SARC-Calf using calf circumference adjusted for BMI predicts six-months readmission and mortality in hospitalized patients: a secondary analysis of a cohort study.

BACKGROUND: Sarcopenia is a prevalent condition associated with worse clinical outcomes in hospitalized patients. The SARC-Calf is an accurate instrument for its screening; however, it includes the calf circumference (CC) measure as a criterion, which is influenced by adiposity. An adjustment for CC based on body mass index (BMI) has been proposed, but the literature lacks studies evaluating the SARC-Calf using adjusted CC. OBJECTIVE: This study aimed to evaluate the prognostic value of the SARC-Calf with BMI-adjusted CC and compare it between adult and older hospitalized patients. METHODS: This is a secondary analysis of a cohort with prospective data collection, including individuals aged ≥18 years, lucid and able to communicate. SARC-Calf was applied using BMI-adjusted CC, obtained by subtracting 3, 7, and 12 cm from CC values when BMI was 25-29.99, 30-39.99, and ≥ 40kg/m2, respectively. Outcomes of interest included prolonged hospital stay, in-hospital death, hospital readmission, and mortality six months after discharge. Logistic and Cox regression analyses, adjusted for Charlson comorbidity index and sex, were performed. RESULTS: We analyzed data from 554 patients (mean age 55.2±14.9 years, 52.9% males). Suggestive signs of sarcopenia by SARC-Calf with BMI-adjusted CC were identified in 40.4% of patients (38.6% in adults and 42.7% in older patients, p=0.380). Suggestive signs of sarcopenia were associated with hospital readmission in adults (OR=1.8; 95%CI 1.1, 2.9), and six-month death in both adult (OR= 4.0; 95% CI 1.3, 12.1) and older patients (OR=2.8; 95%CI 1.2, 6.6). It was not independently associated with in-hospital outcomes. CONCLUSIONS: SARC-Calf with BMI-adjusted CC identified a high frequency of patients with suggestive signs of sarcopenia, regardless of age, and it was independently associated with worse outcomes six months after discharge. STATEMENT OF SIGNIFICANCE: Suggestive signs of sarcopenia cannot be accurately identified by SARC-Calf in individuals with high BMI due to the influence of adiposity on calf circumference (CC) measurements. In this secondary analysis, we explored the prognostic value of SARC-Calf with BMI-adjusted CC, aiming to correct the influence of adiposity on the CC measurement. We confirmed that this approach identifies a high number of patients with suggestive signs of sarcopenia and showed that it was independently related to worse outcomes six months after hospital discharge in both adults and older patients.

Dietary patterns and risk of Chronic Obstructive Pulmonary Disease (COPD) and clinical outcomes in diagnosed patients: A scoping review.

BACKGROUND & AIMS: Limited research exists on the association between dietary patterns (DP) and COPD risk or health-related outcomes. We reviewed existing literature to identify DP as a potential factor influencing COPD development and associated health outcomes in diagnosed individuals. METHODS: We followed the Joanna Briggs Institute methodology for this scoping review, conducting searches on PubMed, Scopus, Embase, and Web of Science to identify studies meeting our inclusion criteria (P, population - adults from the general population with or without COPD diagnosis; C, concept - DP; C, context - any setting). Two reviewers screened titles and abstracts, confirmed eligibility through full-text examination, extracted data using Redcap®, and assessed bias risk with the Newcastle Ottawa Scale. RESULTS: We analyzed 24 studies with sample sizes ranging from 121 to 421,426 individuals aged 20 to 75. Eighty-three percent investigated the role of DP in the COPD etiology, while 16.7 % examined health-related COPD outcomes. Food frequency questionnaires predominated (75 %) in exploring 23 distinct DP. Sixty-seven percent employed a priori-defined DP, focusing on the Mediterranean Diet (MedDiet) and Healthy Eating Index (HEI), while 33.3 % utilized a posteriori-defined DP, mainly represented by the Prudent and Traditional DP. Sixty percent of the studies reported significant associations between DP and COPD risk/odds. However, studies examining DP and COPD patient outcomes produced varied results. CONCLUSIONS: Most studies focused on assessing COPD risk using a priori-defined DP, particularly emphasizing the Med Diet and HEI. Overall, the studies found that healthy DPs are associated with reduced risk of COPD and improved outcomes in diagnosed patients.

Association Between Diabetes and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis of Observational Studies.

