Nutrition最新文献_第10页

Comment on “Evaluation and validation of neutrophil to albumin ratio as a promising prognostic marker for all-cause mortality in patients with cancer: A multicenter cohort study” 评论中性粒细胞与白蛋白比值作为癌症患者全因死亡率预后指标的评估与验证：一项多中心队列研究

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-28 DOI: 10.1016/j.nut.2024.112445

Min Fu M.D.

引用次数: 0

Dysphagia risk evaluated by the Eating Assessment Tool-10 is associated with health-related quality of life in patients with chronic liver disease 进食评估工具-10 评估的吞咽困难风险与慢性肝病患者的健康相关生活质量有关

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-26 DOI: 10.1016/j.nut.2024.112440

Takao Miwa M.D. , Tatsunori Hanai M.D., Ph.D. , Itsuki Hayashi D.D.S. , Sachiyo Hirata R.D. , Kayoko Nishimura R.D. , Shinji Unome M.D. , Yuki Nakahata M.D. , Kenji Imai M.D., Ph.D. , Yohei Shirakami M.D., Ph.D. , Atsushi Suetsugua M.D., Ph.D. , Koji Takai M.D., Ph.D. , Masahito Shimizu M.D., Ph.D.

Objective

This study aimed to reveal the prevalence and characteristics of individuals at risk of dysphagia in patients with chronic liver disease (CLD) and its association with health-related quality of life (HRQOL).

Methods

This cross-sectional study included 335 outpatients with CLD. Dysphagia risk, sarcopenia risk, malnutrition risk, and HRQOL were assessed using the Eating Assessment tool-10 (EAT-10), SARC-F, Royal Free Hospital-Nutrition Prioritizing Tool (RFH-NPT), and Chronic Liver Disease Questionnaire (CLDQ), respectively. Dysphagia risk and low HRQOL were based on EAT-10 ≥3 and CLDQ overall score <5, respectively. Factors associated with dysphagia risk and low HRQOL were assessed using the logistic regression model.

Results

Dysphagia risk and lower HRQOL were observed in 10% and 31% of the patients, respectively. Patients with dysphagia risk were older, had lower liver functional reserve, were at higher risk for sarcopenia and malnutrition, and showed lower CLDQ overall score (median, 4.41 vs. 5.69; P < 0.001) than those without. After adjustment, SARC-F (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.02–1.50; P = 0.029) and RFH-NPT (OR, 1.71; 95% CI, 1.04–2.81; P = 0.034) scores were independently associated with dysphagia risk. EAT-10 (OR, 1.17; 95% CI, 1.04–1.30; P = 0.008) and SARC-F (OR, 1.37; 95% CI, 1.18–1.59; P < 0.001) scores were also independently associated with low HRQOL.

Conclusions

Dysphagia risk was prevalent in approximately 10% of patients with CLD and was associated with a risk of sarcopenia and malnutrition. Furthermore, dysphagia risk was related to HRQOL in patients with CLD.

本研究旨在揭示慢性肝病（CLD）患者中吞咽困难风险个体的患病率和特征，以及吞咽困难与健康相关生活质量（HRQOL）之间的关系。分别使用饮食评估工具-10（EAT-10）、SARC-F、皇家自由医院营养优先工具（RFH-NPT）和慢性肝病问卷（CLDQ）对吞咽困难风险、肌肉疏松症风险、营养不良风险和 HRQOL 进行了评估。吞咽困难风险和低 HRQOL 分别以 EAT-10 ≥3 和 CLDQ 总分 <5 为基础。结果分别有10%和31%的患者存在吞咽困难风险和较低的HRQOL。与无吞咽困难风险的患者相比，有吞咽困难风险的患者年龄较大，肝功能储备较低，患肌少症和营养不良的风险较高，CLDQ总分较低（中位数为4.41 vs. 5.69；P <0.001）。经调整后，SARC-F（几率比 [OR]，1.24；95% 置信区间 [CI]，1.02-1.50；P = 0.029）和 RFH-NPT （OR，1.71；95% CI，1.04-2.81；P = 0.034）得分与吞咽困难风险独立相关。EAT-10（OR，1.17；95% CI，1.04-1.30；P = 0.008）和 SARC-F（OR，1.37；95% CI，1.18-1.59；P <；0.001）评分也与低 HRQOL 独立相关。此外，吞咽困难风险与慢性阻塞性肺病患者的 HRQOL 有关。

