Exploration of an objective and simple index as the outcome of nutrition support for elderly patients and identification of risk factors.

OBJECTIVES: The study aimed to explore the risk factors for the outcome of nutrition support teams (NSTs) for elderly patients. Previously identified risk factors lack general versatility owing to slightly subjective judgment standards; this study aimed to explore an objective and simple index of NST outcome and identify the risk factors for NST outcome. SUBJECTS: This retrospective observational study analyzed, 372 elderly patients enrolled in the NST between January 2014 and July 2018. We identified that the energy fill rate to total energy expenditure (%TEE) at the time of NST termination (post-%TEE) < 75.0% was the most valid index for the outcome in our previous study. The cutoff values of continuous variables at the time of NST enrollment (pre-) were set for post-%TEE < 75.0% using receiver operating characteristic curve analysis, and hazard ratios (HRs) were calculated. RESULTS: From the multivariable Cox proportional hazard analysis, pre-%TEE < 62.6% (HR: 1.96; 95% confidence interval [95% CI]: 1.29-2.99; p = 0.002), presence of pressure ulcers (HR: 1.74; 95% CI: 1.02-2.98; p = 0.042), pre-prognostic nutritional index (PNI) < 32.7 (HR: 1.78; 95% CI: 1.13-2.82; p = 0.014), and presence of pre-peripheral parenteral nutrition (PPN) (HR: 1.74; 95% CI: 1.19-2.56; p = 0.005) were identified as independent risk factors for post-%TEE < 75.0%. CONCLUSION: Post-%TEE < 75.0% was the objective and simple index for NST outcomes. Patients with low pre-%TEE, pressure ulcers, low pre-PNI, or pre-PPN require early nutritional intervention.

Association Between Risk Factors and Intensive Nutritional Intervention Outcomes in Elderly Individuals.

BACKGROUND: The purpose of this study was to identify risk factors for intensive nutritional intervention outcomes in elderly undernourished patients to help reduce the number of patients with prolonged hospital stay or without recuperation of previous activities of daily living and quality of life. METHODS: In total, 230 patients who received interventions from a nutrition support team (NST) between January 2016 and July 2018 were included. Patients were classified into two groups based on NST intervention outcomes: patients with improved nutritional status were included in the successful group, whereas those whose nutritional status did not improve, as defined by progressive illness or death, were classified into the non-successful group. We assessed patient characteristics, laboratory data, and nutrition support methods. RESULTS: Our multivariate Cox proportional hazard analysis showed that: 1) The presence of peripheral parenteral nutrition (hazard ratio (HR): 1.80; 95% confidence interval (CI): 1.13 - 2.88) was identified as an independent risk factor for NST intervention outcomes; 2) The energy fill rate to total energy expenditure was < 66.0% (HR: 1.61; 95% CI: 0.98 - 2.66); and 3) A geriatric nutritional risk index score < 70.0 (HR: 1.54; 95% CI: 0.92 - 2.56) tended to be negatively associated with NST intervention outcomes. CONCLUSIONS: In addition to the nutrition therapy provided by a traditional NST, patients with the risk factors require nutritional intervention. Elderly individuals should also receive nutrition care because they have been recuperating at their home or in long-term care facilities, to prevent experiencing adverse conditions.

Identification of the set of genes, including nonannotated morA, under the direct control of ModE in Escherichia coli.

ModE is the molybdate-sensing transcription regulator that controls the expression of genes related to molybdate homeostasis in Escherichia coli. ModE is activated by binding molybdate and acts as both an activator and a repressor. By genomic systematic evolution of ligands by exponential enrichment (SELEX) screening and promoter reporter assays, we have identified a total of nine operons, including the hitherto identified modA, moaA, dmsA, and napF operons, of which six were activated by ModE and three were repressed. In addition, two promoters were newly identified and direct transcription of novel genes, referred to as morA and morB, located on antisense strands of yghW and torY, respectively. The morA gene encodes a short peptide, MorA, with an unusual initiation codon. Surprisingly, overexpression of the morA 5' untranslated region exhibited an inhibitory influence on colony formation of E. coli K-12.