Objective: A significant portion of colorectal cancer patients lose weight preoperatively. Here we examine the influence of pre-operative significant weight loss on venous thromboembolism (VTE) risk and determine whether pre-operative BMI and albumin could influence VTE outcomes in patients who have lost significant weight prior to surgery.Methods: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and identified 103,455 colorectal cancer patients undergoing major surgery from 2008 to 2012. Patients were assigned to one of two groups based on whether they lost significant weight preoperatively or not. Simple and stepwise multiple logistic regressions were used to evaluate the association between pre-operative unintended weight loss and 30-days postoperative outcomes. The association between weight loss and postoperative thrombosis was further assessed across several strata.Results: The overall prevalence of pre-operative significant weight loss was 6.8%. Significant weight loss prior to surgery was significantly and independently associated with a higher risk of VTE (adjusted OR 1.23, 95% CI 1.06-1.44), mortality (adjusted OR 1.55, 95% CI 1.35-1.78), composite morbidity (adjusted OR 1.52, 95% CI 1.42-1.62), bleeding (adjusted OR 1.78, 95% CI 1.67-1.91) and return to operation room (adjusted OR 1.29, 95% CI 1.16-1.42). The effect of pre-operative significant weight loss on thromboembolic outcome was evident across patients with a BMI <18.5 kg/m2, 18.5 < BMI < 24.99 and BMI >40kg/m2.Conclusions: Significant weight loss and BMI both need to be measured preoperatively to stratify patients who are at a higher risk of VTE.
目的:相当一部分结直肠癌患者术前体重减轻。在这里,我们研究了术前体重明显减轻对静脉血栓栓塞(VTE)风险的影响,并确定术前BMI和白蛋白是否会影响术前体重明显减轻的患者的静脉血栓栓塞结局。方法:采用美国外科医师学会国家手术质量改进计划(ACS NSQIP)进行回顾性队列研究,确定了2008年至2012年接受大手术的103,455例结直肠癌患者。根据术前体重是否明显减轻,患者被分为两组。使用简单和逐步多元逻辑回归来评估术前意外体重减轻与术后30天预后之间的关系。体重减轻与术后血栓形成之间的关系在多个层面得到进一步评估。结果:术前体重明显减轻的总发生率为6.8%。术前体重明显减轻与静脉血栓栓塞(调整OR 1.23, 95% CI 1.06-1.44)、死亡率(调整OR 1.55, 95% CI 1.35-1.78)、综合发病率(调整OR 1.52, 95% CI 1.42-1.62)、出血(调整OR 1.78, 95% CI 1.67-1.91)和返回手术室(调整OR 1.29, 95% CI 1.16-1.42)的高风险显著且独立相关。术前体重显著减轻对血栓栓塞结局的影响在BMI为2,18.5 40kg/m2的患者中是明显的。结论:术前需要测量明显的体重减轻和BMI,以对静脉血栓栓塞风险较高的患者进行分层。
{"title":"Could Preoperative Unintended Weight Loss Predispose to Postoperative Thrombosis in Patients Undergoing Colorectal Cancer Surgery? An Analysis of the NSQIP Data.","authors":"Sally Temraz, Hani Tamim, Aurelie Mailhac, Farah Nassar, Nour Moukalled, Faek Jamali, Ali Taher","doi":"10.1080/07315724.2020.1747031","DOIUrl":"https://doi.org/10.1080/07315724.2020.1747031","url":null,"abstract":"<p><p><b>Objective:</b> A significant portion of colorectal cancer patients lose weight preoperatively. Here we examine the influence of pre-operative significant weight loss on venous thromboembolism (VTE) risk and determine whether pre-operative BMI and albumin could influence VTE outcomes in patients who have lost significant weight prior to surgery.<b>Methods:</b> We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and identified 103,455 colorectal cancer patients undergoing major surgery from 2008 to 2012. Patients were assigned to one of two groups based on whether they lost significant weight preoperatively or not. Simple and stepwise multiple logistic regressions were used to evaluate the association between pre-operative unintended weight loss and 30-days postoperative outcomes. The association between weight loss and postoperative thrombosis was further assessed across several strata.<b>Results:</b> The overall prevalence of pre-operative significant weight loss was 6.8%. Significant weight loss prior to surgery was significantly and independently associated with a higher risk of VTE (adjusted OR 1.23, 95% CI 1.06-1.44), mortality (adjusted OR 1.55, 95% CI 1.35-1.78), composite morbidity (adjusted OR 1.52, 95% CI 1.42-1.62), bleeding (adjusted OR 1.78, 95% CI 1.67-1.91) and return to operation room (adjusted OR 1.29, 95% CI 1.16-1.42). The effect of pre-operative significant weight loss on thromboembolic outcome was evident across patients with a BMI <18.5 kg/m<sup>2</sup>, 18.5 < BMI < 24.99 and BMI >40kg/m<sup>2</sup>.<b>Conclusions:</b> Significant weight loss and BMI both need to be measured preoperatively to stratify patients who are at a higher risk of VTE.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1747031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37807295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01Epub Date: 2020-03-30DOI: 10.1080/07315724.2020.1737985