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引用次数: 0

Should handgrip strength be considered when choosing the administration mode of oral nutritional supplements in geriatric patients? A secondary analysis of the MEDPass Trial 在选择老年患者口服营养补充剂的给药方式时，是否应考虑手握强度？- 对 MEDPass 试验的二次分析

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-22 DOI: 10.1016/j.nut.2024.112429

Katja Uhlmann M.Sc. , Emilie Reber Ph.D. , Katja A. Schonenberger Ph.D. , Zeno Stanga , Silvia Kurmann M.Sc.

Objective

It is important to individualize nutrition therapy and to identify whether certain patient groups benefit from a specific intervention such as oral nutritional supplements (ONS). This study investigated whether patients with weak handgrip strength (HGS) benefit better from ONS administration in the Medication Pass Nutritional Supplement Program (MEDPass) mode regarding the individual coverage of energy and protein requirements throughout their hospitalization.

Methods

A secondary analysis of the intention-to-treat data set of the randomized controlled MEDPass trial was conducted. Weak HGS was defined as <27 kg for men and <16 kg for women. Linear mixed-effect models adjusted for the stratification factors energy density of ONS and nutritional risk screening 2002 score were used to address the aim of the study.

Results

We included 188 participants. Energy and protein coverage did not differ between the patients with weak or normal HGS depending on ONS administration mode (P = 0.084, P = 0.108). Patients with weak HGS and MEDPass administration mode tended to have the lowest energy and protein coverage (estimated mean, 77.2%; 95% confidence interval [CI], 69.3%–85% and estimated mean, 95.1%; 95% CI, 85.3%–105%, respectively). Patients with weak HGS and conventional ONS administration had the highest energy and protein coverage (estimated mean, 90%; 95% CI, 82.8%–97.2% and estimated mean, 110.2%; 95% CI, 101.3%–119%, respectively).

Conclusion

No clear recommendations regarding the mode of ONS administration depending on HGS can be made. In clinical practice, appetite and satiety in patients with weak HGS should be monitored, and the ONS administration mode should be adjusted accordingly.

目标个性化营养治疗以及确定某些患者群体是否能从口服营养补充剂（ONS）等特定干预措施中获益非常重要。本研究调查了手握力量（HGS）较弱的患者在住院期间是否能更好地从 "药物通营养补充计划"（MEDPass）模式下的口服营养补充剂中获得个人所需的能量和蛋白质。弱 HGS 的定义为男性 27 千克，女性 16 千克。为达到研究目的，我们使用了线性混合效应模型，并对ONS能量密度和2002年营养风险筛查评分等分层因素进行了调整。根据 ONS 给药方式的不同，HGS 弱或正常患者的能量和蛋白质覆盖率没有差异（P = 0.084，P = 0.108）。HGS较弱的患者采用 MEDPass 给药模式时，能量和蛋白质覆盖率往往最低（估计平均值分别为 77.2%；95% 置信区间 [CI]，69.3%-85% 和估计平均值分别为 95.1%；95% 置信区间 [CI]，85.3%-105%）。结论目前还没有针对 HGS 的 ONS 施用模式提出明确建议。在临床实践中，应监测弱 HGS 患者的食欲和饱腹感，并相应调整 ONS 给药模式。

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引用次数: 0

Association between oral frailty and sarcopenia among frailty clinic outpatients: A cross-sectional study 虚弱门诊患者口腔虚弱与肌肉疏松之间的关系：一项横断面研究

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-22 DOI: 10.1016/j.nut.2024.112438

Koki Kawamura , Keisuke Maeda , Shuzo Miyahara , Akio Shimizu , Yuria Ishida , Junko Ueshima , Ayano Nagano , Hitoshi Kagaya , Yasumoto Matsui , Hidenori Arai , Naoharu Mori

Objectives

In this study, we aimed to investigate the prevalence of oral frailty and explore its relationship with oral function and sarcopenia among older outpatients.

