Optimizing nutrition in hepatic cirrhosis: A comprehensive assessment and care approach.

Cirrhosis is considered a growing cause of morbidity and mortality, which represents a significant public health problem. Currently, there is no effective treatment to reverse cirrhosis. Treatment primarily centers on addressing the underlying liver condition, monitoring, and managing portal hypertension-related complications, and evaluating the potential for liver transplantation in cases of decompensated cirrhosis, marked by rapid progression and the emergence of complications like variceal bleeding, hepatic encephalopathy, ascites, malnutrition, and more. Malnutrition, a prevalent complication across all disease stages, is often underdiagnosed in cirrhosis due to the complexities of nutritional assessment in patients with fluid retention and/or obesity, despite its crucial impact on prognosis. Increasing emphasis has been placed on the collaboration of nutritionists within hepatology and Liver transplant teams to deliver comprehensive care, a practice that has shown to improve outcomes. This review covers appropriate screening and assessment methods for evaluating the nutritional status of this population, diagnostic approaches for malnutrition, and context-specific nutrition treatments. It also discusses evidence-based recommendations for supplementation and physical exercise, both essential elements of the standard care provided to cirrhotic patients.

Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion. / O Índice Nutricional Prognóstico está Associado ao Grau de Circulação Colateral Coronariana em Pacientes com Angina Estável e Oclusão Total Crônica.

BACKGROUND: Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. OBJECTIVE: To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. METHODS: A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. RESULTS: The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. CONCLUSION: The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

FUNDAMENTO: A circulação colateral coronária (CCC) pode efetivamente melhorar o suprimento sanguíneo miocárdico para a área de OCT (oclusão coronariana total crônica) e pode, assim, melhorar o prognóstico de pacientes com síndrome coronariana estável (SCE). O grau de inflamação e alguns marcadores de inflamação foram associados ao desenvolvimento de colaterais. OBJETIVO: Investigar se o índice nutricional prognóstico (INP) tem associação com o desenvolvimento de CCC em pacientes com SCE. MÉTODOS: Um total de 400 pacientes com SCE com presença de OTC em pelo menos uma importante artéria coronária epicárdica foi incluído neste estudo. Os pacientes foram divididos em dois grupos de acordo com o escore Rentrop. Escores de 0 a 1 foram considerados CCC pouco desenvolvidas e escores de 2 a 3 foram aceitos como CCC bem desenvolvidas. A significância estatística foi definida como um valor p < 0,05 para todas as análises. RESULTADOS: A média de idade da coorte do estudo foi de 63±10 anos; 273 (68,3%) eram do sexo masculino. O grupo CCC pouco desenvolvido apresentou um nível de INP significativamente mais baixo em comparação com o grupo CCC bem desenvolvido (38,29±5,58 vs 41,23±3,85, p<0,001). Na análise multivariada, o INP (odds ratio 0,870; intervalo de confiança de 95% 0,822-0,922; p<0,001) foi um preditor independente de CCC pouco desenvolvida. CONCLUSÃO: O INP pode ser utilizado como um dos preditores independentes da formação do CCC. Foi positivamente associado ao desenvolvimento de colaterais coronárias em pacientes com SCE com OTC.

[Prognostic nutritional index application value for acute-on-chronic liver failure co-infection].

Objective: To explore the predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF). Methods: 220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ(2) test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results: There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group (P < 0.05). Among the 220 ACLF cases, 158 (71.82%) were infected with the hepatitis B virus (HBV). The incidence rate of infection during hospitalization was 69.09% (152/220). The common sites of infection were intraabdominal (57.07%) and pulmonary infection (29.29%). Pearson correlation analysis showed that PNI and MELD-Na were negatively correlated (r = -0.150, P < 0.05). Multivariate logistic analysis results showed that low PNI score (OR=0.916, 95%CI: 0.865~0.970), ascites (OR=4.243, 95%CI: 2.237~8.047), and hepatorenal syndrome (OR=4.082, 95%CI : 1.106~15.067) were risk factors for ACLF co-infection (P < 0.05). The ROC results showed that the PNI curve area (0.648) was higher than the MELD-Na score curve area (0.610, P < 0.05). The effectiveness of predicting infection risk when PNI was combined with ascites and hepatorenal syndrome complications was raised. Patients with co-infections had a good predictive effect when PNI ≤ 40.625. The sensitivity and specificity were 84.2% and 41.2%, respectively. Conclusion: Low PNI score and ACLF co-infection have a close correlation. Therefore, PNI has a certain appraisal value for ACLF co-infection.