Marie Cavuoto Petrizzo, Lauren Block, Doreen M Olvet, Eva M Sheridan, Rebecca Dougherty, Matthew Whitson, Janice T John, Maria-Louise Barilla-LaBarca, Stephanie DiFiglia-Peck, Alice Fornari
Objective: The patient-physician encounter provides an ideal opportunity to assess a patient's dietary history and its impact on total health. However, nutrition assessments and counseling in physician-patient encounters is often lacking. Insufficient nutrition education during medical school may lead to insecurity in assessing and counseling patients.Methods: Physicians and registered dietitians (RD) co-developed and co-facilitated a nutrition workshop for first-year medical students. Goals included increasing recognition of nutrition's impact on health and promoting student confidence and skills when attaining a nutrition history, assessing risk factors, and advising.Results: Seventy percent of students attested to having "sufficient" knowledge to counsel a patient on nutrition after the session compared to 38% before (Z= -4.46, p < 0.001). Sixty eight percent felt comfortable completing a nutritional assessment after the session compared to 35% before (Z= -4.30, p < 0.001). Sixty-three percent felt confident in advising patients about nutrition after the session compared to 32% before (Z= -4.20, p < 0.001). Students also significantly outperformed a control cohort on a nutrition-related component of an Objective Standardized Clinical Examination.Conclusions: Clinical nutrition education can be successfully integrated into the medical school curriculum as early as the first year. Interprofessional collaboration with RDs provided evidence-based content and authentic clinical experience in both the development of the workshop and in facilitating student discussion.
目的:医患接触为评估患者的饮食史及其对整体健康的影响提供了一个理想的机会。然而,营养评估和咨询在医患接触往往是缺乏的。医学院营养教育不足可能导致评估和咨询患者的不安全感。方法:医师和注册营养师(RD)共同开发和共同促进了一年级医学生的营养研讨会。目标包括提高对营养对健康影响的认识,提高学生在获得营养史、评估风险因素和提供建议时的信心和技能。结果:70%的学生在课程结束后证明有“足够”的知识来为患者提供营养咨询,而在课程开始前为38% (Z= -4.46, p Z= -4.30, p Z= -4.20, p)。结论:临床营养教育可以早在第一年就成功地融入医学院课程。与rd的跨专业合作为研讨会的发展和促进学生讨论提供了基于证据的内容和真实的临床经验。
{"title":"Implementation of an Interprofessional Nutrition Workshop to Integrate Nutrition Education into a Preclinical Medical School Curriculum.","authors":"Marie Cavuoto Petrizzo, Lauren Block, Doreen M Olvet, Eva M Sheridan, Rebecca Dougherty, Matthew Whitson, Janice T John, Maria-Louise Barilla-LaBarca, Stephanie DiFiglia-Peck, Alice Fornari","doi":"10.1080/07315724.2020.1737985","DOIUrl":"https://doi.org/10.1080/07315724.2020.1737985","url":null,"abstract":"<p><p><b>Objective:</b> The patient-physician encounter provides an ideal opportunity to assess a patient's dietary history and its impact on total health. However, nutrition assessments and counseling in physician-patient encounters is often lacking. Insufficient nutrition education during medical school may lead to insecurity in assessing and counseling patients.<b>Methods:</b> Physicians and registered dietitians (RD) co-developed and co-facilitated a nutrition workshop for first-year medical students. Goals included increasing recognition of nutrition's impact on health and promoting student confidence and skills when attaining a nutrition history, assessing risk factors, and advising.<b>Results:</b> Seventy percent of students attested to having \"sufficient\" knowledge to counsel a patient on nutrition after the session compared to 38% before (<i>Z</i>= -4.46, <i>p</i> < 0.001). Sixty eight percent felt comfortable completing a nutritional assessment after the session compared to 35% before (<i>Z</i>= -4.30, <i>p</i> < 0.001). Sixty-three percent felt confident in advising patients about nutrition after the session compared to 32% before (<i>Z</i>= -4.20, <i>p</i> < 0.001). Students also significantly outperformed a control cohort on a nutrition-related component of an Objective Standardized Clinical Examination.<b>Conclusions:</b> Clinical nutrition education can be successfully integrated into the medical school curriculum as early as the first year. Interprofessional collaboration with RDs provided evidence-based content and authentic clinical experience in both the development of the workshop and in facilitating student discussion.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1737985","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37780867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01Epub Date: 2020-07-02DOI: 10.1080/07315724.2020.1779554
Harry G Preuss, Okezie I Aruoma
At this point in time, the COVID-19 pandemic appears relentless with no end in sight. Dire predictions of a continuance for as long as an additional two years or more have been voiced. A beneficial...