Materials and Methods

In this cross-sectional study, we retrospectively included older patients who visited a frailty outpatient clinic. We assessed total oral frailty employing, among other measures, oral diadochokinesis (/ta/ sound) for tongue–lip movement and tongue pressure. Patients who did not meet the cut-off values for three or more of these were classified as having oral frailty. Sarcopenia was assessed according to Asian Working Group for Sarcopenia 2019 criteria and analyzed for the relationship with oral function.

Results

The mean ± standard deviation age of the 111 patients was 77.2 ± 5.7 y; 63 were women (57%). Fifteen patients (14%) had either sarcopenia or dynapenia. The overall prevalence of oral frailty was 38%, with no significant difference in its prevalence between the sarcopenia/dynapenia group (44%) and the robust (no sarcopenia/dynapenia) group (35%). The following oral function assessments significantly differed between the sarcopenia/dynapenia group and the robust group: median (interquartile range) total oral frailty score, 2 (2–4) and 2 (1–3) (P = 0.019); tongue–lip motor function, 5.4 ± 1.2 and 5.9 ± 1.2 times/s (P = 0.049); and tongue pressure, 27.3 ± 8.5 kPa and 31.7 ± 8.0 kPa (P = 0.009).

Conclusions

Approximately 40% of patients exhibited a decline in oral function regardless of the presence of sarcopenia. Sarcopenia and dynapenia may particularly affect tongue function. Although assessing patients for sarcopenia is crucial, separate evaluations of oral function should also be considered.

材料与方法在这项横断面研究中，我们回顾性地纳入了到虚弱门诊就诊的老年患者。除其他测量方法外，我们还采用口腔舌唇运动和舌压的口腔双动力（/ta/音）来评估总体口腔虚弱程度。其中三项或三项以上未达到临界值的患者被归类为口腔虚弱。结果 111 名患者的平均年龄为 77.2±5.7 岁，女性 63 人（占 57%）。15名患者（14%）患有肌肉疏松症或动态肌无力症。口腔虚弱的总体患病率为 38%，而肌肉疏松症/动力不足症组（44%）与健壮组（无肌肉疏松症/动力不足症）（35%）的患病率无明显差异。以下口腔功能评估结果在肌肉疏松症/动态关节病组和健壮组之间存在明显差异：口腔虚弱总评分中位数（四分位数间距），2（2-4）和 2（1-3）（P = 0.019）；舌唇运动功能，5.结论无论是否存在肌肉疏松症，约 40% 的患者表现出口腔功能下降。肌肉疏松症和动力不足症尤其会影响舌头功能。虽然评估患者是否患有肌肉疏松症至关重要，但也应考虑对口腔功能进行单独评估。

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引用次数: 0

Parenteral nutrition consensus report from KEPAN 来自 KEPAN 的肠外营养共识报告

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-20 DOI: 10.1016/j.nut.2024.112424

Ferda Sohret Kahveci , Kutay Demirkan , Mutlu Doganay , Ismail Gomceli , Kursat Gundogan , Arzu Topeli , Guzin Tumer , Mehmet Uyar , Osman Abbasoglu

Objectives

Medical nutrition therapy is one of the core components of patient management, although its implication is still limited in Daily practice globally. Clinicians are in need of guidance that will ease the application of medical nutrition therapy. The pre- and post-graduate curriculum for medical nutrition therapy is limited in most regions, worldwide. A report that is short, clear, and having clear-cut recommendations that will guide the primary healthcare professionals in indications, choice, practical application, follow-up, and stopping parenteral nutrition (PN) would facilitate the application and success of medical nutrition therapy. KEPAN is the Clinical Enteral and Parenteral Nutrition Society of Turkey and is an active member of the European Society for Clinical Nutrition and Metabolism (ESPEN).

