Pain and Coping Strategies as Determinants of Malnutrition Risk in Lung Cancer Patients: A Cross-Sectional Study.

Progressive cachexia and malnutrition severely impact the physical and mental condition of cancer patients. Pain is a prognostic factor for shorter survival in cancer patients, and coping strategies are crucial for adapting to treatment and dietary regimens. This study assessed pain levels, pain-related beliefs, and coping strategies as factors increasing malnutrition risk in 257 lung cancer patients. Sociodemographic and clinical data were collected from medical records. The Mini Nutritional Assessment (MNA), Visual Analog Scale (VAS), Beliefs about Pain Control Questionnaire (BPCQ), and Coping Strategies Questionnaire (CSQ) were used. Overall, 42.8% of patients were at risk of malnutrition, and 17.5% were malnourished. Nutritional status negatively correlated with CSQ domains: reinterpretation of pain (RP: rho = -0.194; p = 0.002), catastrophizing (CP: rho = -0.414; p = 0.001), ignoring pain (IP: rho = -0.198; p = 0.001), praying/hoping (PH: rho = -0.253; p < 0.001), and coping self-statements (CS: rho = -0.172; p = 0.006); and BPCQ domains: the power of doctors (PD: rho = -0.196; p = 0.002) and VAS (rho = -0.451; p < 0.001). Nutritional status positively correlated with CSQ domains: pain control (PC: rho = 0.499; p < 0.001) and the ability to reduce pain (AR: rho = 0.512; p < 0.001). In multivariate regression analysis, a better nutritional status was associated with a younger age (ß = -0.094; p < 0.001), non-small-cell lung cancer (NSCLC) (ß = 1.218; p = 0.037), a greater ability to reduce pain (CSQ-AR) (ß = 0.901; p < 0.001), lower catastrophizing (CSQ-CP) (ß = -0.165; p = 0.001), and lower pain perceived (VAS) (ß = 0.639; p < 0.001). Statistical analyses included Spearman's correlation and multivariate regression with a significance level of p < 0.05. Patients with a normal nutritional status had reduced doctor involvement in pain control, less frequent negative coping strategies, and more common positive coping strategies. A normal nutritional status correlates with lower perceived pain. A better nutritional status is linked to a younger age, NSCLC, lower pain levels, greater pain reduction ability, and lower scores in pain catastrophizing.

Malnutrition and its determinants among older adults living in foster families in Guadeloupe (French West Indies). A cross-sectional study.

BACKGROUND: Foster families may represent an alternative model for dependent older adults in many countries where nursing homes are insufficiently developed. This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in foster families in Guadeloupe (French West Indies). METHODS: This cross-sectional study was gathered from the KASAF (Karukera Study of Ageing in Foster families) study (n = 107, 41M/66F, Mdn 81.8 years). Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies- Depression (CESD) and Questionnaire Quality of Life Alzheimer's Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted for age and gender were performed to test the association of nutritional status with socio-demographic variables and geriatric scales. RESULTS: Thirty (28.0%) older adults were malnourished (MNA-SF score ≤7). In bivariate analysis, malnutrition was associated with an increased prevalence of cardiovascular diseases (46.7% versus 19.5%, p = 0.004), the presence of hemiplegia (30.0% versus 6.5%, p = 0.003), a poorer cognitive status (MMSE score 4.7 ± 7.1versus 9.7 ± 10.7; p = 0.031), higher risk of depression (CESD score 27.3 ± 23.0 versus 13.5 ± 14.4; p = 0.035) and dependency (ADL score 1.9 ± 1.9 versus 2.3 ± 2.1; p<0.001). Malnutrition was also associated with lower caregivers'rating of QoL (QoL-AD score 21.8 ± 6.4 versus 26.0 ± 5.7; p = 0.001) but not by older adult's rating (24.1 ± 11.2 versus 28.3 ± 7.7; p = 0.156). Similar associations were observed in logistic models adjusted for age and gender. CONCLUSION: Malnutrition was common among foster families for older adults. Special attention towards the prevention and treatment of malnutrition in older adults from cardiovascular diseases, cognitive impairment, dependency and depression is necessary in this model of dependency support.