{"title":"Suggestions for Combatting COVID-19 by Natural Means in the Absence of Standard Medical Regimens.","authors":"Harry G Preuss, Okezie I Aruoma","doi":"10.1080/07315724.2020.1779554","DOIUrl":"https://doi.org/10.1080/07315724.2020.1779554","url":null,"abstract":"At this point in time, the COVID-19 pandemic appears relentless with no end in sight. Dire predictions of a continuance for as long as an additional two years or more have been voiced. A beneficial...","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1779554","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38110570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01Epub Date: 2020-04-24DOI: 10.1080/07315724.2020.1750073
Samantha B Kostelnik, Kevin P Davy, Valisa E Hedrick, D Travis Thomas, Brenda M Davy
Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely impractical for the general population and athletes to implement on a routine basis. Despite its widespread use, the validity of urine color as an indicator of hydration status has not been systematically evaluated. The objective of this systematic review is to determine the validity of urine color evaluation as a hydration status assessment method in the general adult population, older adults, and athletes. Using the PRISMA guidelines, electronic databases were searched to identify original research articles of all study design types for inclusion. Of the 424 articles screened, 10 met inclusion criteria. Most studies compared urine color to either urinary specific gravity or urine osmolality, and reported significant associations (r) ranging from 0.40 to 0.93. Lower correlations were noted in studies of adults aged >60 years. Studies generally reported a high sensitivity of urine color as a diagnostic tool for detecting dehydration and supported the ability of this method to distinguish across categories of hydration status. Research is needed to determine if clinicians, patients, and clients can accurately utilize this method in clinical and real-world settings. Future research is also needed to extend these findings to other populations, such as children.Key teaching pointsInadequate hydration can lead to impairments in physical performance and cognitive function.Methods used to assess hydration status include plasma/serum osmolality, urinary specific gravity (USG), urine osmolality (Uosm), change in body weight, urine volume, and urine color.Urine color assessment is a practical method that is routinely used in clinical, athletic, and other settings. The validity of this method has not been systemically evaluated.Available research was limited to 10 articles.Validity of this method was generally supported; however, research has not investigated the validity of this method by clinicians, patients and clients.
{"title":"The Validity of Urine Color as a Hydration Biomarker within the General Adult Population and Athletes: A Systematic Review.","authors":"Samantha B Kostelnik, Kevin P Davy, Valisa E Hedrick, D Travis Thomas, Brenda M Davy","doi":"10.1080/07315724.2020.1750073","DOIUrl":"https://doi.org/10.1080/07315724.2020.1750073","url":null,"abstract":"<p><p>Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely impractical for the general population and athletes to implement on a routine basis. Despite its widespread use, the validity of urine color as an indicator of hydration status has not been systematically evaluated. The objective of this systematic review is to determine the validity of urine color evaluation as a hydration status assessment method in the general adult population, older adults, and athletes. Using the PRISMA guidelines, electronic databases were searched to identify original research articles of all study design types for inclusion. Of the 424 articles screened, 10 met inclusion criteria. Most studies compared urine color to either urinary specific gravity or urine osmolality, and reported significant associations (r) ranging from 0.40 to 0.93. Lower correlations were noted in studies of adults aged >60 years. Studies generally reported a high sensitivity of urine color as a diagnostic tool for detecting dehydration and supported the ability of this method to distinguish across categories of hydration status. Research is needed to determine if clinicians, patients, and clients can accurately utilize this method in clinical and real-world settings. Future research is also needed to extend these findings to other populations, such as children.Key teaching pointsInadequate hydration can lead to impairments in physical performance and cognitive function.Methods used to assess hydration status include plasma/serum osmolality, urinary specific gravity (USG), urine osmolality (Uosm), change in body weight, urine volume, and urine color.Urine color assessment is a practical method that is routinely used in clinical, athletic, and other settings. The validity of this method has not been systemically evaluated.Available research was limited to 10 articles.Validity of this method was generally supported; however, research has not investigated the validity of this method by clinicians, patients and clients.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1750073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37868768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01Epub Date: 2020-04-13DOI: 10.1080/07315724.2020.1750072
Carolina Araújo Dos Santos, Carla de Oliveira Barbosa Rosa, Sylvia do Carmo Castro Franceschini, Heloísa Helena Firmino, Andréia Queiroz Ribeiro