Method

In this study, we present the KEPAN PN consensus report on optimal PN use in medical nutrition therapy as outlined by the works of academicians experienced in the clinical application of PN (nine working group academicians and 10 expert group academicians).

Results

This report provides 22 clear-cut recommendations in a question-answer format.

Conclusions

We believe that this report could have a significant impact on the optimum use of PN in the context of medical nutrition therapy when clinicians manage everyday patients.

目标医学营养疗法是患者管理的核心组成部分之一，但在全球范围内，其在日常实践中的应用仍然有限。临床医生需要能简化医学营养疗法应用的指导。在全球大多数地区，医学营养疗法的研究生课程都很有限。一份简短、清晰、建议明确的报告将在适应症、选择、实际应用、随访和停止肠外营养 (PN) 等方面为初级医疗保健专业人员提供指导，从而促进医学营养疗法的应用和成功。KEPAN 是土耳其临床肠内和肠外营养学会，也是欧洲临床营养与代谢学会 (ESPEN) 的积极成员。方法在本研究中，我们介绍了 KEPAN 肠外营养共识报告，该报告由在肠外营养临床应用方面经验丰富的院士（9 位工作组院士和 10 位专家组院士）撰写，概述了在医学营养治疗中肠外营养的最佳应用。结果这份报告以问答的形式提出了 22 条明确的建议。结论我们相信，这份报告将对临床医生在管理日常患者时在医学营养治疗中优化 PN 的使用产生重大影响。

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引用次数: 0

Enhancing gut barrier integrity: Upregulation of tight junction proteins by chitosan oligosaccharide through the ERK1/2 signaling pathway 增强肠道屏障完整性：壳聚糖低聚糖通过 ERK1/2 信号通路上调紧密连接蛋白

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-19 DOI: 10.1016/j.nut.2024.112428

Yin Li , Lianyun Wu , Yanhong Yong Ph.D. , Xueting Niu , Yuan Gao , Qiu Zhou , Huili Xie , Xiaoxi Liu Ph.D. , Youquan Li Ph.D. , Zhichao Yu Ph.D. , A.M. Abd El-Aty Ph.D. , Xianghong Ju Ph.D.

Objectives

This study aimed to explore the protective mechanism of chitosan oligosaccharide (COS) against lipopolysaccharide (LPS)-induced inflammatory responses in IEC-6 cells and dextran sodium sulfate (DSS)-induced colitis in mice.

Methods

The cell inflammation model was constructed by LPS in vitro and enteritis model by DSS in vivo.

Results

Following LPS exposure, IEC-6 cell proliferation significantly decreased, epithelial cell integrity was compromised, and TNF-α and IL-1β levels were increased. However, COS pretreatment reversed these changes. In vivo, DSS-treated mice exhibited evident pathological alterations, including heightened inflammatory levels and significantly decreased expression of tight junction proteins and critical proteins in the Mitogen activated proteins kinase signaling pathway. Nevertheless, COS administration notably reduced inflammatory levels and increased the expression of tight junction proteins and key proteins in the Mitogen activated proteins kinase signaling pathway.

Conclusions

Our findings suggest that COS safeguards gut barrier integrity by upregulating tight junction proteins through the ERK1/2 signaling pathway. Therefore, COS has emerged as a promising candidate for novel drug interventions against inflammatory bowel disease.