Nutritional impairment, psychological health and quality of life among older adults with advanced cancer: A secondary analysis of a randomized clinical trial.

BACKGROUND: Nutritional impairment is associated with treatment toxicity and worse overall survival in patients with cancer. We aimed to (1) evaluate the association of nutritional impairment with psychological health and quality of life (QOL) and (2) examine which measures of nutrition had the strongest association with psychological health and QOL among older adults receiving cancer treatment with palliative intent. METHODS: This secondary analysis was performed on baseline data from a nationwide cluster randomized clinical trial (ClinicalTrials.gov identifier: NCT02107443; PI: Mohile). Adults age ≥70 with advanced cancer and ≥1 geriatric assessment (GA) impairment were enrolled from 2014 to 2017. In line with geriatric oncology standards, we defined nutritional impairment as Mini Nutritional Assessment Short Form (MNA-SF) ≤11, body mass index (BMI) <21 kg/m2, or >10% involuntary weight loss in the past 6 months. We conducted multivariable linear regressions to evaluate the association of nutritional impairment with each measure of psychological health and QOL: Geriatric Depression Scale (GDS-15, range 0-15), Generalized Anxiety Disorder-7 (GAD-7, range 0-21), NCCN Distress Thermometer (NCCN DT, range 0-10), and Functional Assessment of Cancer Therapy-General (FACT-G, range 0-108). Analyses were adjusted for patient demographics, clinical characteristics, and GA. RESULTS: Among 541 patients, the mean age was 77 (range 70-96) and 60% had nutritional impairment. Mean baseline scores: GDS-15 3.1 (SD 2.7), GAD-7 2.9 (SD 4.0), NCCN DT 2.9 (SD 2.7), and FACT-G 80 (SD 15). In the adjusted model, compared to those with no nutritional impairment, older adults with nutritional impairment had greater depression (ß = 0.79, 95% CI 0.36-1.23) and anxiety severity (ß = 0.86, 95% CI 0.19-1.53), and worse QOL (ß = -6.31, 95% CI -8.62 to -4.00). Of the measures of nutrition, MNA-SF ≤11 demonstrated the strongest associations with depression, anxiety, distress, and QOL. CONCLUSION: Nutritional impairment is associated with impaired psychological health and worse QOL. Clinicians should use the MNA-SF to screen older adults for nutritional impairment and offer tailored supportive interventions.

The relationship between malnutrition and neutrophil-to-lymphocyte ratio in hospitalized older patient.

OBJECTIVES: Aging is characterized by appetite loss and cachexia, i.e., factors that contribute to malnutrition. An inflammation marker, neutrophil-to-lymphocyte ratio (NLR), is a significant prognostic predictor of many geriatric syndromes. We aim to determine the association between NLR and malnutrition. METHODS: We designed a retrospective study on hospitalized patients in the geriatric unit of a university hospital between January 2019 and January 2021. Demographic data, chronic diseases, history of smoking, length of hospital stay, number of drugs, laboratory and further examinations, and comprehensive geriatric assessment scores were recorded from the hospital data system. The nutritional status of the patients was evaluated using the mini-nutritional assessment (MNA) questionnaire. RESULTS: Of the 220 patients, 121 (55 %) were female, and the mean age was 77.9 ± 7.3 years. According to the MNA, 60 % (n = 132) were malnourished or at risk of malnutrition. As many as 47.3 % (n = 104) of the patients had depressive symptoms, and 41.4 % (n = 91) were cognitively impaired. The mean age (79.3 ± 7.3), NLR, and GDS scores were significantly higher, and MMSE scores were significantly lower in malnourished patients or in those at risk of malnutrition as compared to patients with normal nutritional status. We showed that NLR (OR: 1.248; 95% CI: 1.066‒1.461; p = 0.006), age (OR: 1.056; 95% CI: 1.005‒1.109; p = 0.031), depressive symptoms (OR: 1.225; 95% CI: 1.096‒1.369; p 4.5, with a sensitivity of 37.9 %, specificity of 85.2 %, negative predictive value of 47.8 %, and positive predictive value of 79.4 %. CONCLUSION: NLR, age, depressive symptoms, and cognitive impairment were independently associated risk factors for malnutrition. NLR may be a useful nutritional marker for evaluating the nutritional status of hospitalized geriatric patients (Tab. 4, Fig. 1, Ref. 28). Text in PDF www.elis.sk Keywords: malnutrition, neutrophil-to-lymphocyte ratio, geriatric syndromes, inpatient, older adults.