PURPOSE: Metabolic diseases such as diabetes mellitus may play a role in the development and progression of prostate cancer (PC); however, this association remains to be explored in the context of specific PC stages. The objective of this study was to systematically review the evidence for an association between diabetes and overall, early, or advanced PC risk. MATERIALS AND METHODS: A systematic review with meta-analysis was performed (MEDLINE, EMBASE, and CINAHL) from inception until September 2023. Cohort and case-control studies that assessed PC risk in adult males (≥18 years) associated with type 2 diabetes mellitus or diabetes (if there was no distinction between diabetes type) were included. The Newcastle-Ottawa Scale (NOS) was used to assess study bias; those with NOS<7 were excluded. Evidence certainty was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. RESULTS: Thirty-four studies (n=26 cohorts and n=8 case-controls) were included. Of these, 32 assessed diabetes and all PC stages combined, 12 included early PC stages, and 15 included advanced PC stages. Our meta-analysis showed diabetes had a protective effect against early PC development (n=11, risk ratio [RR]=0.71; 95% confidence interval [CI]=0.61-0.83, I²=84%) but no association was found for combined (n=21, RR=0.95; 95% CI=0.79-1.13, I²=99%) or advanced PC stages (n=15, RR=0.96; 95% CI=0.77-1.18, I²=98%) at diagnosis. According to GRADE, the evidence certainty was very low. CONCLUSIONS: Diabetes may be protective against early PC stages, yet evidence linking diabetes to risk across all stages, and advanced PC specifically, is less conclusive. High heterogeneity may partially explain discrepancy in findings and was mostly associated with study design, method used for PC diagnosis, and risk measures. Our results may aid risk stratification of males with diabetes and inform new approaches for PC screening in this group, especially considering the reduced sensitivity of prostate-specific antigen values for those with diabetes.

Refeeding syndrome risk at ICU admission is an independent predictor of ICU readmission but it is not associated with mortality or length of stay in critically ill patients.

OBJECTIVES: This study evaluated the association between refeeding syndrome (RFS) risk and intensive care unit (ICU)/in-hospital mortality and length of stay (LOS) and ICU readmission in critically ill patients. METHODS: This secondary analysis of a cohort study included patients aged ≥ 18 years admitted at ICU 24 h before data collection. We evaluated RFS risk based on the National Institute for Health and Clinical Excellence (NICE), stratifying it into four categories (no, low, high, and very-high risk). SETTING: Five adult ICUs in Brazil. MAIN OUTCOME MEASURES: ICU/in-hospital mortality and LOS and ICU readmission data were obtained from electronic medical records analysis, following patients until discharge (alive or not). RESULTS: The study involved 447 patients, categorized into no (19.2 %), low (28.6 %), high (48.8 %), and very-high (3.4 %) RFS risk groups. No significant differences emerged between the two groups (at RFS risk and no RFS risk) regarding the ICU death ratio (34.3 % versus 23.4 %) and LOS (5 versus 4 days), respectively. In contrast, patients at RFS risk experienced higher in-hospital mortality rates (34.3 % versus 23.4 %) prolonged hospital LOS (21 days versus 17 days), and increased ICU readmission rates (15 % versus 8.4 %) than patients without RFS risk. After adjusting for age and Sequential Organ Failure Assessment (SOFA) Score, we found no association between RFS risk and increased mortality in the ICU or hospital. Also, there was no significant association between RFS risk and prolonged LOS in the ICU or hospital setting. However, patients identified as at risk of RFS showed nearly double the odds of ICU readmission (Odds ratio, 1.90; 95 % CI 1.02-3.43). CONCLUSIONS: This study found no significant association between RFS risk and increased mortality in both the ICU and hospital settings, nor was there a significant association with prolonged LOS in the ICU or hospital among critically ill patients. However, patients at risk of RFS exhibited nearly double the odds of ICU readmission. IMPLICATIONS FOR CLINICAL PRACTICE: Our findings may contribute to understanding risks associated with ICU readmissions, highlighting the complexity of discharge decision-making through comprehensive assessments.

Reporting completeness of nutrition and diet-related randomised controlled trials protocols.