Objective: To assess whether the nutritional risk classified by StrongKids is associated with anemia and inflammation (total leukocytes and C-reactive protein (CRP)), as well as to compare the ability of StrongKids with anthropometry in identifying these changes in hospitalized pediatric patients.Methods: Cross-sectional study with patients admitted to the pediatric ward of a public hospital in Brazil, from 2014 to 2018. The experimental protocol included: nutritional risk screening by StrongKids; weight and height measurements; and biochemical tests (complete blood count and C-reactive protein - CRP). Sensitivity, specificity, positive predictive value and negative predictive value were calculated to assess the ability of StrongKids and anthropometry to identify patients with the biochemical changes.Results: The study included 482 patients (54.2% male), with a median age of 2.7 years. The frequency of nutritional risk (medium or high) was 85.9% and the prevalence of malnutrition (acute and/or chronic) was 20.2%. Overall, of the patients evaluated, 40.2% had anemia, 28.2% leukocytosis, and 78.0% high CRP. Children and adolescents classified as at nutritional risk (moderate/high) had lower levels of hemoglobin and higher levels of CRP and total leukocytes, as well as a higher frequency of leukocytosis, high CRP and the three alterations combined when compared with individuals at low risk. No association was found between anthropometric variables and biochemical alterations. The sensitivity of nutritional screening was high to detect all biochemical alterations and was superior to the anthropometric assessment.Conclusion: StrongKids was associated with alterations in biochemical parameters with a better performance than anthropometry.
{"title":"Usefulness of the StrongKids Screening Tool in Detecting Anemia and Inflammation in Hospitalized Pediatric Patients.","authors":"Carolina Araújo Dos Santos, Carla de Oliveira Barbosa Rosa, Sylvia do Carmo Castro Franceschini, Heloísa Helena Firmino, Andréia Queiroz Ribeiro","doi":"10.1080/07315724.2020.1750072","DOIUrl":"https://doi.org/10.1080/07315724.2020.1750072","url":null,"abstract":"<p><p><b>Objective:</b> To assess whether the nutritional risk classified by StrongKids is associated with anemia and inflammation (total leukocytes and C-reactive protein (CRP)), as well as to compare the ability of StrongKids with anthropometry in identifying these changes in hospitalized pediatric patients.<b>Methods:</b> Cross-sectional study with patients admitted to the pediatric ward of a public hospital in Brazil, from 2014 to 2018. The experimental protocol included: nutritional risk screening by StrongKids; weight and height measurements; and biochemical tests (complete blood count and C-reactive protein - CRP). Sensitivity, specificity, positive predictive value and negative predictive value were calculated to assess the ability of StrongKids and anthropometry to identify patients with the biochemical changes.<b>Results:</b> The study included 482 patients (54.2% male), with a median age of 2.7 years. The frequency of nutritional risk (medium or high) was 85.9% and the prevalence of malnutrition (acute and/or chronic) was 20.2%. Overall, of the patients evaluated, 40.2% had anemia, 28.2% leukocytosis, and 78.0% high CRP. Children and adolescents classified as at nutritional risk (moderate/high) had lower levels of hemoglobin and higher levels of CRP and total leukocytes, as well as a higher frequency of leukocytosis, high CRP and the three alterations combined when compared with individuals at low risk. No association was found between anthropometric variables and biochemical alterations. The sensitivity of nutritional screening was high to detect all biochemical alterations and was superior to the anthropometric assessment.<b>Conclusion:</b> StrongKids was associated with alterations in biochemical parameters with a better performance than anthropometry.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1750072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37826399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01Epub Date: 2020-04-10DOI: 10.1080/07315724.2020.1747032
Josiane C Vettori, Luanda G da Silva, Karina Pfrimer, Alceu A Jordão Junior, Júlio C Moriguti, Eduardo Ferriolli, Nereida K C Lima
Objective: The aim of this study was to characterize nutritional status, body composition, oxidative stress, and inflammatory activity and to determine the possible associations between nutritional status and clinical variables in advanced cancer patients.Method: This was a cross-sectional study of 46 elderly cancer patients under palliative care with a prognosis of 30 days or more. Nutritional status, food intake, anthropometry, body composition (deuterium oxide method), metabolic profile, inflammation damage (C-reactive protein), oxidative damage (8-hydroxy-2'-deoxyguanosine), and symptom intensity were evaluated.Results: Among elderly cancer patients, 36.9% were malnourished or at risk of malnutrition. Systemic inflammation was detected, with a correlation between worse nutritional status and higher C-reactive protein levels (p < 0.01, r= -0.57), while lower lean mass (p < 0.01, r = 0.62) and higher fat mass percentages (p < 0.01, r = 0.62) correlated with higher levels of 8-hydroxy-2'-deoxyguanosine. Furthermore, daily energy (n = 25; 57.4%) and protein intake (n = 24; 52.2%) were lower than recommended in more than half the patients. The most prevalent symptoms were anxiety, impairment of well-being, drowsiness, tiredness, and lack of appetite.Conclusions: Despite preserved functionality, patients already had clinical and laboratory changes that, together with inadequate food intake, risk of malnutrition, systemic inflammation, and the presence of uncontrolled symptoms, alerted to the importance of an early and comprehensive palliative approach.