Analysis of the Relationship among Cognitive Impairment, Nutritional Indexes and the Clinical Course among COVID-19 Patients Discharged from Hospital-Preliminary Report.

Numerous data indicate the presence of cognitive impairment in people who have undergone COVID-19, often called COVID Fog (CF). This phenomenon persists even 6 months after infection, and its etiology and pathogenesis are not fully known. The aim of this article was to analyze the relationship among cognitive functioning, clinical data and nutrition indexes in patients discharged from the COVID-19 hospital of the Military Institute of Medicine, Warsaw, Poland. The sample comprised 17 individuals-10 women and 7 men, with ages of 65 ± 14 years. Cognitive impairment was measured with the use of the Montreal Cognitive Assessment (MoCA). The nutrition parameters included: hemoglobin, red blood cells, total cholesterol and its fractions, triglycerides, total protein, albumin, urea, creatinine, phosphates, calcium and sodium. The analysis showed that albumin concentration significantly correlated with the total MoCA score and especially with the short-term memory test score. Conversely, total cholesterol, and especially LDL concentrations, were highly and negatively associated with the MoCA score. In conclusion: markers of nutritional status are correlated with the severity of CF. Individuals with malnutrition or risk of malnutrition should be screened for CF. Further studies need to be performed in this area.

Relationship between Eating Alone and Poor Appetite Using the Simplified Nutritional Appetite Questionnaire.

One prominent factor associated with malnutrition is poor appetite. In Japan, the number of older adults living alone has increased annually. Those living alone tended to eat alone, which may lead to poor appetite. This study aimed to investigate the association between eating alone and poor appetite using an index called the Simplified Nutritional Appetite Questionnaire (SNAQ). We surveyed 818 people aged 70 and over in Takashimadaira, Itabashi-ku, Tokyo, Japan, in 2016. Comparisons were made between two groups, a poor appetite group (n = 295) and a good appetite group (n = 523), and results indicate that the poor appetite group had a higher rate of eating alone than the good appetite group (38.0% vs. 20. 1%: p < 0.001). Multivariable logistic regression (OR; 95%CI) was performed and poor appetite was significantly associated with the Geriatric Depression Scale (GDS) score (1.707; 1.200-2.427), the number of medications (1.061; 1.007-1.118), JST score (0.894; 0.841-0.950), the indication of "very healthy" on a self-rated health scale (0.343; 0.152-0.774), and reports of eating alone (1.751; 1.130-2.712). Our results suggest that eating alone is associated with a poor appetite.

Impaired social cognition caused by perinatal protein malnutrition evokes neurodevelopmental disorder symptoms and is intergenerationally transmitted.

Nutritional inadequacy before birth and during postnatal life can seriously interfere with brain development and lead to persistent deficits in learning and behavior. In this work, we asked if protein malnutrition affects domains of social cognition and if these phenotypes can be transmitted to the next generation. Female mice were fed with a normal or hypoproteic diet during pregnancy and lactation. After weaning, offspring were fed with a standard chow. Social interaction, social recognition memory, and dominance were evaluated in both sexes of F1 offspring and in the subsequent F2 generation. Glucose metabolism in the whole brain was analyzed through preclinical positron emission tomography. Genome-wide transcriptional analysis was performed in the medial prefrontal cortex followed by gene-ontology enrichment analysis. Compared with control animals, malnourished mice exhibited a deficit in social motivation and recognition memory and displayed a dominant phenotype. These altered behaviors, except for dominance, were transmitted to the next generation. Positron emission tomography analysis revealed lower glucose metabolism in the medial prefrontal cortex of F1 malnourished offspring. This brain region showed genome-wide transcriptional dysregulation, including 21 transcripts that overlapped with autism-associated genes. Our study cannot exclude that the lower maternal care provided by mothers exposed to a low-protein diet caused an additional impact on social cognition. Our results showed that maternal protein malnutrition dysregulates gene expression in the medial prefrontal cortex, promoting altered offspring behavior that was intergenerationally transmitted. These results support the hypothesis that early nutritional deficiency represents a risk factor for the emergence of symptoms associated with neurodevelopmental disorders.