BACKGROUND AND AIMS: There is a need to consolidate reporting guidance for nutrition randomised controlled trial (RCT) protocols. The reporting completeness in nutrition RCT protocols and study characteristics associated with adherence to SPIRIT and TIDieR reporting guidelines are unknown. We, therefore, assessed reporting completeness and its potential predictors in a random sample of published nutrition and diet-related RCT protocols. METHODS: We conducted a meta-research study of 200 nutrition and diet-related RCT protocols published in 2019 and 2021 (aiming to consider periods before and after the start of the COVID pandemic). Data extraction included bibliometric information, general study characteristics, compliance with 122 questions corresponding to items and subitems in the SPIRIT and TIDieR checklists combined, and mention to these reporting guidelines in the publications. We calculated the proportion of protocols reporting each item and the frequency of items reported for each protocol. We investigated associations between selected publication aspects and reporting completeness using linear regression analysis. RESULTS: The majority of protocols included adults and elderly as their study population (n = 73; 36.5%), supplementation as intervention (n = 96; 48.0%), placebo as comparator (n = 89; 44.5%), and evaluated clinical status as the outcome (n = 80; 40.0%). Most protocols described a parallel RCT (n = 188; 94.0%) with a superiority framework (n = 141; 70.5%). Overall reporting completeness was 52.0% (SD = 10.8%). Adherence to SPIRIT items ranged from 0% (n = 0) (data collection methods) to 98.5% (n = 197) (eligibility criteria). Adherence to TIDieR items ranged from 5.5% (n = 11) (materials used in the intervention) to 98.5% (n = 197) (description of the intervention). The multivariable regression analysis suggests that a higher number of authors [ß = 0.53 (95%CI: 0.28-0.78)], most recent published protocols [ß = 3.19 (95%CI: 0.24-6.14)], request of reporting guideline checklist during the submission process by the journal [ß = 6.50 (95%CI: 2.56-10.43)] and mention of SPIRIT by the authors [ß = 5.15 (95%CI: 2.44-7.86)] are related to higher reporting completeness scores. CONCLUSIONS: Reporting completeness in a random sample of 200 diet or nutrition-related RCT protocols was low. Number of authors, year of publication, self-reported adherence to SPIRIT, and journals' endorsement of reporting guidelines seem to be positively associated with reporting completeness in nutrition and diet-related RCT protocols.

Association of handgrip strength with nutritional status and clinical outcomes in hospitalized pediatric patients.

BACKGROUND & AIMS: Malnutrition in children and adolescents is prevalent at hospital admission and the incidence increases with length of stay. Malnourished patients have loss of muscle mass and strength, compromising their functionality. Handgrip strength (HGS) is a nutritional marker understudied in pediatrics although it is capable of detecting nutritional deprivation before changes in body composition are observed. Therefore, this study aimed to evaluate the association between reduced HGS at hospital admission, compromised nutritional status and worse clinical outcomes of pediatric patients. METHODS: Cohort study conducted with patients aged 6-18 years admitted to a pediatric ward. Nutritional status was assessed in the first 48 h of hospital admission using the z-score of height for age (H/A) and body mass index for age (BMI/A), percentile of mid-arm muscle circumference for age (MAMC/A) and the pediatric global subjective nutritional assessment (SGNA). HGS was measured using a digital dynamometer and considered reduced when the maximum value of three measurements was below the 5th percentile for sex and age. The clinical outcomes analyzed were length of hospital stay and frequency of readmission within 3 months after hospital discharge. RESULTS: A total of 135 patients were evaluated (median age 10.9 years, 55.6% male) and 17.8% had reduced HGS. Patients with reduced HGS had lower H/A z-score (-0.50 vs 0.22, p = 0.012) and a higher frequency of reduced MAMC when compared to those with normal HGS (8% vs 13%, p = 0.007). Reduced HGS was not associated with malnutrition (OR = 0.63; 95%CI 0.23-1.77), prolonged hospital stay (OR = 1.89; 95%CI 0.72-4.92) or readmission to hospital 3 months after hospital discharge (OR = 1.82; 95%CI 0.67-4.93), in a model adjusted for the clinical condition. CONCLUSION: Reduced HGS was not a predictor of malnutrition and clinical outcomes. However, it was associated with lower H/A Z-score and MAMC/A percentile values and can be used as a complementary measure in the nutritional status assessment of hospitalized pediatric patients.

Association between isolated or combined malnutrition and sarcopenia and quality of life in heart failure outpatients: A cross-sectional study.