Awareness and Self-Reported Knowledge and Training on Nutrition in Older People among Primary Care Practitioners.

OBJECTIVES: To assess the awareness and training of primary care physicians on nutrition in older patients. DESIGN: Observational, real-world data survey. SETTING: Primary Care. PARTICIPANTS: One hundred sixty-two physicians, generalists and specialists, working in primary care. MEASUREMENTS: Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience. RESULTS: 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)]. CONCLUSION: Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies.

GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment.

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

Construction of artificial neural network (ANN) based on predictive value of prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) in patients with cervical squamous cell carcinoma.

To explore the analytical worth of prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) in patients with cervical squamous cell carcinoma. The clinical data of 539 patients with cervical cancer in the Affiliated Tumor Hospital of Nantong University from December 2007 to October 2016 were analyzed retrospectively. The ROC is used to select the best cutoff values of PNI and NLR, which are 48.95 and 2.4046. Cox regression analysis was used for univariate and multivariate analysis. Survival differences were assessed by Kaplan-Meier (KM) survival method. Finally, a 3-layer artificial neural network (ANN) model is established. In cervical squamous cell carcinoma, the KM survival curve showed that the overall survival (OS) rate of high-level PNI group was significantly higher than that of low-level PNI group (P < .001), while the OS rate of low-level NLR group was significantly higher than that of high-level NLR group (P = .002). In non-squamous cell carcinoma, there was no significant difference in OS between the 2 groups (P > .005). According to Cox multivariate analysis, preliminary diagnosed PNI and NLR were independent prognostic factors of cervical squamous cell carcinoma (P < .001, P = .008), and pathological type and International Federation of Gynecology and Obstetrics (FIGO) stage also had a certain impact on tumor progression (P = .042, P = .048). The increase of PNI and the decrease of NLR will help patients with cervical squamous cell carcinoma live longer. ANN showed that PNI and NLR were of great importance in predicting survival. Preoperative PNI and NLR are independent predictors of cervical squamous cell carcinoma patients related to clinicopathological features, and have particular value in judging prognosis.

Prevalence and factors associated with malnutrition among hemodialysis patients in a single hemodialysis center in Vietnam: A cross-sectional study.

Malnutrition is a common problem among hemodialysis patients that increases morbidity and mortality and decreases the quality of life. This study aimed to assess the prevalence of malnutrition and associated factors and survey the consumption of energy and several nutrients among hemodialysis patients. A prospective observational study with a cross-sectional design was conducted on 76 patients on hemodialysis therapy at Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam, for 2 months (from May to July 2022). Dialysis malnutrition score was used to determine patients' nutritional status. Data about their biochemical parameters were retrieved from records with the newest results. Among the 76 patients, 38 (50.0%) were female. The mean age of the patients was 55.0 ±â€…13.5 years. Based on the dialysis malnutrition score, 56 (73.7%) patients had mild to moderate malnutrition, while 2 (2.6%) had severe malnutrition. The average energy intake was 21.5 kcal/kg/day, with only 3.9% meeting the recommended intake. The average protein intake was 1.0 g/kg/day, and about 10.5% of participants complied with the recommended protein level. In addition, the majority of patients did not reach the recommendations for sodium (56.6%), potassium (88.2%), phosphate (75.0%), and calcium (82.9%). We found a significant association between patients' occupation (P < .05), dialysis vintage (P < .001), and malnutrition status. Malnutrition is widespread among Vietnamese hemodialysis patients, which necessitates regular assessment and monitoring. We recommend paying more attention to the nutritional status of patients who are unemployed, retired, or stopped working and those with ≥ 5 years of hemodialysis.

The impact of preoperative nutritional status on postoperative outcomes: an insight from Geriatric Nutritional Risk Index in elderly pancreaticoduodenectomy patients.