Cognitive Frailty in Thai Community-Dwelling Elderly: Prevalence and Its Association with Malnutrition.

Cognitive frailty (CF) is defined by the coexistence of physical frailty and mild cognitive impairment. Malnutrition is an underlying factor of age-related conditions including physical frailty. However, the evidence associating malnutrition and cognitive frailty is limited. This cross-sectional study aimed to determine the association between malnutrition and CF in the elderly. A total of 373 participants aged 65-84 years were enrolled after excluding those who were suspected to have dementia and depression. Then, 61 CF and 45 normal participants were randomly selected to measure serum prealbumin level. Cognitive function was assessed using the Montreal Cognitive Assessment-Basic (MoCA-B). Modified Fried's criteria were used to define physical frailty. Nutritional status was evaluated by the Mini Nutritional Assessment-short form (MNA-SF), serum prealbumin, and anthropometric measurements. The prevalence of CF was 28.72%. Malnourished status by MNA-SF category (aOR = 2.81, 95%CI: 1.18-6.67) and MNA-SF score (aOR = 0.84, 95%CI = 0.74-0.94) were independently associated with CF. However, there was no correlation between CF and malnutrition assessed by serum prealbumin level and anthropometric measurements. Other independent risk factors of CF were advanced age (aOR = 1.06, 95%CI: 1.02-1.11) and educational level below high school (aOR = 6.77, 95%CI: 1.99-23.01). Malnutrition was associated with CF among Thai elderly. High-risk groups who are old and poorly educated should receive early screening and nutritional interventions.

Caregiving for a Spouse with Cognitive Impairment: Effects on Nutrition and Other Lifestyle Factors.

BACKGROUND: Being a spousal caregiver (SCG) for a patient with cognitive impairment is well known to be associated with increased risk for dementia and cognitive decline. OBJECTIVE: This study examined the impact of the care-recipient's cognitive status on lifestyle factors influencing cognitive decline in SCGs, focusing on nutritional status and blood biomarkers. METHODS: Fifty-one SCGs participated (mean age 73.5±7.0 years) in this study. All participants underwent clinical assessment including the Mini Nutritional Assessment (MNA), Geriatric Depression Scale, Pittsburgh Sleep Quality Index, and International Physical Activity Questionnaire to evaluate lifestyle factors, and the Mini-Mental State Examination to assess global cognition. Also, nutritional blood biomarkers were measured. RESULTS: SCGs caring for a demented spouse showed significantly higher depression scores (t = -3.608, p = 0.001) and malnutrition risk (t = 2.894, p = 0.006) compared to those caring for a non-demented spouse. Decreased care recipients' cognition was significantly correlated with higher GDS (ß= -0.593, t = -4.471, p < 0.001) and higher MNA scores (ß= 0.315, t = 2.225, p = 0.031) and lower level of high-density lipoprotein (HDL) cholesterol (ß= 0.383, t = 2.613, p = 0.012) in their SCGs. Gender had moderating effects on association of care-recipients' cognition with sleep quality (B[SE] = 0.400[0.189], p = 0.041) and HDL cholesterol (B[SE] = -1.137[0.500], p = 0.028) among SCGs. Poorer care-recipient's cognition was associated with worse sleep quality and low HDL cholesterol among wives but not husband caregivers. CONCLUSION: This study provides substantial evidence that SCGs are at risk for depression and malnutrition, which can further affect cognitive decline. As such, these factors should be well assessed and monitored among SCGs for patient with cognitive impairment.

