Nutrition in Clinical Practice最新文献

Background: Hospitalized individuals present high rates of malnutrition and loss of muscle mass (MM). Imaging techniques for assessing MM are expensive and scarcely available in hospital practice. The Global Leadership Initiative on Malnutrition (GLIM) proposed a framework for malnutrition diagnosis that includes simple measurements to assess MM, such as calf circumference (CC) and mid-upper arm circumference (MUAC). This study aimed to analyze the validity of the GLIM criteria with CC and MUAC for malnutrition diagnosis, using Subjective Global Assessment (SGA) as the reference standard, in inpatients.

Methods: A prospective cohort study was conducted on 453 inpatient adults in a university hospital. The presence of malnutrition was assessed within 48 h of hospital admission using SGA and GLIM criteria using CC and MUAC as phenotypic criteria for malnutrition diagnosis. Accuracy, agreement tests, and logistic regression analysis adjusted for confounders were performed to test the validity of the GLIM criteria for malnutrition diagnosis.

Results: The patients were aged 59 (46-68) years, 51.4% were male, and 67.8% had elective surgery. Compared with SGA, the GLIM criteria using the two MM assessment measures showed good accuracy (area under the curve > 0.80) and substantial agreement (κ > 0.60) for diagnosing malnutrition. The highest sensitivity was obtained with GLIM_CC (89%), whereas GLIM_MUAC showed high specificity (>90%). Also, malnutrition identified by GLIM_CC and GLIM_MUAC was significantly associated with prolonged hospitalization and in-hospital death.

Conclusion: In the absence of imaging techniques to assess MM, the use of CC and MUAC measurements from the GLIM criteria demonstrated satisfactory validity for diagnosing malnutrition in hospitalized patients.

Background: This study investigated the prevalence of sarcopenic obesity (SO) among older adults in Chinese communities and its association with chronic diseases.

Methods: We conducted a post-hoc analysis of a 2014-2015 multicenter cross-sectional study involving adults aged ≥60 years from three representative cities in China. The Asian Working Group for Sarcopenia diagnostic criteria and Chinese local cutoffs were employed to define SO. Data on medical history, lifestyle, quality of life, and cognitive function were collected.

Results: The overall prevalence of SO was 3.58% in men and 2.88% in women among 2821 participants. There was a notable increase in prevalence with age, with rates reaching 6.58% for men and 4.40% for women aged 70-79 years. In the group aged ≥80 years, the prevalence rate increased significantly, reaching 13.16% for men and 18.18% for women. Those with SO had higher body mass index (25.29 ± 1.55 kg/m² vs 24.16 ± 2.48 kg/m²; P < 0.001) and triceps skinfold thickness (21.17 ± 5.93 mm vs 19.34 ± 6.87 mm; P < 0.05) than the normal group. The prevalence of cardiovascular disease (15.38% vs 6.59%; P < 0.01), hypertension (56.04% vs 38.93%; P < 0.01), and stroke (7.69% vs 2.25%; P < 0.01) was also significantly higher in the SO group. Logistic regression showed that those with SO were more likely to have cardiac disease (odds ratio [OR] = 2.20; P = 0.016) and stroke (OR = 2.61; P = 0.039).

Conclusion: The prevalence of SO increases with age among the older adult population in China, notably after age 80 years. SO individuals were more likely to have cardiac disease and stroke. It is important to focus on early identification and management strategies.

The presence and impact of malnutrition in adult hospitalized patients has been well documented by a significant body of literature. However, current malnutrition care practices often vary widely and frequently lack standardization. The Global Malnutrition Composite Score (GMCS), the first nutrition-related electronic clinical quality measure, is intended to evaluate the quality of malnutrition care provided to inpatient adults. This measure aims to aid in standardizing malnutrition care through performance measurement. The four components of the measure (nutrition screening, nutrition assessment, malnutrition diagnosis, and nutrition care plans) follow the well-established Nutrition Care Process and encourage the use of standardized terminology. Facilities with high-performance scores on the GMCS are likely to experience improved outcomes associated with high-quality malnutrition care.

Background: The two-step Global Leadership Initiative on Malnutrition (GLIM) approach was recently introduced to malnutrition diagnosis in a hospital setting. This study compares the diagnostic performance of this approach that uses the Nutritional Risk Screening-2002 (NRS-2002) as a screening tool and the direct application of GLIM malnutrition diagnostic criteria in hospitalized patients.