BACKGROUND: Malnutrition is not uncommon among the elderly undergoing pancreatoduodenectomy (PD) and is related to increased complications. Previous studies have shown that the Geriatric Nutritional Risk Index (GNRI) predicts outcomes in various populations. Nevertheless, the research exploring the correlation between GNRI and postoperative outcomes in PD is scarce. This study aimed to investigate the preoperative malnutrition, as measured by GNRI, on outcomes in elderly patients undergoing PD. MATERIALS AND METHODS: This retrospective analysis enrolled 144 elderly patients underwent PD for periampullary tumors from November 2016 to December 2021. Patients were stratified based on the GNRI value: high/moderate nutrition risk (GNRI ≤ 92, N = 54), low nutrition risk (92 < GNRI ≤ 98, N = 35), and no nutrition risk (GNRI > 98, N = 55). Perioperative outcomes and postoperative surgical complications were compared between these groups. Univariate and multivariate analyses were performed on major postoperative complications and prolonged postoperative length of stay (PLOS). RESULTS: Patients in the high/moderate risk group were significantly older, with lower BMI (P = 0.012), higher mortality rate (11.1%, P = 0.024), longer PLOS (P < 0.001), and higher incidence of over grade IIIB complications (37.0%, P = 0.001), Univariate and multivariate analyses showed the high/moderate risk GNRI group (OR 3.61, P = 0.032), increased age (OR 1.11, P = 0.014) and operative time over 8 h (OR 3.04, P = 0.027) were significantly associated with increased major postoperative complications. The high/moderate risk GNRI group was also a significant predictor for prolonged PLOS (OR 3.91, P = 0.002). CONCLUSIONS: Preoperative GNRI has the potential to be a predictive tool for identifying high-risk elderly patients and monitoring nutritional status preoperatively to improve postoperative surgical outcomes following PD.

The Prognostic Value of the Combination of the Prognostic Nutritional Index and the Lymphocyte:Monocyte Ratio for the Prediction of Patients with Muscle-Invasive Bladder Cancer.

OBJECTIVE: To explore the efficacy of combining the prognostic nutritional index (PNI) and the lymphocyte:monocyte ratio (LMR) for patients with muscle-invasive bladder cancer (MIBC). METHODS: Of 172 patients who were diagnosed with MIBC in our hospital, 94 were eligible for the study. The clinical data of the 94 patients with MIBC were collected. The patients were divided according to the optimal cut-off values for the preoperative PNI and LMR into a low-PNI subgroup (PNI <44.15, 52 patients), a high-PNI subgroup (PNI ≥44.15, 42 patients), a low-LMR subgroup (LMR <2.98, 50 patients) and a high-LMR subgroup (LMR ≥2.98, 44 patients). The area under the receiver operating characteristic (ROC) curve (AUC) was used to analyse the efficacy of the PNI and the LMR in predicting the prognosis of patients with MIBC. Univariate and multivariate logistic regression analyses were performed to evaluate prognostic factors for patients with MIBC. Kaplan-Meier (K‒M) survival analysis was used for overall survival (OS) analysis to explore the ability of the PNI combined with the LMR to predict the prognosis of patients with MIBC. RESULTS: The optimal cut-off values for the preoperative PNI and the preoperative LMR were 44.15 and 2.98, respectively, on the basis of ROC curves. ROC curve analysis revealed that the PNI (AUC = 0.720, sensitivity 65.9%, specificity 74.50%, Youden index 0.399) and the LMR (AUC = 0.724, sensitivity 65.9%, specificity 70.0%, Youden index 0.395) both had good prognostic efficacy for patients with MIBC. The results of univariate and multivariate logistic regression analyses showed that preoperative PNI <44.15 was an independent risk factor for OS in patients with MIBC (p = 0.027). Based on K‒M survival curve analysis, patients with PNI <44.15 and LMR <2.98 had the shortest OS (p = 0.00002). CONCLUSIONS: Low preoperative PNI and LMR values are indicative of poor prognosis in patients with MIBC. The efficacy of their combination was better than that of the factors independently.

A taste alteration-related scale assesses megestrol to improve chemotherapy-induced anorexia.