[显示省略]

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引用次数: 0

Ketogenic Diet as a Treatment and Prevention Strategy for Cancer: A Therapeutic Alternative 生酮饮食作为癌症治疗和预防策略：一种治疗方法

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-16 DOI: 10.1016/j.nut.2024.112427

Neha, Rishabh Chaudhary

Cancer remains a significant global health problem, contributing substantially to morbidity and mortality rates. While traditional treatments like surgery, chemotherapy, and radiation therapy are mainstays in cancer care, their efficacy as standalone modalities is often limited. Consequently, there is a growing interest in novel approaches that may enhance therapeutic outcomes. Over recent years, both preclinical and clinical investigations have highlighted the potential of the ketogenic diet as a complementary strategy in cancer treatment. The ketogenic diet, characterized by low carbohydrate, high fat, and moderate protein intake, has emerged as a promising avenue for augmenting the efficacy of conventional therapies by altering the metabolic dynamics of cancer cells. Research suggests that integrating the ketogenic diet with standard treatment protocols may enhance the anti-tumor effects of chemotherapy, improve treatment tolerability, and enhance overall quality of life. This review aims to elucidate the underlying mechanisms that drive the purported anti-cancer properties of the ketogenic diet. By inducing a metabolic state characterized by ketosis, the diet creates an unfavorable metabolic environment for cancerous cells, potentially hindering their growth and proliferation. Through a comprehensive analysis of preclinical and clinical data, this review aims to explain the therapeutic potential of the ketogenic diet as an adjunctive treatment strategy in cancer. Understanding the metabolic underpinnings of the ketogenic diet and its impact on tumor biology is essential for optimizing its clinical utility and informing treatment decisions. By exploring the synergistic interactions between the ketogenic diet and conventional therapies, clinicians and researchers may reveal new avenues for improving cancer care and outcomes.

癌症仍然是一个重大的全球健康问题，对发病率和死亡率的影响很大。虽然手术、化疗和放疗等传统疗法是癌症治疗的主要手段，但它们作为独立疗法的疗效往往有限。因此，人们对可提高治疗效果的新方法越来越感兴趣。近年来，临床前和临床研究都强调了生酮饮食作为癌症治疗补充策略的潜力。生酮饮食的特点是摄入低碳水化合物、高脂肪和适量蛋白质，它已成为通过改变癌细胞代谢动态来增强传统疗法疗效的一种很有前景的方法。研究表明，将生酮饮食与标准治疗方案相结合可增强化疗的抗肿瘤效果、改善治疗耐受性并提高整体生活质量。本综述旨在阐明生酮饮食所谓抗癌特性的内在机制。通过诱导以酮症为特征的代谢状态，生酮饮食为癌细胞创造了一个不利的代谢环境，有可能阻碍癌细胞的生长和增殖。通过对临床前和临床数据的全面分析，本综述旨在解释生酮饮食作为癌症辅助治疗策略的治疗潜力。了解生酮饮食的代谢基础及其对肿瘤生物学的影响，对于优化生酮饮食的临床应用和为治疗决策提供信息至关重要。通过探索生酮饮食与传统疗法之间的协同作用，临床医生和研究人员可能会发现改善癌症治疗和预后的新途径。

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引用次数: 0

Impact of CFTR modulator therapy on body composition as assessed by thoracic computed tomography: A follow-up study 胸部计算机断层扫描评估 CFTR 调节器疗法对身体构成的影响：随访研究

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-15 DOI: 10.1016/j.nut.2024.112425

Víctor Navas-Moreno , Fernando Sebastian-Valles , Víctor Rodríguez-Laval , Carolina Knott-Torcal , Mónica Marazuela , Nuria Sánchez de la Blanca , Jose Alfonso Arranz Martín , Rosa María Girón , Miguel Antonio Sampedro-Núñez

Objective

Treatment with cystic fibrosis transmembrane conductance regulator (CFTR) modulators in individuals with cystic fibrosis (CF) has brought a significant change in forced expiratory volume in 1 second (FEV₁) and clinical parameters. However, it also results in weight gain. The aim of our study is to evaluate the effect of CFTR modulator treatment on body composition, measured by computed tomography (CT).