{"title":"Older Adult Cancer Patients Under Palliative Care With a Prognosis of 30 Days or More: Clinical and Nutritional Changes.","authors":"Josiane C Vettori, Luanda G da Silva, Karina Pfrimer, Alceu A Jordão Junior, Júlio C Moriguti, Eduardo Ferriolli, Nereida K C Lima","doi":"10.1080/07315724.2020.1747032","DOIUrl":"https://doi.org/10.1080/07315724.2020.1747032","url":null,"abstract":"<p><p><b>Objective:</b> The aim of this study was to characterize nutritional status, body composition, oxidative stress, and inflammatory activity and to determine the possible associations between nutritional status and clinical variables in advanced cancer patients.<b>Method:</b> This was a cross-sectional study of 46 elderly cancer patients under palliative care with a prognosis of 30 days or more. Nutritional status, food intake, anthropometry, body composition (deuterium oxide method), metabolic profile, inflammation damage (C-reactive protein), oxidative damage (8-hydroxy-2'-deoxyguanosine), and symptom intensity were evaluated.<b>Results:</b> Among elderly cancer patients, 36.9% were malnourished or at risk of malnutrition. Systemic inflammation was detected, with a correlation between worse nutritional status and higher C-reactive protein levels (p < 0.01, r= -0.57), while lower lean mass (p < 0.01, r = 0.62) and higher fat mass percentages (p < 0.01, r = 0.62) correlated with higher levels of 8-hydroxy-2'-deoxyguanosine. Furthermore, daily energy (n = 25; 57.4%) and protein intake (n = 24; 52.2%) were lower than recommended in more than half the patients. The most prevalent symptoms were anxiety, impairment of well-being, drowsiness, tiredness, and lack of appetite.<b>Conclusions:</b> Despite preserved functionality, patients already had clinical and laboratory changes that, together with inadequate food intake, risk of malnutrition, systemic inflammation, and the presence of uncontrolled symptoms, alerted to the importance of an early and comprehensive palliative approach.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1747032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37822928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01Epub Date: 2020-04-10DOI: 10.1080/07315724.2020.1740629
Virginia M Lindley, Kamal Bhusal, Laura Huning, Steven N Levine, Sushil K Jain
Introduction: Reduced circulating levels of 25(OH)VD are associated with an increased incidence of chronic lung diseases. Alpha-1-antitrypsin (AAT) is needed to maintain healthy lung function.Objective: This study examined the hypothesis that circulating levels of AAT are lower in adult type 2 diabetic patients and that a positive association exists between circulating AAT levels and 25(OH)VD levels in these patients.Methods: Fasting blood was obtained after written informed consent from type 2 diabetic patients (n = 80) and normal siblings or volunteers (n = 22) attending clinics at LSUHSC according to the protocol approved by the Institutional Review Board for Human studies. Plasma AAT and 25(OH)VD levels were determined using ELISA kits. HbA1c levels and chemistry profiles were analyzed at the clinical laboratory of LSUHSC hospital.Results: ATT and 25(OH)VD levels were significantly lower in type 2 diabetic patients compared with those of age-matched healthy controls. There was a significant positive correlation between 25(OH)VD and ATT deficiency. AAT levels showed significant positive correlation with HDL cholesterol levels in type 2 diabetic patients. There was no correlation between AAT levels and those of HbA1c or with the duration of diabetes of T2D patients.Conclusions: These results suggest that 25(OH)VD deficiency may predispose type 2 diabetic patients to AAT deficiency. Whether reduced levels of circulating AAT indeed contribute to the increased risk for lung dysfunction in subjects with type 2 diabetes needs further investigation.