BACKGROUND: Heart failure (HF) is a chronic condition with symptoms linked to worse quality of life. Malnutrition and sarcopenia are conditions frequently found in patients with HF. This study aims to evaluate the association between isolated or combined malnutrition and sarcopenia and quality of life in outpatients with HF. METHODS: This is a cross-sectional study with a sample of outpatients with HF aged ≥18 years. Malnutrition was assessed according to the criteria of the Global Leadership Initiative on Malnutrition, and sarcopenia was evaluated by the European Working Group on Sarcopenia in Older People. Quality of life was assessed using the Minnesota Living with HF questionnaire (MLHFQ). Clinical and sociodemographic data were collected. RESULTS: One hundred and fifty-one patients were included in this study, with a median (interquartile range) age of 58 (48-65) years, 58.9% were adults, and 68.9% were male. A total of 29.5% of the patients were malnourished, and 28.5% and 2.6% were identified with probable sarcopenia and sarcopenia, respectively. Of the total, 15.9% of patients were identified with both conditions. Sarcopenia was associated with higher odds of increase in the MLHFQ total score, indicating worse quality of life (odds ratio [OR] = 3.61; 95% CI, 1.65-7.89). The same was found in the presence of two conditions (OR 3.97; 95% CI, 1.32-11.54), whereas isolated malnutrition was not related to life quality (OR = 1.62; 95% CI, 0.73-3.60). CONCLUSION: The presence of malnutrition and sarcopenia simultaneously were associated with worse quality of life scores when compared with these isolated conditions.

Identifying nutrition risk in emergency patients: What is the most appropriate screening tool?

BACKGROUND: The emergency department (ED) is the most frequent access route to the hospital. Nutrition risk (NR) screening allows the early identification of patients at risk of malnutrition. This study aimed to evaluate the feasibility and predictive validity of five different tools in EDs: Nutritional Risk Screening 2002 (NRS-2002), Nutritional Risk Emergency 2017 (NRE-2017), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), Malnutrition Universal Screening (MUST), and Malnutrition Screening Tool (MST). METHODS: Patients with scores ≥3 according to the NRS-2002, ≥1.5 according to the NRE-2017, and ≥2 according to the MUST, RFH-NPT, or MST were classified with NR. Prolonged length of stay (LOS) and 1-year mortality were evaluated. RESULTS: 431 patients were evaluated (57.31 ± 15.6 years of age; 54.4% women) in a public hospital in southern Brazil. The prevalence of NR was: 35% according to the NRS-2002, 43% according to the MST, 45% according to the NRE-2017 and MUST, and 49% according to the RFH-NPT. Patients with NR, had a greater risk of prolonged LOS (P < 0.001). The presence of NR was associated with an increased risk of 1-year mortality according to the NRS-2002 (hazard ratio [HR]: 4.04; 95% CI, 2.513-6.503), MST (HR: 2.60; 95% CI, 1.701-3.996), NRE-2017 (HR: 4.82; 95% CI, 2.753-8.443), MUST (HR: 4.00; 95% CI, 2.385-6.710), and RFH-NPT (HR: 5.43; 95% CI, 2.984-9.907). CONCLUSIONS: NRE-2017 does not require objective data and presented predictive validity for all outcomes assessed, regardless of the severity of the disease, and thus appears to be the most appropriate tool for carrying out NR screening in the ED.

Complementarity of nutrition screening with Global Leadership Initiative on Malnutrition criteria for diagnosing malnutrition in critically ill patients: A comparison study of Nutritional Risk Screening 2002 and modified Nutrition Risk in the Critically Ill Score.