The Perception of Vitamins and Their Prevalence in Fortified Food and Supplements in Japan.

Most vitamins are primarily ingested from foods. However, it has been reported that intakes of some vitamins do not meet the nutrition reference values even in high-income countries. In this case, vitamin-fortified foods and/or vitamin supplements are helpful to fix insufficient/deficient status. However, it is not clear whether consumers are aware of their nutritional status or whether they use these products efficiently. To address this issue, we conducted an online cross-sectional questionnaire survey among 14,741 Japanese adults (over 20 years old, 7489 males and 7252 females) concerning the perceptions and prevalence of vitamin-fortified food and/or vitamin supplements. Differences in distribution among groups were compared using the chi-squared test. According to dietary habits, 33.2% of the participants consumed a well-balanced diet every day, but 25.5% could not because of time (41.6%) or money (36.9%) constraints. The perception of each vitamin varied: the highest was for vitamin C (93.2%) and the lowest was for biotin (41.9%). In addition, only a portion of the participants believed that they took sufficient amounts of each vitamin; the highest was vitamin C (22.3%) and the lowest was biotin (5.2%). Despite this situation, most did not use vitamin-fortified food and/or vitamin supplements due to economic reasons. Among vitamin-fortified food and/or vitamin supplement users, the purposes for the usage of these products were varied, such as maintaining health (80.5%), supplementation of nutrients (47.8%), beauty-related purposes (27.5%), and to prevent infectious disease (23.2%). To remedy nutritional status in individuals, it is important to improve not only consumer awareness but also the environment, which can lead consumers to use acceptable vitamin products without any burden.

Nutritional Status and Adverse Outcomes in Older Depressed Inpatients: A Prospective Study.

OBJECTIVES: Significant weight loss and/or loss of appetite is a criterion of a depressive episode. While malnutrition is associated with many adverse health outcomes, the impact of malnutrition in late-life depression has hardly been examined. The present study aims to (1) evaluate the prevalence of malnutrition in depressed older inpatients, and (2) whether and which indices of malnutrition predict adverse health outcomes in late-life depression. DESIGN: A prospective study at 6 months follow-up. SETTING: A University-based psychiatric hospital. PARTICIPANTS: 105 older adults (psychiatric inpatients suffering from unipolar MDD). MEASUREMENTS: Participants were evaluated according the Mini Nutritional Assessment (MNA) and anthropometric measures to assess their nutritional status. Multiple regression analyses were used to evaluate the association between the MNA score as well as anthropometric measures with either falls or rehospitalization for any reason. RESULTS: Based on the MNA score, 78 (74.3%) patients were at risk of malnutrition and 13 (12.4%) actually presented malnutrition. Malnutrition was associated with a higher age, frailty, lower body mass index, and smaller calf circumference. During follow-up, 21 (20%) patients fell, 27 (25.7%) were rehospitalized, and 3 died (2.9%). The MNA score was associated with adverse health outcomes, but a low calf circumference predicted falling (OR 4.93 [95% CI: 1.42-17.2], p=.012) and a higher calf circumference rehospitalization (OR 1.17 [95% CI: 1.01-1.35], p=.032). CONCLUSION: Malnutrition is prevalent in older depressed inpatients. In contrast to subjective proxies for malnutrition, which are common in depression, only objective measures of malnutrition predict adverse health outcomes such as falls and rehospitalization.

Evaluation of Malnutrition and Quality of Life in Patients Treated for Oral and Oropharyngeal Cancer.