PURPOSE: We evaluated the efficacy of megestrol in improving chemotherapy-related anorexia by analyzing the related scales of taste alteration. METHODS: We conducted the current study on a group of advanced patients with cancer with two or more chemotherapy cycles. The chemotherapy-induced taste alteration scale (CiTAs) scale helped assess the megestrol effects on basic taste perception, aversive taste changes, unpleasant symptoms, and associated concerns. Furthermore, the Short Nutritional Assessment Questionnaire scale (SNAQ) helped measure the impact of megestrol on malnutrition likelihood in patients experiencing chemotherapy-induced anorexia. The World Health Organization Quality of Life (WHOQOL)-BREF Scale was used to evaluate the quality of life of participants, producing scores related to physical health, psychological well-being, environmental factors, and social relationships. RESULTS: The CiTAs scale assessment indicated that administering megestrol significantly enhanced taste perception among advanced patients with cancer undergoing chemotherapy. Notably, the megestrol group patients showed significantly higher Short Nutritional Assessment Questionnaire (SNAQ) scores than the control group. The megestrol group patients also exhibited higher physiological (PHYS) scores than their control group counterparts. However, this distinction was not statistically significant. The study findings indicate that patients who received megestrol demonstrated significantly higher scores in psychological (PSYCH) and environmental(ENVIR) domains than the control group. Furthermore, megestrol administration was associated with significantly elevated SOCIL and ENVIR levels in patients. CONCLUSION: The proficient efficacy evaluation of megestrol in enhancing appetite, mitigating malnutrition likelihood, and improving the quality of life of chemotherapy-induced anorexic patients can be achieved through taste-related scales.

Targeted metabolomic profiles of serum amino acids are independently correlated with malnutrition in older adults.

BACKGROUND: Malnutrition is a common geriatric syndrome that is closely associated with adverse clinical outcomes and poses significant harm to older adults. Early assessment of nutritional status plays a crucial role in preventing and intervening in cases of malnutrition. However, there is currently a lack of measurable methods and biomarkers to evaluate malnutrition in older adults accurately. The aim of this study is to investigate the independent correlation between serum levels of amino acids and malnutrition in older adults, and to identify effective metabolomics biomarkers that can aid in the early detection of geriatric malnutrition. METHODS: A total of 254 geriatric medical examination participants from Beijing Hospital were included in the study, consisting of 182 individuals with normal nutritional status (Normal group) and 72 patients at risk of malnutrition or already malnourished (MN group). Malnutrition was assessed using the Mini-Nutritional Assessment Short-Form (MNA-SF). Demographic data were collected, and muscle-related and lipid indexes were determined. Serum amino acid concentrations were measured using isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS). The correlation between serum amino acid levels and malnutrition was analyzed using non-parametric tests, partial correlation analysis, linear regression, and logistic regression. RESULTS: The geriatric MN group exhibited significantly lower serum aromatic amino acid levels (P < 0.05) compared to the normal group. A positive correlation was observed between serum aromatic amino acid levels and the MNA-SF score (P = 0.002), as well as with known biomarkers of malnutrition such as body mass index (BMI) (P < 0.001) and hemoglobin (HGB) (P = 0.005). Multivariable logistic or linear regression analyses showed that aromatic amino acid levels were negatively correlated with MN and positively correlated with the MNA-SF score, after adjusting for some confounding factors, such as age, gender, BMI, smoking status, history of dyslipidemia, diabetes mellitus and frailty. Stratified analyses revealed that these trends were more pronounced in individuals without a history of frailty compared to those with a history of frailty, and there was an interaction between aromatic amino acid levels and frailty history (P = 0.004). CONCLUSION: Our study suggests that serum aromatic amino acids are independently associated with malnutrition in older adults. These results have important implications for identifying potential biomarkers to predict geriatric malnutrition or monitor its progression and severity, as malnutrition can result in poor clinical outcomes.

Is self-screening for 'at risk of malnutrition' feasible in a home setting?