BACKGROUND AND AIM: Critical illness induces hypermetabolism and hypercatabolism, increasing nutrition risk (NR). Early NR identification is crucial for improving outcomes. We assessed four nutrition screening tools (NSTs) complementarity with the Global Leadership Initiative on Malnutrition (GLIM) criteria in critically ill patients. METHODS: We conducted a comparative study using data from a cohort involving five intensive care units (ICUs), screening patients for NR using NRS-2002 and modified-NUTRIC tools, with three cutoffs (≥3, ≥4, ≥5), and malnutrition diagnosed by GLIM criteria. Our outcomes of interest included ICU and in-hospital mortality, ICU and hospital length of stay (LOS), and ICU readmission. We examined accuracy metrics and complementarity between NSTs and GLIM criteria about clinical outcomes through logistic regression and Cox regression. We established a four-category independent variable: NR(-)/GLIM(-) as the reference, NR(-)/GLIM(+), NR(+)/GLIM(-), and NR(+)/GLIM(+). RESULTS: Of the 377 patients analyzed (median age 64 years [interquartile range: 54-71] and 53.8% male), NR prevalence varied from 87% to 40.6%, whereas 64% presented malnutrition (GLIM criteria). NRS-2002 (score ≥4) showed superior accuracy for GLIM-based malnutrition. Multivariate analysis revealed mNUTRIC(+)/GLIM(+) increased >2 times in the likelihood of ICU and in-hospital mortality, ICU and hospital LOS, and ICU readmission compared with the reference group. CONCLUSION: No NST exhibited satisfactory complementarity to the GLIM criteria in our study, emphasizing the necessity for comprehensive nutrition assessment for all patients, irrespective of NR status. We recommend using mNUTRIC if the ICU team opts for nutrition screening, as it demonstrated superior prognostic value compared with NRS-2002, and applying GLIM criteria in all patients.

Validity of the GLIM criteria for the diagnosis of malnutrition in patients with colorectal cancer: A multicenter study on the diagnostic performance of different indicators of reduced muscle mass and disease severity.

OBJECTIVES: To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS: A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS: For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS: Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.

Derivation of the Screening of Nutritional Risk in Intensive Care risk prediction score: A secondary analysis of a prospective cohort study.

BACKGROUND: For patients who are critically ill, the recommended nutrition risk screening tools are the Nutrition Risk in the Critically Ill (NUTRIC) and the Nutritional Risk Screening 2002 (NRS-2002) have limitations. OBJECTIVE: To develop a new screening tool, the Screening of Nutritional Risk in Intensive Care (SCREENIC score), and assess its predictive validity. METHODS: A secondary analysis of a prospective cohort study was conducted. Variables from several nutritional screening and assessment tools were considered. The high nutrition risk cutoff point was defined using mNUTRIC as a reference. Predictive validity was evaluated using logistic regression and Cox regression. RESULTS: The study included 450 patients (64 [54-71] years, 52.2% men). The SCREENIC score comprised six questions: (1) does the patient have ≥2 comorbidities (1.3 points); (2) was the patient hospitalized for ≥2 days before intensive care unit (ICU) admission (0.9 points); (3) does the patient have sepsis (1.0 point); (4) was the patient on mechanical ventilation upon ICU admission (1.2 points); (5) is the patient aged >65 years (1.2 points); and (6) does the patient exhibit signs of moderate/severe muscle mass loss according to the physical exam (0.6 points). The high nutrition risk cutoff point was set at 4.0. SCREENIC demonstrated moderate agreement (κ = 0.564) and high accuracy (0.896 [95% CI, 0.867-0.925]) with mNUTRIC. It predicted prolonged ICU (odds ratio [OR] = 1.81 [95% CI, 1.14-2.85]) and hospital stay (OR = 2.15 [95% CI, 1.37-3.38]). CONCLUSION: The SCREENIC score comprises questions with variables that do not require nutrition history. Further evaluation of its applicability, reproducibility, and validity in guiding nutrition therapy is needed using large external cohorts.

Remote nutrition care during the first wave of COVID-19 pandemic: Did it impact nutrition therapy goals?

BACKGROUND AND AIMS: Nutrition societies recommended remote hospital nutrition care during the coronavirus disease 2019 (COVID-19) pandemic. However, the pandemic's impact on nutrition care quality is unknown. We aimed to evaluate the association between remote nutrition care during the first COVID-19 wave and the time to start and achieve the nutrition therapy (NT) goals of critically ill patients. METHODS: A cohort study was conducted in an intensive care unit (ICU) that assisted patients with COVID-19 between May 2020 and April 2021. The remote nutrition care lasted approximately 6 months, and dietitians prescribed the nutrition care based on medical records and daily telephone contact with nurses who were in direct contact with patients. Data were retrospectively collected, patients were grouped according to the nutrition care delivered (remote or in person), and we compared the time to start NT and achieve the nutrition goals. RESULTS: One hundred fifty-eight patients (61.5 ± 14.8 years, 57% male) were evaluated, and 54.4% received remote nutrition care. The median time to start NT was 1 (1-3) day and to achieve the nutrition goals was 4 (3-6) days for both groups. The percentage of energy and protein prescribed on day 7 of the ICU stay concerning the requirements did not differ between patients with remote and patients with in-person nutrition care [95.5% ± 20.4% × 92.1% ± 26.4% (energy) and 92.9% ± 21.9% × 86.9% ± 29.2% (protein); P > 0.05 for both analyses]. CONCLUSION: Remote nutrition care in patients critically ill with COVID-19 did not impact the time to start and achieve the NT goals.

Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study.

BACKGROUND: Despite its correlation with skeletal muscle mass and its predictive value for adverse outcomes in clinical settings, calf circumference is a metric underexplored in intensive care. We aimed to determine whether adjusting low calf circumference for adiposity provides prognostic value superior to its unadjusted measurement for intensive care unit (ICU) mortality and other clinical outcomes in critically ill patients. METHODS: In a secondary analysis of a cohort study across five ICUs, we assessed critically ill patients within 24 h of ICU admission. We adjusted calf circumference for body mass index (BMI) (25-29.9, 30-39.9, and ≥40) by subtracting 3, 7, or 12 cm from it, respectively. Values ≤34 cm for men and ≤33 cm for women identified low calf circumference. RESULTS: We analyzed 325 patients. In the primary risk-adjusted analysis, the ICU death risk was similar between the low and preserved calf circumference (BMI-adjusted) groups (hazard ratio, 0.90; 95% CI, 0.47-1.73). Low calf circumference (unadjusted) increased the odds of ICU readmission 2.91 times (95% CI, 1.40-6.05). Every 1-cm increase in calf circumference as a continuous variable reduced ICU readmission odds by 12%. Calf circumference showed no significant association with other clinical outcomes. CONCLUSION: BMI-adjusted calf circumference did not exhibit independent associations with ICU and in-hospital death, nor with ICU and in-hospital length of stay, compared with its unadjusted measurement. However, low calf circumference (unadjusted and BMI-adjusted) was independently associated with ICU readmission, mainly when analyzed as a continuous variable.

Independent and joint association of sarcopenia and frailty with mortality in older patients with gastrointestinal cancer: a cohort study with prospective data collection.

PURPOSE: Sarcopenia and frailty are associated with mortality in older patients with gastrointestinal cancer. However, it is unclear if there is an additional risk when both are present. This study aimed to investigate the independent and overlapping of sarcopenia and frailty with mortality in this population. METHODS: A prospective cohort study including older patients (≥ 60 years old) with gastrointestinal cancer. Sarcopenia was defined by the EWGSP2 criteria: (i) low muscle strength (handgrip test), (ii) low muscle mass (skeletal muscle index), and/or low muscle quality (skeletal muscle radiodensity) by computed tomography. Frailty was defined according to Fried phenotype (at least three of the five components): (i) low muscle strength (handgrip test), (ii) unintentional weight loss, (iii) self-reported exhaustion, (iv) low physical activity, and (v) low gait speed. Cox proportional hazards model was used to assess overall survival rates and risk of mortality. RESULTS: We evaluated 179 patients with gastrointestinal cancer [68.0 (61.0-75.0) years old; 45% women]. The prevalence of sarcopenia, frailty, and sarcopenia-frailty was 32.9% (n = 59), 59.2% (n = 106), and 24.6% (n = 44), respectively. The incidence of mortality was 27.9% (n = 50) over a 23-month (IQR, 10, 28) period. There was an association of sarcopenia (HR = 1.78, 95% CI 1.03-3.06) with mortality, but no association was found of frailty and the outcome. Sarcopenia-frailty was associated with the highest risk of mortality (HR = 2.23, 95% CI 1.27-3.92). CONCLUSION: Sarcopenic-frail older patients with gastrointestinal cancer have a higher risk of mortality than those with sarcopenia or frailty alone, which reinforces the importance of assessing both conditions in oncology clinical care.

Feasibility and criterion validity of the GLIM criteria in the critically ill: A prospective cohort study.