Methods: This cross-sectional study involved 290 adult and older adult patients who were hospitalized. A trained nutritionist implemented the two-step GLIM approach, including NRS-2002 (in the first step) and GLIM criteria (in the second step) for each patient. Then, the accuracy, kappa index, area under the receiver operating characteristic curve (AUC ROC), sensitivity, and specificity of malnutrition diagnostic performance of the two-step GLIM approach and NRS-2002 were evaluated compared to the direct use of GLIM criteria.

Results: The NRS-2002 identified 145 (50.0%) patients as at risk of malnutrition. The prevalence of malnutrition using the two-step GLIM approach and GLIM malnutrition diagnosis criteria were 120 (41.4%) and 141 (48.6%), respectively. The kappa index showed substantial and almost perfect agreement for NRS-2002 (κ = 68%) and the two-step GLIM approach (κ = 85%) with GLIM malnutrition diagnostic criteria, respectively. Furthermore, the AUC ROC (0.926; 95% confidence interval (CI): 0.89-0.96) and accuracy (92.8%) of the two-step GLIM approach compared to the GLIM criteria indicated an acepptable ability to distinguish between malnourished and well-nourished patients.

Conclusion: The two-step GLIM approach using NRS-2002 as a screening tool (in step one) had acceptable malnutrition diagnostic performance compared to the direct application of GLIM criteria in hospitalized patients.

Background: Malnutrition is a prevalent complication in patients undergoing peritoneal dialysis (PD). This study established a multidisciplinary team for medical nutrition therapy (MNT) to investigate the impact of this approach on enhancing the nutrition, anemic, and microinflammatory status of patients receiving PD.

Methods: This randomized controlled trial study involved 81 patients undergoing PD (n = 41 in the intervention group, n = 40 in the control group). The intervention group received comprehensive MNT management, whereas the control group received standard nutrition care. The intervention spanned a 6-month period. Various nutrition parameters, markers of anemia, and microinflammatory indexes were assessed before the intervention, at 3 months, and at 6 months postintervention. Repeated-measures analysis of variance and the nonparametric Scheirer-Ray-Hare test were used for within-group and between-group comparisons.

Results: There were no statistically significant differences between the groups in terms of age, sex, duration of dialysis, primary disease, or baseline prenutrition inflammation data. At 6 months postintervention, the intervention group exhibited higher levels of serum albumin, blood calcium, serum iron, hemoglobin, total iron-binding capacity, body mass index, midarm circumference, triceps skinfold thickness, handgrip strength, and daily energy and protein intake compared with the control group (P < 0.05). Additionally, the intervention group demonstrated lower levels of subjective nutrition assessment value, C-reactive protein, and neutrophil-to-lymphocyte ratio than the control group (P < 0.05), with no statistically significant differences in other markers after interventions.

Conclusion: Multidisciplinary MNT can ameliorate the nutrition status of patients receiving PD, decrease the incidence of malnutrition, and improve anemia and microinflammatory outcomes.

Background: Although reuse of enteral feeding equipment has been linked to risk of microbial contamination and risk of infection, there is a paucity of research in this area. Per the manufacturer's instructions low-profile gastrostomy feeding extension sets (LPG-FES) may be reusable for the same patient, but there are no recommendations on replacement intervals.

Methods: We conducted a prospective observational study to analyze and compare the contamination rate of LPG-FES after 15 (T1) and after 30 days (T2) of regular use. We included children 2-18 years of age exclusively receiving long-term home enteral nutrition (HEN) via LPG.

Results: We included 17 patients with a median age of 5 years (interquartile range: 3-8 years). We did not find statistically significant differences in microbial overgrowth comparing LPG-FES obtained after 15 or 30 days of use, although overgrowth was slightly higher in LPG-FES used for 30 days (64.7% and 70.6% vs 52.9% and 58.8%). Every patient presented at least one positive culture, either in T1 or T2. Candida parapsilosis was globally the most frequent microbiological finding. We found no relation between duration of HEN and type of feeding and positive culture at T1 and T2. We found no symptoms of local nor systemic infection during the study period.

Conclusion: Despite the high rate of microbial overgrowth in the LPG-FES, no patient had clinical symptoms of infection secondary to this finding. Microbiological isolation in FES may represent only a form of contamination without clinical implications, which raises doubts on possible LPG-FES dwell times.