INTRODUCTION: Despite malnutrition being established as a well-known risk for postoperative complications, the lack of screening for nutritional risk remains a challenge. The aim of this study was to investigate whether self-screening for nutritional risk prior to surgery is feasible in a home setting and if it will increase number of patients screened for nutritional risk, and secondly, to compare their screening results with the "in-hospital assessments" conducted by healthcare professionals. MATERIALS AND METHODS: This was a prospective study involving patients from six randomly selected surgical wards at two Norwegian hospitals as a part of the "Feasibility study of implementing the surgical Patient Safety Checklist the (PASC)". This checklist included a self-reported screening tool based on the Nutritional Risk Screening tool (NRS 2002) to identify "at risk of malnutrition" in patients that will undergo surgery the next 3 months or less. The original screening tool (NRS 2002) was used as a standard routine to identify "at risk of malnutrition" by healthcare professionals at hospital. The interrater reliability between these results was investigated using Fleiss multi rater Kappa with overall agreement and reported with Landis and Koch's grading system (poor, slight, fair, moderate, substantial, and almost perfect). RESULTS: Out of 215 surgical patients in the home setting, 164 (76.7%) patients completed the self-reported screening tool. A total of 123 (57.2%) patients were screened in-hospital, of whom 96 (44.7%) prior to surgery and 96 (44.7%) were screened both at hospital (pre- and post-surgery) and at home. Self-screening at home improved malnutrition screening participation by 71.9% compared to hospital screening prior to surgery (165 (76.7%) and 96 (44.7%), respectively) and by 34.1% compared to pre- and postoperative in-hospital screening, 165 (76.7%) and 123 (57.2%), respectively). The degree of agreement between patients identified to be "at risk of malnutrition" by the self-reported screening tool and healthcare professionals was poor (κ = - 0.04 (95% CI: -0.24, 0.16), however, the degrees of agreement between the patients and healthcare professionals answers to the initial NRS 2002 questions "low BMI", "weight loss", and "reduced food intake" were almost perfect (κ = 1.00 (95% CI: 0,82, 1.18)), moderate (κ = 0.55 (95% CI: 0.34, 0.75)), and slight (κ = 0.08 (95% CI: - 0.10, 0.25) respectively. CONCLUSIONS: Three out of four patients completed the self-screening form and the preoperative screening rate improved with 70%. Preoperatively self-screening in a home setting may be a feasible method to increase the number of elective surgical patients screened for risk of malnutrition. TRIAL REGISTRATION: The trial is registered in ClinicalTrials.gov ID NCT03105713. https://classic.clinicaltrials.gov/ct2/show/NCT03105713.

Lower Geriatric Nutritional Risk Index and Prognostic Nutritional Index Predict Postoperative Prognosis in Patients with Hepatocellular Carcinoma.

Increasing evidence suggests that nutritional indices, including the geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI), are predictors of poor prognosis in patients with hepatocellular carcinoma (HCC). Hence, this study aimed to explore the value of the GNRI and PNI in evaluating postoperative prognosis in patients with HCC, particularly regarding its recurrence patterns. We performed a retrospective analysis of 203 patients with HCC who underwent initial hepatic resection. Patients were divided into two groups according to the GNRI (cutoff: 98) and PNI (cutoff: 45). The GNRI and PNI were significantly associated with body composition (body mass index and skeletal muscle mass index), hepatic function (Child-Pugh Score), tumor factors (tumor size and microvascular invasion), and perioperative factors (blood loss and postoperative hospitalization). Patients with a low PNI or low GNRI had significantly worse overall survival (OS) and recurrence-free survival. Patients with early recurrence had lower PNI and GNRI scores than those without early recurrence. Patients with extrahepatic recurrence had lower PNI and GNRI scores than those without extrahepatic recurrence. The PNI and GNRI might be useful in predicting the prognosis and recurrence patterns of patients with HCC after hepatic resection.

Association between a malnutrition screening tool and mealtime observation checklist items in older people receiving oral intake support: A cross-sectional study of four long-term care facilities.

