Undernutrition Risk and Undernutrition in Pulmonology Department Inpatients: A Systematic Review and Meta-Analysis.

Pulmonology patients are predisposed to be undernourished and a wide variability in the estimates of frequency of undernutrition risk and undernutrition is found in the literature. The aim of this systematic review and meta-analysis was to investigate the prevalence of undernutrition risk and undernutrition on hospital admission in pulmonology department inpatients. We also intend to take into account the different methodologies used to evaluate undernutrition risk and undernutrition in this population. Pubmed, ISI-Web of Science, and Scopus were searched until January 2015. The evidence regarding the prevalence of undernutrition risk and undernutrition was summarized. Twenty-two studies were included in the qualitative analysis and 21 in meta-analysis. The overall prevalence of undernutrition risk (32.73%; 95% confidence interval [CI], 31.29%-34.17%, I2 = 97.6%) was lower than undernutrition prevalence (36.95%; 95% CI, 34.80%-39.10%, I2 = 99.7%). The subtotal prevalence of undernutrition risk was similar using the Malnutrition Universal Screening Tool and Nutritional Risk Screening-2002. The studies using only anthropometric parameters for the assessment of undernutrition reported lower prevalence of undernutrition than the studies that used Subjective Global Assessment. Cross-sectional studies reported higher prevalence of undernutrition risk and undernutrition than cohort studies. Studies including larger samples reported a prevalence estimate similar to the overall prevalence for undernutrition risk and undernutrition. Studies conducted in non-pulmonology departments showed lower prevalence of undernutrition risk than those from pulmonology departments, contrary to the estimates for undernutrition prevalence. Undernutrition risk and undernutrition prevalence at hospital admission are high among pulmonology inpatients, but the heterogeneity between the studies illustrates the lack of standardized methods to assess nutritional status in this population. The assessment of undernutrition must always be preceded by nutritional screening, according to guidelines, which did not take place in some analyzed studies. Teaching Points • Undernutrition risk and undernutrition prevalence are high among pulmonology inpatients. • The heterogeneity between the analyzed studies reveals that there is no standard pattern in the choice of methods for nutritional status assessment in these patients. • Timely screening and identification of undernutrition is of the utmost relevance in earlier nutritional interventions and implementation of nutritional support. • The assessment of undernutrition must always be preceded by nutritional screening, in accordance with guidelines, which did not occur in some of the analyzed studies.

Predictors of circulating endothelial progenitor cell levels in patients without known coronary artery disease referred for multidetector computed tomography coronary angiography.

INTRODUCTION: Endothelial progenitor cells (EPCs) have an important role in vascular repair. Levels in peripheral circulation are thought to be related to overall cardiovascular risk and may represent potential therapeutic targets. The aim of this work is to identify predictors of circulating EPC concentrations in patients without known coronary artery disease (CAD). METHODS: The study population consisted of 215 patients without known CAD referred for multidetector computed tomography (MDCT) coronary angiography (CTA) during a 6-month period. All patients underwent: 1) short anamnesis; 2) anthropometric measurements; 3) blood pressure and heart rate assessment; 4) blood tests; and 5) MDCT (including quantification of visceral fat, quantification of coronary artery calcification [CAC] and CTA). RESULTS: The patients' mean age was 58±11 years (26-84) and 61% were male. Dyslipidemia (59%) and hypertension (57%) were the most prevalent risk factors. Twenty-seven percent met the ATP III criteria for metabolic syndrome. Mean Framingham risk score was 12±9%. Sixty-seven percent had no significant CAD but 64% had some degree of coronary calcification. The mean CAC (Agatston) was 186±433. Mean EPC concentration, expressed as a percentage of total white blood cells, was 0.05±0.08% (0.0-0.58%). EPCs were inversely related to the presence of diabetes mellitus and smoking, and positively related to C-reactive protein. No significant correlations were found between EPCs and other risk factors, measurements of adiposity, atherosclerotic burden or severity of CAD. CONCLUSION: In patients without known CAD referred for MDCT, EPC levels in peripheral blood cannot be significantly estimated or predicted from knowledge of patient anamnesis, risk factors, visceral fat, CAC or CTA.

Nutritional screening of pulmonology department inpatients.

Undernutrition is associated with worse clinical outcomes and so screening is recommended. Given the paucity of information on nutritional status and on the clinical impact of undernutrition in Pulmonology patients who have been hospitalized, it is of the utmost importance that it is studied. Through a longitudinal study conducted of 323 patients consecutively admitted to a Pulmonology hospital department, undernutrition was screened using the Malnutrition Universal Screening Tool and the association between length of hospital stay, pathology type, discharge destination and undernutrition risk was quantified. There was found to be a high proportion of patients at risk of undernutrition, with 18.3% at high risk and 15.5% at moderate risk. Patients at risk of undernutrition had a higher risk of dying during hospitalization (OR=2.72, 95% CI: 1.48- 4.97). One in three patients admitted to this unit is at risk of undernutrition; chronic obstructive pulmonary disease was the pathology most strongly associated with undernutrition risk. Present data reinforces the need for screening for undernutrition on admission.