BACKGROUND: Oral and oropharyngeal cancer is a debilitating disease with high morbidity and mortality. Depending on the site and extent of the involvement of the cancer and the type of treatment modality, these patients can develop pain, trismus, xerostomia, dysphagia, and taste disturbances, compromising them socially and nutritionally. The aim of the study was to evaluate malnutrition and quality of life in patients treated for oral and oropharyngeal cancer. Methodology. A cross-sectional study was conducted which included 97 patients treated for oral and oropharyngeal cancer. The quality of life of the selected patients was assessed by using a validated European Organization for the Research and Treatment of Cancer's Quality of Life Questionnaire, Head and Neck and Mandibular Function Impairment Questionnaire. Pre- and posttreatment weight of the patients were assessed, and weight loss of ≥10% of pretreatment weight was considered as malnutrition. The chi-square test was used to correlate the symptoms with the quality of life. A paired t test was used to assess the differences in weight before and after treatment, and a p value of <0.005 was considered as significant. RESULTS: The most commonly reported symptoms were xerostomia (93.81%), pain (81.44%), and dysphagia (76.3%). A total of 40.2% of the individuals in the study had malnutrition. Malnutrition was comparatively lower in the group who had nutritional supplements. CONCLUSION: The quality of life in patients treated for oral and oropharyngeal cancer deteriorates immediately after the treatment; however, it significantly improves over time.

Development of a Scale to Measure Infant Eating Behaviour Worldwide.

In order to create a short, internationally valid scale to assess eating behaviour (EB) in young children at risk of undernutrition, we refined 15 phrases describing avidity or food refusal (avoidance). In study one, 149 parents matched phrases in English, Urdu, Cantonese, Indonesian or Greek to videos showing avidity and avoidance; 82-100% showed perfect agreement for the avidity phrases and 73-91% for the avoidant phrases. In study two, 575 parents in the UK, Cyprus and Indonesia (healthy) and in Kenya, Pakistan and Guatemala (healthy and undernourished) rated their 6-24 months old children using the same phrases. Internal consistency (Cronbach's α) was high for avidity (0.88) and moderate for avoidance (0.72). The best-performing 11 items were entered into a principal components analysis and the two scales loaded separately onto 2 factors with Eigen values > 1. The avidity score was positively associated with weight (r = 0.15 p = 0.001) and body mass index (BMI) Z scores (r = 0.16 p = 0.001). Both high and low avoidance were associated with lower weight and BMI Z scores. These scales are internationally valid, relate to nutritional status and can be used to inform causes and treatments of undernutrition worldwide.

Malnutrition: A Misunderstood Diagnosis by Primary Care Health Care Professionals and Community-Dwelling Older Adults in Ireland.

BACKGROUND: Language and communication have an impact on how a clinical condition is treated and experienced, from both the health care professional (HCP) and patient perspective. Malnutrition is prevalent among community-dwelling older adults, yet perceptions of patient understanding of the term malnutrition to date remain underexplored. OBJECTIVE: This qualitative study explored the use and perceptions of the term malnutrition among HCPs and older adults at risk of malnutrition. DESIGN: Semi-structured interviews and focus groups were conducted with HCPs and older adults with a prescription for oral nutritional supplements (ONS) in the community, to explore perspectives. PARTICIPANTS AND SETTING: HCPs with experience of working with older adults were recruited in primary care centers, general practitioner practices, community health organizations, and community pharmacies in County Dublin, Ireland, between 2018 and 2019. Older adults, aged ≥60 years, with a current or previous prescription for ONS were recruited from daycare centers. One-to-one interviews were conducted with general practitioners (n = 16) and patients (n = 13), and focus groups were conducted with other HCPs, including dietitians (n = 22), nurses (n = 22), pharmacists (n = 9), physiotherapists (n = 12), occupational therapists (n = 6), and speech and language therapists (n = 4). DATA ANALYSIS: Data from interviews and focus groups were transcribed verbatim and analyzed using thematic analysis. RESULTS: There was mutual agreement between HCPs and patients on the main theme, "malnutrition is a term to be avoided." There were three subthemes with varying input from the different HCP groups and patients: "Malnutrition is a term a patient doesn't want to hear"-malnutrition has negative connotations that imply neglect and stigma; "malnutrition is a clinical term which patients don't understand"-with perceptions that it is better to substitute the term with simpler motivating messages; and "lack of confidence identifying malnutrition"-expressed by non-dietetics HCPs who believed they had insufficient expertise on malnutrition to communicate effectively with patients. CONCLUSIONS: HCPs and patients perceived negative connotations with the term malnutrition, and HCPs used alternatives in practice. Additional consultation with HCPs and patients is recommended to explore appropriate language for conveying health risks associated with malnutrition. Future research should also address how current communication challenges can be addressed as part of strategic management programs or interventions to prevent and treat malnutrition.