BACKGROUND: Multiple nutritional screening tools are available for older people; however, few screening tools include specific eating behaviours as risk factors that could lead to poor food intake. The 24-item mealtime observation checklist (MOCL), developed by the Japanese Ministry of Health, Labour and Welfare in 2015, comprises signs, symptoms and conditions during mealtime that reflect eating and swallowing functions and oral conditions. OBJECTIVES: To examine factors associated with malnutrition among the MOCL items in older people. METHODS: A cross-sectional study was conducted using data from a retrospective cohort study conducted at four long-term care facilities in Japan. Among the older people residing in the facilities, 198 who received oral intake support were included in the analyses. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA®-SF), and comparisons were made between 'malnutrition' and 'at-risk or well-nourished'. The association between each MOCL item and malnutrition was assessed using multivariable logistic regression analysis. RESULTS: Of the 198 participants, 98 (49.5%) were classified as 'malnutrition', 98 (49.5%) as 'at-risk' and 2 (1%) as 'well-nourished' by MNA®-SF. After adjusting for participant characteristics such as age and sex, significant associations with malnutrition were observed for four items from the 24-item MOCL: 'Has fatigue due to extended mealtime (odds ratio [OR] = 3.20, 95% confidence interval [CI]: 1.36-7.53)', 'Food residues in the oral cavity are conspicuous (OR = 2.77, 95% CI: 1.38-5.52)', 'Has difficulty swallowing food and takes time to swallow (OR = 3.78, 95% CI: 1.45-9.84)' and 'Assisted feeding is required (OR = 3.70, 95% CI: 1.73-7.91)'. CONCLUSIONS: The four signs, symptoms and conditions during mealtime identified in this study may be associated with malnutrition in older people. IMPLICATIONS FOR PRACTICE: These may indicate the potential eating problems that can lead to malnutrition. By incorporating them into early intervention and prevention measures, health care providers may help prevent malnutrition and improve the nutritional status of older people.

Letter to editor: C­reactive protein levels, the prognostic nutritional index, and the lactate dehydrogenase­to­lymphocyte ratio are important prognostic factors in primary central nervous system lymphoma: a single­center study of 223 patients.

This critique evaluates a letter to the editor discussing prognostic factors in primary central nervous system lymphoma (PCNSL), focusing on C-reactive protein (CRP) levels, prognostic nutritional index (PNI), and lactate dehydrogenase (LDH)-to-lymphocyte ratio. While the letter provides valuable insights, limitations including reliance on a single-center dataset, lack of consideration for potential confounders, insufficient contextualization within existing literature, and limited discussion of clinical implications are identified. Addressing these limitations is crucial for enhancing the relevance and applicability of the findings in PCNSL management.

[Effects of Different Nutritional Scoring Systems on Prognosis of Elderly Patients with Multiple Myeloma].

OBJECTIVE: To analyze the prognostic nutritional index (PNI), controlling nutritional status (CONUT) and fibrinogen/albumin ratio (FAR) levels in elderly patients with multiple myeloma (MM) and their prognostic impact. METHODS: The clinical data of 74 elderly MM patients diagnosed in Gansu Provincial Hospital from January 2020 to July 2022 were retrospectively analyzed. The optimal cut-off values for PNI, CONUT score and FAR were obtained by receiver operating characteristic (ROC) curve, which were used for grouping patients. The correlation of above three indexes with clinical parameters such as sex, serum calcium (Ca), ß2-microglobulin (ß2-MG), serum creatinine (Cr) in elderly MM patients were analyzed. The survival rates of patients with different levels of each index were compared. Univariate and multivariate analysis of the impact of clinical indicators on the prognosis of patients were performed. RESULTS: The optimal cut-off values for PNI, CONUT score and FAR were 39.775, 3.5 and 0.175, respectively, according to which the patients were divided into high and low group. Statistical analysis showed that there were significant differences in albumin level among different groups (all P < 0.05). In addition, there was a significant difference in hemoglobin between high-PNI group and low-PNI group (P < 0.05), while in sex distribution between high-FAR and low-FAR group (P < 0.05). The survival rate of elderly MM patients with increased PNI, decreased CONUT score and FAR was higher (all P < 0.05). Univariate and multivariate analysis showed that ß2-MG, Cr, PNI, CONUT score and FAR were independent prognostic factors for elderly MM patients. CONCLUSION: PNI, CONUT score and FAR are related to some clinical indicators of elderly MM patients, and have an impact on the prognosis.

Dietary assessment and prevention of hypertension in Nigeria: Protocol for a retrospective cross-sectional study for the development and validation of a food frequency questionnaire for clinical use.