BACKGROUND: This study aimed to evaluate the feasibility and validity of the Global Leadership Initiative on Malnutrition (GLIM) criteria in the intensive care unit (ICU). METHODS: This was a cohort study involving critically ill patients. Diagnoses of malnutrition by the Subjective Global Assessment (SGA) and GLIM criteria within 24 h after ICU admission were prospectively performed. Patients were followed up until hospital discharge to assess the hospital/ICU length of stay (LOS), mechanical ventilation duration, ICU readmission, and hospital/ICU mortality. Three months after discharge, the patients were contacted to record outcomes (readmission and death). Agreement and accuracy tests and regression analyses were performed. RESULTS: GLIM criteria could be applied to 377 (83.7%) of 450 patients (64 [54-71] years old, 52.2% men). Malnutrition prevalence was 47.8% (n = 180) by SGA and 65.5% (n = 247) by GLIM criteria, presenting an area under the curve equal to 0.835 (95% confidence interval [CI], 0.790-0.880), sensitivity of 96.6%, and specificity of 70.3%. Malnutrition by GLIM criteria increased the odds of prolonged ICU LOS by 1.75 times (95% CI, 1.08-2.82) and ICU readmission by 2.66 times (95% CI, 1.15-6.14). Malnutrition by SGA also increased the odds of ICU readmission and the risk of ICU and hospital death more than twice. CONCLUSION: The GLIM criteria were highly feasible and presented high sensitivity, moderate specificity, and substantial agreement with the SGA in critically ill patients. It was an independent predictor of prolonged ICU LOS and ICU readmission, but it was not associated with death such as malnutrition diagnosed by SGA.

The association between reduced calf and mid-arm circumferences and ICU mortality in critically ill COVID-19 patients.

BACKGROUND & AIMS: Patients with COVID-19 are at a high risk of malnutrition caused by inflammatory syndrome and persistent hypermetabolism, which may affect clinical outcomes. This study aimed to evaluate the changes in nutritional status indicators between two time points of nutritional assessments of COVID-19 patients during their stay in the intensive care unit (ICU). Moreover, the study also assessed the association of nutritional status with ICU mortality. METHODS: This cohort study included retrospective data of adult patients admitted to a public hospital ICU in southern Brazil, between March and September 2020. These participants with confirmed COVID-19 diagnosis received nutritional assessment within the first 72 h after ICU admission. The anthropometric measurements collected included mid-arm circumference (MAC) and calf circumference (CC). The percentage (%) of MAC adequacy was calculated, and values < 50th percentile for sex and age were considered low. CC values of ≤33 cm for women and ≤34 cm for men were indicative of reduced muscle mass. Data on the date of discharge from the ICU and mortality outcome were collected. RESULTS: A total of 249 patients were included (53.4% men, 62.2 ± 13.9 years of age, SOFA severity score 9.6 ± 3.5). Of these, 22.7 and 39.1% had reduced MAC and CC at ICU admission, respectively. In these participants, weight, MAC, CC, and % MAC decreased significantly from the first to second nutritional assessment (p < 0.05), but there was no significant difference between survivors and non-survivors. Patients with reduced CC (HR = 2.63; 95% CI 1.65-4.18) or reduced MAC (HR = 2.11; 95% CI 1.37-3.23) at the first nutritional assessment had approximately twice the risk of death in the ICU than those with normal CC and normal MAC, regardless of the severity assessed by the SOFA score and age. CONCLUSION: Reduced MAC and CC values were identified in approximately 20 and 40% of COVID-19 patients admitted to the ICU, respectively. Additionally, these indicators of nutritional depletion were associated with an approximately 2-fold increase in the risk of ICU mortality. A significant reduction in anthropometric indicators during the first weeks of ICU stay confirmed the deterioration of nutritional status in these patients, although this was not associated with mortality.

Prognostic value of different cut-off points of the NRS-2002 tool to identify nutritional risk in critically ill patients: a longitudinal study.

The American Society of Parenteral and Enteral Nutrition recommends nutritional risk (NR) screening in critically ill patients with Nutritional Risk Screening - 2002 (NRS-2002) ≥ 3 as NR and ≥ 5 as high NR. The present study evaluated the predictive validity of different NRS-2002 cut-off points in intensive care unit (ICU). A prospective cohort study was conducted with adult patients who were screened using the NRS-2002. Hospital and ICU length of stay (LOS), hospital and ICU mortality, and ICU readmission were evaluated as outcomes. Logistic and Cox regression analyses were performed to evaluate the prognostic value of NRS-2002, and a receiver operating characteristic curve was constructed to determine the best cut-off point for NRS-2002. 374 patients (61·9 ± 14·3 years, 51·1 % males) were included in the study. Of these, 13·1 % were classified as without NR, 48·9 % and 38·0 % were classified as NR and high NR, respectively. An NRS-2002 score of ≥ 5 was associated with prolonged hospital LOS. The best cut-off point for NRS-2002 was a score ≥ 4, which was associated with prolonged hospital LOS (OR = 2·13; 95 % CI: 1·39, 3·28), ICU readmission (OR = 2·44; 95 % CI: 1·14, 5·22), ICU (HR = 2·91; 95 % CI: 1·47, 5·78) and hospital mortality (HR = 2·01; 95 % CI: 1·24, 3·25), but not with ICU prolonged LOS (P = 0·688). NRS-2002 ≥ 4 presented the most satisfactory predictive validity and should be considered in the ICU setting. Future studies should confirm the cut-off point and its validity in predicting nutrition therapy interaction with outcomes.