Methods

Adult subjects with CF under follow-up at La Princesa University Hospital were recruited. All of them were on elexacaftor–tezacaftor–ivacaftor (ELX/TEZ/IVA) treatment. Body composition analysis was conducted using CT scans and an open-source software. The results were then compared with bioimpedance estimations, as well as other clinical and spirometry data.

Results

Our sample consisted of 26 adult subjects. The fat mass compartments on CT scans correlated with similar compartments on bioimpedance, and normal-density muscle mass exhibited a strong correlation with phase angle. Higher levels of very low-density muscle prior to treatment were associated with lower final FEV₁ and less improvement in FEV₁ after therapy. We observed an increase in total body area (P < 0.001), driven by increases in total fat mass (P < 0.001), subcutaneous fat (P < 0.001), visceral fat (P = 0.002), and intermuscular fat (P = 0.022). The only muscle compartment that showed an increase after treatment was very low-density muscle (P = 0.032).

Conclusions

CT scans represent an opportunity to assess body composition on CF. Combination treatment with CFTR modulators, leads to an improvement in FEV₁ and to an increase in body mass in all compartments primarily at the expense of fat mass.

在囊性纤维化（CF）患者中使用囊性纤维化跨膜传导调节剂（CFTR）调节剂的治疗效果显著。然而，它也会导致体重增加。我们的研究旨在通过计算机断层扫描（CT）评估 CFTR 调节剂治疗对身体成分的影响。我们招募了在拉普林塞萨大学医院接受随访的 CF 患者。他们都在接受 Elexacaftor-Tezacaftor-Ivacaftor （ELX/TEZ/IVA）治疗。使用 CT 扫描和开源软件进行了身体成分分析。然后将分析结果与生物阻抗估计以及其他临床和肺活量数据进行比较。我们的样本由 26 名成年受试者组成。CT 扫描中的脂肪含量与生物阻抗中的相似含量相关，正常密度的肌肉含量与相位角有很强的相关性。治疗前极低密度肌肉含量较高与最终 FEV1 值较低有关，治疗后 FEV1 值改善较少。我们观察到，在总脂肪量（p < 0.001）、皮下脂肪（p < 0.001）、内脏脂肪（p = 0.002）和肌间脂肪（p = 0.022）增加的驱动下，患者的总身体面积有所增加（p < 0.001）。治疗后唯一出现增加的肌肉区是极低密度肌肉（p = 0.032）。CT 扫描是评估 CF 患者身体成分的一个机会。与 CFTR 调节剂联合治疗可改善 FEV1，增加各部位的体质量，但主要以脂肪量为代价。

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引用次数: 0

Effectiveness of nutritional counseling with overweight pregnant women on child growth at 6 months: A randomized controlled trial 对超重孕妇进行营养咨询对六个月后儿童生长的影响：随机对照试验

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-14 DOI: 10.1016/j.nut.2024.112426

Izabela S. Santos , Mariana R. Carvalho , Naiara F. Baroni , Lívia C. Crivellenti , Daniela S. Sartorelli

Objective

Studies that have investigated the effect of nutritional counseling during the prenatal period on the follow-up outcomes of children at 6 mo have produced inconclusive results. The present study aimed to investigate the effect of nutritional counseling, based on the NOVA food classification, encouraging the consumption of fresh and minimally processed foods, with overweight adult pregnant women on infant growth at 6 mo of age.

Methods

A randomized controlled trial with 195 pairs of pregnant overweight women and their infants at 6 mo of age was conducted in a Brazilian municipality. The pregnant women were allocated to the control group (CG) or intervention group (IG) at the beginning of the pregnancy. The IG received three sessions of nutrition counseling throughout the pregnancy. Linear regression models were used to investigate the effect of the nutritional counseling on infant growth.