Role of nutritional care and general guidance for patients with advanced or metastatic gastric cancer.

Patients with advanced or metastatic gastric cancer often suffer from malnutrition, which can have an impact on quality of life, increase the toxicity of chemotherapy and reduce overall survival. Options available to the clinician to manage a patient's nutritional status include screening and assessment of malnutrition at diagnosis, monitoring during the 'cancer journey', early detection of precachexia and the ongoing use of a multidisciplinary team (oncologists, other medical specialists and nutritionists). Because malnutrition is frequently overlooked and under treated in patients with advanced or metastatic gastric cancer, this narrative review focuses on the clinical meaning of nutritional status in gastric cancer and provides general guidance regarding nutritional care management for patients with advanced or metastatic gastric cancer.

Lay abstract Patients with gastric cancer that has spread to other parts of the body often suffer from malnutrition. This can impact patients' lives, increase side effects from cancer treatment and reduce life expectancy. This article provides guidance for healthcare providers on nutritional care for patients with gastric cancer. Key ways healthcare providers can contribute to nutritional care include: looking for malnutrition when a patient is diagnosed with gastric cancer; watching carefully for malnutrition during cancer treatment; keeping a lookout for early signs of extreme weight loss and muscle wasting; and involving a team of healthcare providers with a broad range of expertise in patients' nutritional care.

ALTERTASTE: improving food pleasure and intake of oncology patients receiving chemotherapy.

ALTERTASTE is a prospective study to evaluate changes in taste/flavor perception and food preferences in patients treated with adjuvant or neoadjuvant chemotherapy for breast or colorectal cancer. The study adopts a longitudinal approach. Taste and odor responsiveness, food preferences and habits, emotions elicited by foods, and quality of life will be measured at six-time points: before chemotherapy (T0), after two cycles (T1, after around 1 month), after four cycles (T2, after around 2 months), after six cycles (T3, after around 4 months), at the end of chemotherapy (T4, after around 6 months) and 3 months after the conclusion of the therapy (T5). In addition, patients will be characterized for oral responsiveness and their psychological traits and attitudes toward food. The ALTERTASTE trial is expected to improve the understanding of the impact of chemotherapy on taste and smell and the repercussions of these alterations on food behaviors. Furthermore, the trial aims to develop an easy and reliable procedure to test smell, taste and food behavior alterations to allow a routine measure with patients. Clinical trial registration: NCT04495387 (ClinicalTrials.gov).

Lay abstract Malnutrition (under- or over-nutrition) is highly prevalent in cancer patients receiving chemotherapy and is an important predictor of morbidity, mortality, treatment response and toxicity. Alterations in taste and smell are frequently reported as side effects of chemotherapy and may contribute strongly to malnutrition through an impact on eating behaviors and to a worse quality of life. ALTERTASTE is a prospective longitudinal study to evaluate changes in taste/flavor perception and food preferences in patients treated with chemotherapy for breast, colon or rectal cancer. Taste and odor responsiveness, food preferences and habits, emotions elicited by foods, and quality of life will be measured at six-time points: before chemotherapy (T0), after two cycles (T1, after around 1 month), after four cycles (T2, after around 2 months), after six cycles (T3, after around 4 months), at the end of chemotherapy (T4, after around 6 months) and 3 months after the conclusion of the therapy (T5). In addition, patients will be characterized for oral responsiveness and psychological traits and attitudes toward food. The ALTERTASTE trial is expected to improve the understanding of the impact of chemotherapy on taste and smell and the repercussions of these alterations on food behaviors.