{"title":"Reduced 25(OH) Vitamin D Association with Lower Alpha-1-Antitrypsin Blood Levels in Type 2 Diabetic Patients.","authors":"Virginia M Lindley, Kamal Bhusal, Laura Huning, Steven N Levine, Sushil K Jain","doi":"10.1080/07315724.2020.1740629","DOIUrl":"https://doi.org/10.1080/07315724.2020.1740629","url":null,"abstract":"<p><p><b>Introduction:</b> Reduced circulating levels of 25(OH)VD are associated with an increased incidence of chronic lung diseases. Alpha-1-antitrypsin (AAT) is needed to maintain healthy lung function.<b>Objective:</b> This study examined the hypothesis that circulating levels of AAT are lower in adult type 2 diabetic patients and that a positive association exists between circulating AAT levels and 25(OH)VD levels in these patients.<b>Methods:</b> Fasting blood was obtained after written informed consent from type 2 diabetic patients (n = 80) and normal siblings or volunteers (n = 22) attending clinics at LSUHSC according to the protocol approved by the Institutional Review Board for Human studies. Plasma AAT and 25(OH)VD levels were determined using ELISA kits. HbA<sub>1c</sub> levels and chemistry profiles were analyzed at the clinical laboratory of LSUHSC hospital.<b>Results:</b> ATT and 25(OH)VD levels were significantly lower in type 2 diabetic patients compared with those of age-matched healthy controls. There was a significant positive correlation between 25(OH)VD and ATT deficiency. AAT levels showed significant positive correlation with HDL cholesterol levels in type 2 diabetic patients. There was no correlation between AAT levels and those of HbA<sub>1c</sub> or with the duration of diabetes of T2D patients.<b>Conclusions:</b> These results suggest that 25(OH)VD deficiency may predispose type 2 diabetic patients to AAT deficiency. Whether reduced levels of circulating AAT indeed contribute to the increased risk for lung dysfunction in subjects with type 2 diabetes needs further investigation.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1740629","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37822925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01Epub Date: 2020-03-23DOI: 10.1080/07315724.2020.1740114
Ionas Papassotiriou, Sheikh Mohammed Shariful Islam
Objective: The aim of this work was to examine the association between adherence to a Mediterranean diet (MD) and lung function in older adults.Design: This was an observational and cross-sectional study.Setting: This research was conducted among community-dwelling older adults from the 2014 Health and Retirement Study (HRS).Subjects: Subjects were 2108 adults aged 50 years or older, 1234 (58.5%) of whom were female.Measures: Dietary intakes from respondents of the Health and Retirement Study (HRS) were used for the current analysis. Adherence to MD was evaluated using the MedDietScore, while lung function was evaluated through peak expiratory flow rate (PEF; l/min). Multiple linear regression and logistic regression were performed, adjusted for potential confounders, to examine the relation between adherence to MD and lung function.Results: Mean MedDietScore was 28.0 (± 5.0), indicating a moderate adherence to MD. Multiple linear regression showed a significant association between the MedDietScore and lung function (β = 0.072, 95% confidence interval [CI]: 0.039-0.104) after adjusting for age, gender, body mass index, race, comorbidities, education, height, grip strength, smoking history, physical activity, and daily caloric intake. Specific food groups such as grains, dairy products, and fish consumption were also associated with PEF rate (p < 0.05). Logistic regression confirmed these findings, and high adherence to MD was associated with reduced risk of having PEF rate < 80% of its peak predictive value (odds ratio: 0.65, 95% CI: 0.48-0.89).Conclusions: The results of this study indicate that adherence to MD is an independent predictor of lung function in older adults, and dietary interventions could be a possible preventive measure in adults with a high risk of developing lung function decline.