Prone position, time to reach nutrition target, and energy/protein achievement rate on the seventh day of intensive care unit stay in patients with COVID-19: A cohort study.

BACKGROUND: We aimed to evaluate the mean time to reach the energy (EAR) and protein (PAR) achievement rate among patients with coronavirus disease 2019 (COVID-19) who did or did not undergo prone position (PP) therapy in the first week of their stay in the intensive care unit (ICU), and the interaction of these nutrition therapy indicators on the association between PP and clinical outcomes. METHODS: This cohort study used retrospective data collected from medical records of patients with COVID-19 admitted to the ICU (≥18 years). We collected nutrition data, clinical information, prescription of PP, and its frequency during the first week, and clinical outcomes. RESULTS: PP therapy was administered to 75.2% of 153 patients (61.5 ± 14.8 years, 57.6% males) during the first week of their ICU stay. Patients who underwent PP reached nutrition therapy goals later (4 [3-6] vs 3 [2-4] days; P = 0.030) and had lower EAR (91.9 ± 25.7 vs 101.6 ± 84.0; P = 0.002) and PAR (88.0 ± 27.7 vs 98.1 ± 13.5; P = 0.009) in comparison to those who did not receive PP. Grouping patients who underwent PP according to the EAR (≥70% or <70%) did not show any differences in the incidence of ICU death, duration of mechanical ventilation, or ICU stay (P > 0.05). CONCLUSIONS: In this exploratory study, PP was associated with a delayed time to reach the nutrition target and the lowest EAR and estimated protein requirement on the seventh day of ICU stay in patients with COVID-19. Permissive enteral nutrition prescription in patients who underwent PP was not associated with worse clinical outcomes.

A scoping review on the GLIM criteria for malnutrition diagnosis: Understanding how and for which purpose it has been applied in studies on hospital settings.

AIMS: This scoping review aimed to identify and map the literature on malnutrition diagnosis made using the GLIM criteria in hospitalized patients. METHODS: The scoping review was conducted using the Joanna Briggs Institute's methodology. We searched PubMed, Embase, Scopus, and Web of Science (until 16 April 2022) to identify studies based on the 'population' (adults or elderly patients), 'concept' (malnutrition diagnosis by the GLIM criteria), and 'context' (hospital settings) framework. Titles/abstracts were screened, and two independent reviewers extracted data from eligible studies. RESULTS: Ninety-six studies were eligible (35.4% from China, 30.2% involving oncological patients, and 30.5% with prospective data collection), 32 followed the two-step GLIM approach, and 50 applied all the criteria. All the studies evaluated body mass index (BMI), while 92.7% evaluated weight loss; 77.1%, muscle mass; 93.8%, inflammation; and 70.8%, energy intake. A lack of details on the methods adopted for criterion evaluation was observed in five (muscle mass evaluation) to 40 studies (energy intake evaluation). The frequency of the use of the GLIM criteria ranged from 22.2% (frequency of low BMI) to 84.7% (frequency of inflammation), and the malnutrition prevalence ranged from 0.96% to 87.9%. Less than 30% of studies aimed to assess the GLIM criterion validity, eight studies cited the guidance on validation of the GLIM criteria, and a minority implemented it. CONCLUSIONS: This map of studies on the GLIM criteria in hospital settings demonstrated that they are applied in a heterogeneous manner, with a wide range of malnutrition prevalence. Almost 50% of the studies applied all the criteria, while one-third followed the straightforward two-step approach. The recommendations of the guidance on validation of the criteria were scarcely adhered to. The gaps that need to be explored in future studies have been highlighted.