Nutrition in Clinical Practice最新文献

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: 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.

Background: There is debate as to the association between dehydration and malnutrition. Thus, this study aimed to investigate the correlation between dehydration and malnutrition and their impact on geriatric syndromes.

Methods: This cross-sectional study included older adults (≥60 years) who attended one outpatient geriatric clinic. Malnutrition was defined according to the Mini Nutritional Assessment (MNA) score (<17), and dehydration was based on a single calculation method (plasma osmolarity [Posm] > 295 mmol/L).

Results: Among the 1409 patients studied, the prevalence of malnutrition and dehydration was 19% and 33%, respectively. The rate of malnutrition in the setting of dehydration was 18%, and the rate of dehydration in patients with malnutrition was 30% (P > 0.05). Polypharmacy, hypertension, diabetes mellitus, and higher body mass index (BMI) were associated solely with dehydration, whereas older age, a lower level of education, depression, and lower BMI were associated solely with malnutrition. Among patients with dehydration, there was a significant negative correlation between the MNA and Posm (P < 0.001, r = -0.20). Inversely, among patients without dehydration, the correlation was positive and significant (P < 0.001, r = 0.14).

Conclusion: A negative correlation was found between the MNA score and Posm in patients with dehydration, whereas the correlation is positive among patients without dehydration. This inverse relationship between the MNA score and Posm in patients with different levels of hydration is one potential reason for the lack of a significant correlation between malnutrition and dehydration in previously reported studies. Different risk factors of malnutrition may predominate in settings of dehydration vs no dehydration.

Background: The SARC-CalF was developed as a screening tool for sarcopenia, but little is still known about its validity in surgical patients. Thus, this study aimed to assess the prognostic value of SARC-CalF in predicting clinical outcomes in patients admitted for any elective surgery in a hospital.

Methods: Cohort study with prospective data collection of surgical patients ≥18 years of age screened for sarcopenia within 48 h of admission using the SARC-CalF (score ≥11 points classified patients at suggestive signs of sarcopenia). A standard questionnaire for sociodemographic and clinical data was filled and anthropometric data were measured. Clinical outcomes of interest comprised postoperative complications, length of postoperative hospital stay (LPHS), length of hospital stay (LOS), and in-hospital death.

Results: Among the 303 patients admitted for elective surgery across various specialties (58.2 ± 14.6 years; 53.8% men) included, 21.5% presented suggestive signs of sarcopenia (SARC-CalF ≥11). LOS (16.0 [10.0-29.0] vs 13.5 [8.0-22.0] days; P < 0.05) and LPHS (6.0 [3.0-14.5] vs 5.0 [1.0-8.2] days; P < 0.05) were longer in patients with SARC-CalF ≥11 compared with those without this condition. The frequency of severe postoperative complications (23.1% vs 8.8%; P < 0.05) and the incidence of death (12.3% vs 2.9%; P < 0.05) were higher in patients with SARC-CalF ≥11. However, in the multivariate analyses, no association between SARC-CalF ≥11 and clinical outcomes was found.

Conclusion: Signs of sarcopenia (SARC-CalF ≥11) were present in >20% of patients who were hospitalized for any elective surgery, but it was not an independent predictor of extended hospital stay, complications, and death.

Background: Pediatric acute liver failure (PALF) is a clinical diagnosis in which previously asymptomatic children exhibit a rapid loss of liver function.

Objectives: To describe the clinical and nutrition conditions at admission and during hospitalization in patients with PALF who underwent liver transplantation (LT) at a referral center and establish a possible association between nutrition status and prognosis in this population.

Methods: A prospective study was conducted on children underwent LT because of PALF. Nutrition assessment was performed at admission and repeated weekly until hospital discharge, and their relationships with clinical outcomes were tested.

Results: The study population consisted of 23 patients with a median age of 60 months and, in most cases, the etiology of acute liver failure (ALF) was indeterminate (69.6%). The majority of the patients were well nourished according to the z score body mass index-for-age (82.6%) and z arm circumference-for-age (zAC/A) (82.6%). A decline in nutrition status was observed in 47.6% of the patients, as indicated by a decrease in zAC. Clinical and nutrition improvement was demonstrated by the progressive increase in zAC, serum albumin levels, and phase angle (PA) values and by the reduction in C-reactive protein levels. There was no statistically significant relationship between nutrition status and clinical outcomes.

Conclusion: Most children and adolescents with ALF presented adequate nutrition status at the time of LT, and some patients worsened their nutrition status during hospitalization, suggesting that post-LT is a period of high nutrition risk, and early nutrition therapy (NT) must be a priority in these patients.

Background: Given the lack of evidence regarding the effects of adherence to oral nutritional supplements (ONS) and the types of formulas used in clinical practice, we aimed to assess the impact of adherence to ONS and the high-protein formula on the nutrition status and muscle strength in patients with gastrointestinal cancer.

Methods: This study evaluated newly diagnosed outpatients with esophageal, gastric, pancreatic, and colorectal cancer prescribed ONS. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), and muscle strength was assessed using handgrip strength (HGS) dynamometry. ONS adherence was calculated as the ratio of self-reported intake to the prescribed amount and categorized as ≥80% or <80%.

Results: A total of 54 patients were included. Most patients were ≥60 years of age (63%), were diagnosed with colorectal cancer (63%), were classified as stage III and IV (83%), and exhibited nutrition risk or malnutrition according to PG-SGA (89%). Patients with adherence ≥80% to ONS exhibited less weight loss and HGS reduction compared with patients with adherence <80% (P < 0.05). Although patients consuming a high-protein formula maintained HGS and those on a standard formula experienced a reduction, formula type did not predict HGS change in the multivariate analysis. ONS protein intake, adjusted for adherence, was a predictor of weight change (β: 0.09; 95% CI: 0.02-0.2; P = 0.011).

Conclusion: Patients with adherence ≥80% to ONS experienced less reduction in both weight and HGS, whereas those consuming a high-protein formula maintained HGS. Notably, ONS protein intake, adjusted for adherence, was an independent predictor of weight change.