{"title":"Adherence to Mediterranean Diet Is Associated With Lung Function in Older Adults: Data From the Health and Retirement Study.","authors":"Ionas Papassotiriou, Sheikh Mohammed Shariful Islam","doi":"10.1080/07315724.2020.1740114","DOIUrl":"https://doi.org/10.1080/07315724.2020.1740114","url":null,"abstract":"<p><p><b>Objective:</b> The aim of this work was to examine the association between adherence to a Mediterranean diet (MD) and lung function in older adults.<b>Design:</b> This was an observational and cross-sectional study.<b>Setting:</b> This research was conducted among community-dwelling older adults from the 2014 Health and Retirement Study (HRS).<b>Subjects:</b> Subjects were 2108 adults aged 50 years or older, 1234 (58.5%) of whom were female.<b>Measures:</b> Dietary intakes from respondents of the Health and Retirement Study (HRS) were used for the current analysis. Adherence to MD was evaluated using the MedDietScore, while lung function was evaluated through peak expiratory flow rate (PEF; l/min). Multiple linear regression and logistic regression were performed, adjusted for potential confounders, to examine the relation between adherence to MD and lung function.<b>Results:</b> Mean MedDietScore was 28.0 (± 5.0), indicating a moderate adherence to MD. Multiple linear regression showed a significant association between the MedDietScore and lung function (<i>β</i> = 0.072, 95% confidence interval [CI]: 0.039-0.104) after adjusting for age, gender, body mass index, race, comorbidities, education, height, grip strength, smoking history, physical activity, and daily caloric intake. Specific food groups such as grains, dairy products, and fish consumption were also associated with PEF rate (<i>p</i> < 0.05). Logistic regression confirmed these findings, and high adherence to MD was associated with reduced risk of having PEF rate < 80% of its peak predictive value (odds ratio: 0.65, 95% CI: 0.48-0.89).<b>Conclusions:</b> The results of this study indicate that adherence to MD is an independent predictor of lung function in older adults, and dietary interventions could be a possible preventive measure in adults with a high risk of developing lung function decline.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1740114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37763232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective:Cordyceps cicadae, a medicinal fungus, is assessed as having many functions: anti-cancer, anti-fatigue, anti-aging, immune-boosting, renal and liver protection. Since the industrial production of C. cicadae mycelium consistently manufactures bioactive compounds superior to wild fruiting bodies, there is a need to confirm the toxicity of liquid fermented C. cicadae mycelium. Studies showed the toxicity evaluation of C. cicadae mycelium in animal models, but safety reports in clinical studies are scarce. As such, a safety assessment of oral N6-(2-hydroxyethyl) adenosine (HEA-enriched) C. cicadae mycelium in humans is provided here.Method: After 49 participants ingested granules of 1.05 g of freeze-dried C. cicadae mycelium once a day for 3 months, their blood samples were collected at the beginning and end of the experiment for analysis.Results: There were no significant differences between the initial and final measurements in renal and liver function. Also, there was no influence on blood electrolytes as well as blood lipid levels. In clinical observation, there were also no side effects or adverse feelings mentioned by participants.Conclusion: These results suggested that HEA-enriched C. cicadae mycelium produced by liquid fermentation is safe and can be developed as a functional health food.
{"title":"Safety Assessment of HEA-Enriched <i>Cordyceps cicadae</i> Mycelium: A Randomized Clinical Trial.","authors":"You-Shan Tsai, Jui-Hsia Hsu, David Pei-Cheng Lin, Han-Hsin Chang, Wen-Jui Chang, Yen-Lien Chen, Chin-Chu Chen","doi":"10.1080/07315724.2020.1743211","DOIUrl":"https://doi.org/10.1080/07315724.2020.1743211","url":null,"abstract":"<p><p><b>Objective:</b><i>Cordyceps cicadae</i>, a medicinal fungus, is assessed as having many functions: anti-cancer, anti-fatigue, anti-aging, immune-boosting, renal and liver protection. Since the industrial production of <i>C. cicadae</i> mycelium consistently manufactures bioactive compounds superior to wild fruiting bodies, there is a need to confirm the toxicity of liquid fermented <i>C. cicadae</i> mycelium. Studies showed the toxicity evaluation of <i>C. cicadae</i> mycelium in animal models, but safety reports in clinical studies are scarce. As such, a safety assessment of oral N6-(2-hydroxyethyl) adenosine (HEA-enriched) <i>C. cicadae</i> mycelium in humans is provided here.<b>Method:</b> After 49 participants ingested granules of 1.05 g of freeze-dried <i>C. cicadae</i> mycelium once a day for 3 months, their blood samples were collected at the beginning and end of the experiment for analysis.<b>Results:</b> There were no significant differences between the initial and final measurements in renal and liver function. Also, there was no influence on blood electrolytes as well as blood lipid levels. In clinical observation, there were also no side effects or adverse feelings mentioned by participants.<b>Conclusion:</b> These results suggested that HEA-enriched <i>C. cicadae</i> mycelium produced by liquid fermentation is safe and can be developed as a functional health food.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1743211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38183720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. An increasing body of evidence argues for a direct implication of vitamin D deficiency, low serum calcium on poor outcomes in COVID-19 patients. This study was designed to investigate the relationship between these two factors and COVID-19 in-hospital mortality.
Materials: This is a prospective study, including 120 severe cases of COVID-19, admitted at the department of Reanimation-Anesthesia. Vitamin D was assessed by an immuno-fluoroassay method. Total serum calcium by a colorimetric method, then, corrected for serum albumin levels. The association with in-hospital mortality was assessed using the Kaplan-Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve.
