUrl":"10.1016/j.clnesp.2024.07.1055","url":null,"abstract":"<p><p>Evidence is growing that the individual adjustment of energy targets guided by indirect calorimetry (IC) can improve outcome. With the development of a new generation of devices that are easier to use and rapid, it appears important to share knowledge and expertise that may be used to individualize nutrition care. Despite the focus of this tutorial being on one contemporary device, the principles of IC apply across existing devices and can assist tailoring the nutrition prescription and in assessing response to nutrition therapy. The present tutorial addresses its clinical application in intubated mechanically ventilated and spontaneously breathing adult patients (canopy), i.e. it covers the range from critical illness to outpatients. The cases that are presented show how the measured energy expenditure (mEE), and the respiratory quotient (RQ), i.e. the ratio of expired CO<sub>2</sub> to consumed O<sub>2</sub>, should be applied in different cases, to adapt and individualize nutrition prescription, as it is a good marker of over- or underfeeding at the different stages of disease. The RQ also informs about the patient's body's capacity to use different substrates: the variations of RQ indicating the metabolic changes revealing insufficient or excessive feeding. The different cases reflect the use of a new generation device as a metabolic monitor that should be combined with other clinical observations and laboratory biomarkers. The tutorial also points to some shortcomings of the method, proposing alternatives.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":"856-869"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Retraction notice to \"Corrigendum to 'The correlation of serum adiponectin and insulin resistance with the presence and severity of dementia in non-obese Alzheimer's patients'\" [Clin Nutr ESPEN 53C (2023) 282 / 1590].","authors":"Seyed Amir Hejazi, Kambiz Rohampour, Ehsan Sharifipour, Soruosh Sharifimoghadam, Sepideh Paybast, Abdoreza Ghoreishi, Navid Hassanzadeh, Mostafa Vahedian","doi":"10.1016/j.clnesp.2024.06.031","DOIUrl":"10.1016/j.clnesp.2024.06.031","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"63 ","pages":"971"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.clnesp.2024.09.022
ChiouYi Ho , Barakatun Nisak Mohd Yusof , Hazreen Abdul Majid , Zulfitri Azuan Mat Daud
Background
Gynecologic cancer (GC) patients often experience systemic inflammation, malnutrition, and compromised postoperative outcomes. This systematic review aims to comprehensively synthesize existing data regarding the impact of perioperative immunonutrition (IMN) intervention on GC patients.
Methods
The databases of CENTRAL, EMBASE, Web of Science, and the Cochrane Library were used to conduct a literature search, supplemented by internet search engines and manual searches. Publications released between January 2009 and October 2023 was identified, reviewed, and data extracted.
Results
The review encompasses six studies involving 712 patients, comprising two randomized controlled trials (RCTs), two prospective studies, and two retrospective cohort studies. Three studies prescribed IMN perioperatively; two pre-operatively and one post-operatively. Four out of six studies reported less post-operative infection and complications. Two studies reported shorter hospitalization using the IMN formula. One study reported a longer hospitalization with IMN supplementation. Overall survival showed no significant difference in the two studies. Four studies reported positive modulation of inflammatory markers and lymphocytes as outcomes, with IMN formulas.
Discussion and conclusion
Perioperative IMN emerge as a promising intervention, demonstrating notable benefits included shortened hospitalization as well and positive modulation of inflammatory markers.
{"title":"Effect of perioperative immunonutrition intervention among gynecological cancer patients: A systematic review","authors":"ChiouYi Ho , Barakatun Nisak Mohd Yusof , Hazreen Abdul Majid , Zulfitri Azuan Mat Daud","doi":"10.1016/j.clnesp.2024.09.022","DOIUrl":"10.1016/j.clnesp.2024.09.022","url":null,"abstract":"<div><h3>Background</h3><div>Gynecologic cancer (GC) patients often experience systemic inflammation, malnutrition, and compromised postoperative outcomes. This systematic review aims to comprehensively synthesize existing data regarding the impact of perioperative immunonutrition (IMN) intervention on GC patients.</div></div><div><h3>Methods</h3><div>The databases of CENTRAL, EMBASE, Web of Science, and the Cochrane Library were used to conduct a literature search, supplemented by internet search engines and manual searches. Publications released between January 2009 and October 2023 was identified, reviewed, and data extracted.</div></div><div><h3>Results</h3><div>The review encompasses six studies involving 712 patients, comprising two randomized controlled trials (RCTs), two prospective studies, and two retrospective cohort studies. Three studies prescribed IMN perioperatively; two pre-operatively and one post-operatively. Four out of six studies reported less post-operative infection and complications. Two studies reported shorter hospitalization using the IMN formula. One study reported a longer hospitalization with IMN supplementation. Overall survival showed no significant difference in the two studies. Four studies reported positive modulation of inflammatory markers and lymphocytes as outcomes, with IMN formulas.</div></div><div><h3>Discussion and conclusion</h3><div>Perioperative IMN emerge as a promising intervention, demonstrating notable benefits included shortened hospitalization as well and positive modulation of inflammatory markers.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 168-176"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}