Results

One hundred ninety-five mother–infant pairs with complete data were included (96 CG, and 99 IG). The mean ± SD infant weight (g) at 6 mo was 7856.1 ± 1.1, and length (cm) was 67.0 ± 2.9. There were no differences in maternal and newborn characteristics between the groups. In the linear regression models, the counseling had no effect on anthropometric parameters of the infants at 6 mo of age: weight-for-length Z-score (β 0.089 [95% CI −0.250; 0.427], P = 0.61); length-for-age Z-score (β 0.032 [95% CI −0.299; 0.363], P = 0.85); weight-for-age Z-score (β 0.070 [95% CI −0.260; 0.400], P = 0.68); BMI-age Z-score (β 0.072 [95% CI −0.270; 0.414], P = 0.68).

Conclusions

There was no effect on infant growth at 6 mo of age after the nutritional counseling during pregnancy. Future studies are needed to confirm this hypothesis.

[显示省略]

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引用次数: 0

Factors and predictive model for malnutrition in poststroke disabled patients: A multicenter cross-sectional study 中风后残疾患者营养不良的因素和预测模型：一项多中心横断面研究

IF 4.4 3区医学 Q1 Nursing

Nutrition

Pub Date : 2024-03-14 DOI: 10.1016/j.nut.2024.112423

Hongji Zeng , Ang Cai , Weijia Zhao , Junfa Wu , Yu Ding , Xi Zeng

Background

Although malnutrition has been shown to influence the clinical outcome of poststroke disabled patients, the associated factors and the prediction model have yet to be uncovered.

Objectives

This study aims to assess the current prevalence and factors associated with malnutrition in poststroke disabled patients and establish a prediction model.

Methods

A multicenter cross-sectional survey among Chinese poststroke disabled patients (≥18 y old) was conducted in 2021. Information on patients’ basic data, medical history, Barthel Index, dysphagia, and nutritional status was collected. A multivariable logistic regression model was used to identify the factors that influence malnutrition. Nomogram was developed and internal validation was conducted using 5-fold cross-validation. External validation was performed using the data from a preliminary survey. Receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA) were used to analyze the predictive value of the nomogram.

Results

Four hundred fifty-seven cases were enrolled, with the prevalence of malnutrition as 71.77%. Age (aOR = 1.039, 95% CI: 1.006–1.078), pulmonary infection (aOR = 4.301, 95% CI: 2.268–14.464), dysphagia (aOR = 24.605, 95% CI: 4.966–191.058), total intake volume (aOR = 0.997, 95% CI: 0.995–0.999), Barthel Index (aOR = 0.965, 95% CI: 0.951–0.980), and nasogastric tube (aOR = 16.529, 95% CI: 7.418–52.518) as nutrition support mode (compared to oral intake) were identified as the associated factors of malnutrition in stroke-disabled patients (P < 0.05). ROC analysis showed that the area under the curve (AUC) for nomogram was 0.854 (95% CI: 0.816–0.892). Fivefold cross-validation showed the mean AUC as 0.829 (95% CI: 0.784–0.873). There were no significant differences between predicted and actual probabilities. The DCA revealed that the model exhibited a net benefit when the risk threshold was between 0 and 0.4.

Conclusions

Age, pulmonary infection, dysphagia, nutrition support mode, total intake volume, and Barthel Index were factors associated with malnutrition in stroke-related disabled patients. The nomogram based on the result exhibited good accuracy, consistency and values.