Results: Hypovitaminosis D and hypocalcemia were very common, occurring in 75% and 35.8% of patients. When analyzing survival, both were significantly associated with in-hospital mortality in a dose-effect manner (pLog-Rank = 0.009 and 0.001 respectively). A cutoff value of 39 nmol/l for vitamin D and 2.05 mmol/l for corrected calcemia could predict poor prognosis with a sensitivity of 76% and 84%, and a specificity of 69% and 60% respectively. Hazard ratios were (HR = 6.9, 95% CI [2.0-24.1], p = 0.002 and HR = 6.2, 95% CI [2.1-18.3], p = 0.001) respectively.
Conclusion: This study demonstrates the high frequency of hypocalcemia and hypovitaminosis D in severe COVID-19 patients and provides further evidence of their potential link to poor short-term prognosis. It is, therefore, possible that the correction of hypocalcemia, as well as supplementation with vitamin D, may improve the vital prognosis.
背景:2019冠状病毒病(COVID-19)的严重程度是一种多因素疾病。越来越多的证据表明,维生素D缺乏、低血清钙与COVID-19患者预后不良有直接关系。本研究旨在探讨这两个因素与COVID-19住院死亡率之间的关系。材料:这是一项前瞻性研究,包括120例在复苏麻醉科入院的COVID-19重症病例。用免疫荧光法测定维生素D。然后,用比色法校正血清白蛋白水平。使用Kaplan-Meier生存曲线、比例Cox回归分析和受试者工作特征曲线评估与住院死亡率的关系。结果:低维生素D症和低钙血症发生率较高,分别为75%和35.8%。在分析生存率时,两者均以剂量效应方式与住院死亡率显著相关(pLog-Rank分别= 0.009和0.001)。维生素D的临界值为39 nmol/l,校正钙的临界值为2.05 mmol/l,预测不良预后的敏感性分别为76%和84%,特异性分别为69%和60%。风险比分别为(HR = 6.9, 95% CI [2.0 ~ 24.1], p = 0.002; HR = 6.2, 95% CI [2.1 ~ 18.3], p = 0.001)。结论:本研究证实了COVID-19重症患者低钙血症和维生素D缺乏症的高频率,并进一步证明了它们与短期预后不良的潜在联系。因此,纠正低钙血症以及补充维生素D可能会改善生命预后。
{"title":"Vitamin D Deficiency and Low Serum Calcium as Predictors of Poor Prognosis in Patients with Severe COVID-19.","authors":"Salam Bennouar, Abdelghani Bachir Cherif, Amel Kessira, Djamel-Eddine Bennouar, Samia Abdi","doi":"10.1080/07315724.2020.1856013","DOIUrl":"https://doi.org/10.1080/07315724.2020.1856013","url":null,"abstract":"<p><strong>Background: </strong>The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. An increasing body of evidence argues for a direct implication of vitamin D deficiency, low serum calcium on poor outcomes in COVID-19 patients. This study was designed to investigate the relationship between these two factors and COVID-19 in-hospital mortality.</p><p><strong>Materials: </strong>This is a prospective study, including 120 severe cases of COVID-19, admitted at the department of Reanimation-Anesthesia. Vitamin D was assessed by an immuno-fluoroassay method. Total serum calcium by a colorimetric method, then, corrected for serum albumin levels. The association with in-hospital mortality was assessed using the Kaplan-Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve.</p><p><strong>Results: </strong>Hypovitaminosis D and hypocalcemia were very common, occurring in 75% and 35.8% of patients. When analyzing survival, both were significantly associated with in-hospital mortality in a dose-effect manner (p<sub>Log-Rank</sub> = 0.009 and 0.001 respectively). A cutoff value of 39 nmol/l for vitamin D and 2.05 mmol/l for corrected calcemia could predict poor prognosis with a sensitivity of 76% and 84%, and a specificity of 69% and 60% respectively. Hazard ratios were (HR = 6.9, 95% CI [2.0-24.1], p = 0.002 and HR = 6.2, 95% CI [2.1-18.3], p = 0.001) respectively.</p><p><strong>Conclusion: </strong>This study demonstrates the high frequency of hypocalcemia and hypovitaminosis D in severe COVID-19 patients and provides further evidence of their potential link to poor short-term prognosis. It is, therefore, possible that the correction of hypocalcemia, as well as supplementation with vitamin D, may improve the vital prognosis.</p>","PeriodicalId":17193,"journal":{"name":"Journal of the American College of Nutrition","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/07315724.2020.1856013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38744225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}