Contrary to North America and Europe, the prevalence of hypertension is rising in West Africa. With a transition from whole foods to processed foods in Nigeria, diet plays a key driver of hypertension. To combat this, the national nutritional guidelines in Nigeria were implemented, but their translation into actionable tools for clinicians remains a challenge. Currently, there are no simple dietary assessment tools that are concise and suitable to be incorporated into clinical care without requiring extensive data analysis while still providing personalised dietary support to their patients. This study aims to deliver a clinically tested and validated short dietary assessment tool for clinicians, patients, and researchers across Nigeria to provide personalised dietary advice for patients with hypertension. The study will be conducted in two phases: Phase 1 (n = 75) will investigate the feasibility of the short FFQ and its agreement with 24-hour dietary recalls (3x) in a clinical setting in Nigeria. During the analysis of Phase 1 data, a scoring system will be developed based on the associations between individual food items in the FFQ and measures of hypertension. Phase 2 (n = 50) will assess the acceptability of the FFQ and validate the association between the FFQ score and hypertension. Expected outcomes: The development of a clinically tested and validated short food frequency questionnaire that will be ready to use by clinicians, patients, and researchers across Nigeria to support the prevention and management of hypertension. This study will contribute to knowledge on dietary assessment and hypertension prevention by developing a validated and acceptable FFQ, which will be valuable for clinicians and researchers for personalised dietary recommendations to combat hypertension in Nigeria.

Body composition change indices combined with Prognostic Nutritional Index predicts the clinical outcomes of patients with gastric cancer treated with immune checkpoint inhibitor.

OBJECTIVE: This study aimed to investigate the prognostic significance of the Prognostic Nutritional Index (PNI) in conjunction with body composition change indices, namely subcutaneous fat area (SFA) and skeletal muscle index (SMI), with regard to clinical outcomes in patients with gastric cancer (GC) undergoing immune checkpoint inhibitors (ICIs) treatment. METHODS: This retrospective investigation encompassed patients with comprehensive clinical and pathological data, inclusive of portal phase enhanced CT images. Continuous variables underwent analysis utilizing the Student t-test or Mann-Whitney U-test, while categorical variables were assessed employing the Pearson chi-squared test or Fisher test. Survival outcomes were evaluated using Kaplan-Meier survival curves and the Log-rank test. Independent prognostic indicators were determined through Cox regression analysis, and a nomogram predicting survival probability for progression-free survival (PFS) and overall survival (OS) was constructed. RESULTS: Within the PNI-SFA groups, patients in Group 1 exhibited inferior PFS and OS compared to the other two groups. Similarly, among the PNI-SMI groups, Group 1 patients demonstrated poorer PFS and OS. PNI-SMI and Eosi were identified as independent prognostic factors through Cox regression analysis. Furthermore, positive associations with patient prognosis were observed for BMI, SAF, SMI, and PNI. CONCLUSION: The comprehensive consideration of PNI-SFA and PNI-SMI proved to be a superior prognostic predictor for GC patients undergoing ICI treatment.

Novel Indices for Lumbar Discectomy: Systemic Immune Inflammation Index, Systemic Inflammatory Response Index, Multi Inflammatory Index, and Prognostic Nutrition Index.

AIM: To evaluate systemic immune inflammation index (SII), systemic inflammatory response index (SIRI), multi-inflammatory index (MII), and prognostic nutrition index (PNI), and to compare them with the previously reported inflammation-related hematologic index in lumbar discectomy (LD). MATERIAL AND METHODS: This was a retrospective, cross-sectional, single-center study with 105 consecutive patients who underwent surgery for LD. The study comprised three groups: Group I included data from healthy participants, Group II included data before LD, and Group III included data after LD. We analyzed mean platelet volume (MPV), platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), SIRI, SII, MII, and PNI, in comparison with the Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), and Visual analog scale for leg (VASLeg). RESULTS: CRP and MPV were similar for the preoperative and postoperative periods (p=0.489). In the postoperative measurements, NLR, PLR, SII, and SIRI increased (p < 0.0001). On the contrary, PNI decreased with LD (p < 0.0001). NLR (p < 0.001), SII (p < 0.001), and SIRI (p < 0.001) were the valuable indices for LD. PLR (p < 0.001), MII-1 (p=0.004), and MII-2 (p < 0.001) also predicted LD. ODI, RMDQ, and VASLeg correlated with MII-1, MII-2, and SIRI. CONCLUSION: LD's most substantial and valuable indices were NLR, SII, and SIRI. Regarding superiority to SII and NLR, SIRI showed significant agreement with the scales and drew a more appropriate marker profile for LD than MII-1, MII-2, and PNI.