尽管营养不良已被证明会影响脑卒中后残疾患者的临床预后，但相关因素和预测模型仍有待揭示。本研究旨在评估目前脑卒中后残疾患者营养不良的发生率及相关因素，并建立预测模型。本研究从 2021 年开始对中国脑卒中后残疾患者（≥18 岁）进行多中心横断面调查。调查收集了患者的基本资料、病史、Barthel指数、吞咽困难和营养状况等信息。采用多变量逻辑回归模型确定影响营养不良的因素。制定了提名图，并使用 5 倍交叉验证进行了内部验证。利用初步调查的数据进行了外部验证。采用接收者操作特征（ROC）分析、校准曲线、决策曲线分析（DCA）来分析提名图的预测价值。共登记了 457 个病例，营养不良发生率为 71.77%。年龄（aOR=1.039，95%CI：1.006-1.078）、肺部感染（aOR=4.301，95%CI：2.268-14.464）、吞咽困难（aOR=24.605，95%CI：4.966-191.058）、总摄入量（aOR=0.997，95%CI：0.995-0.999）、巴特尔指数（aOR=0.965，95%CI：0.951-0.980）、鼻胃管（aOR=16.529，95%CI：7.418-52.518）作为营养支持方式（与口服摄入相比）被认为是脑卒中残疾患者营养不良的相关因素（P<0.05）。ROC分析显示，提名图的曲线下面积（AUC）为0.854（95% CI：0.816-0.892）。5 倍交叉验证显示平均 AUC 为 0.829（95% CI：0.784-0.869）。预测概率和实际概率之间没有明显差异。DCA 显示，当风险阈值介于 0 和 0.4 之间时，模型显示出净效益。年龄、肺部感染、吞咽困难、营养支持模式、总摄入量和 Barthel 指数是中风相关残疾患者营养不良的相关因素。根据该结果绘制的提名图具有良好的准确性、一致性和价值。

{"title":"Factors and predictive model for malnutrition in poststroke disabled patients: A multicenter cross-sectional study","authors":"Hongji Zeng , Ang Cai , Weijia Zhao , Junfa Wu , Yu Ding , Xi Zeng","doi":"10.1016/j.nut.2024.112423","DOIUrl":"10.1016/j.nut.2024.112423","url":null,"abstract":"<div><h3>Background</h3><p>Although malnutrition has been shown to influence the clinical outcome of poststroke disabled patients, the associated factors and the prediction model have yet to be uncovered.</p></div><div><h3>Objectives</h3><p>This study aims to assess the current prevalence and factors associated with malnutrition in poststroke disabled patients and establish a prediction model.</p></div><div><h3>Methods</h3><p>A multicenter cross-sectional survey among Chinese poststroke disabled patients (≥18 y old) was conducted in 2021. Information on patients’ basic data, medical history, Barthel Index, dysphagia, and nutritional status was collected. A multivariable logistic regression model was used to identify the factors that influence malnutrition. Nomogram was developed and internal validation was conducted using 5-fold cross-validation. External validation was performed using the data from a preliminary survey. Receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA) were used to analyze the predictive value of the nomogram.</p></div><div><h3>Results</h3><p>Four hundred fifty-seven cases were enrolled, with the prevalence of malnutrition as 71.77%. Age (aOR = 1.039, 95% CI: 1.006–1.078), pulmonary infection (aOR = 4.301, 95% CI: 2.268–14.464), dysphagia (aOR = 24.605, 95% CI: 4.966–191.058), total intake volume (aOR = 0.997, 95% CI: 0.995–0.999), Barthel Index (aOR = 0.965, 95% CI: 0.951–0.980), and nasogastric tube (aOR = 16.529, 95% CI: 7.418–52.518) as nutrition support mode (compared to oral intake) were identified as the associated factors of malnutrition in stroke-disabled patients (<em>P</em> < 0.05). ROC analysis showed that the area under the curve (AUC) for nomogram was 0.854 (95% CI: 0.816–0.892). Fivefold cross-validation showed the mean AUC as 0.829 (95% CI: 0.784–0.873). There were no significant differences between predicted and actual probabilities. The DCA revealed that the model exhibited a net benefit when the risk threshold was between 0 and 0.4.</p></div><div><h3>Conclusions</h3><p>Age, pulmonary infection, dysphagia, nutrition support mode, total intake volume, and Barthel Index were factors associated with malnutrition in stroke-related disabled patients. The nomogram based on the result exhibited good accuracy, consistency and values.</p></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140170087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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