Association between Malnutrition and Quality of Life in Elderly Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a progressive articular disease. In addition to damaging the joints, it may cause multiple organ complications, and considerably impair the patient's functioning. Elderly patients with RA report pain, fatigue, mood disorders, sleep disorders and insomnia, accompanied by weakness, poor appetite, and weight loss. All these factors combined have an adverse effect on the patient's perceived quality of life (QoL). Due to the chronic nature of RA and the high risk of malnutrition in this patient group, the present study investigated QoL, activities of daily living, and frailty syndrome severity in relation to MNA (Mini Nutritional Assessment) questionnaire scores among elderly RA patients. The study included 98 patients (aged over 60) diagnosed with RA per the ARA (American Rheumatism Association) criteria. The following standardized instruments were used: WHOQoL-BREF for QoL, the Edmonton Frail Scale for frailty syndrome severity, MNA for nutritional status assessment, and MMSE (Mini-Mental State Examination) to assess any cognitive impairment. Medical data were obtained from hospital records. Patients with a different nutritional status differed significantly in terms of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Higher levels of malnutrition were associated with greater limitations in activity. An adverse impact of lower body weight on cognitive function was also observed (dementia was identified in 33.33% of malnourished patients vs. 1.79% in patients with a normal body weight). Likewise, frailty was more common in malnourished patients (mild frailty syndrome in 33.3%, moderate in 16.67%, and severe in 16.67%). Malnourished patients had significantly lower QoL scores in all WHOQoL-BREF questionnaire domains than those with a normal body weight, and multiple-factor analysis for the impact of selected variables on QoL in each domain demonstrated that frailty was a significant independent determinant of poorer QoL in all domains: perceived quality of life (ß = -0.069), perceived health (ß = -0.172), physical domain (ß = -0.425), psychological domain (ß = -0.432), social domain (ß = -0.415), environmental domain (ß = -0.317). Malnutrition was a significant independent determinant of QoL in the "perceived health" domain (ß = -0.08). In addition, regression analysis demonstrated the positive impact of male sex on QoL scores in the psychological (ß = 1.414) and environmental domains (ß = 1.123). Malnourished patients have a lower QoL than those with a normal body weight. Malnutrition adversely affects daily functioning, cognitive function, and the severity of frailty syndrome. Frailty syndrome is a significant independent determinant of poorer QoL in all WHOQoL BREF domains.

Nutrition, Cognition, and Social Emotion among Preschoolers in Poor, Rural Areas of South Central China: Status and Correlates.

Existing empirical evidence suggests that the prevalence of undernutrition in remote and poor, rural areas is still high among Chinese children. While evidence reveals that undernutrition may detrimentally affect child development, studies focusing on rural Chinese preschoolers are sparse. Using the baseline survey of a preschool's free nutritious lunch pilot program, this study examined the relationship between child undernutrition and developmental outcomes among a preschool-aged sample in poor, rural areas of China. We conducted the baseline survey in Hunan province in south central China in September 2018. A total of 1293 preschoolers living in two (then) nationally designated poverty counties in rural Hunan served as our study sample. Children's nutritional statuses were measured using height-for-age z-score, weight-for-age z-score, and anemia, while their cognitive and socio-emotional skills were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and Strengths and Difficulties Questionnaire (SDQ), respectively. We find that 33% of sample preschoolers were anemic, whereas the incidences of stunting and wasting were 11% and 2%, respectively. About 54% of the sample children had delay in at least one of the developmental domains measured in this study. Our findings provide suggestive evidence supporting that children from certain backgrounds tend to experience worse nutritional and developmental outcomes than their counterparts. After controlling for socioeconomic status, we observed that both anemia and stunting were negatively associated with children's cognitive performance; however, they were not associated with socio-emotional performance. As such, this study suggests that free lunch programs have the potential to change children's developmental trajectory in preschool. We believe that our results will contribute to the debate surrounding whether the nutritious lunch program in China should be expanded to the preschool education level.

A poorer nutritional status impacts quality of life in a sample population of elderly cancer patients.

RATIONALE: Quality of Life (QoL) is impaired in cancer, and the elderly are particularly vulnerable to malnutrition. A diagnosis of cancer in elderly patients further exacerbates risks of negative health outcomes. Here we investigated associations between QoL and nutritional status in a sample population of mostly socially deprived elderly cancer patients. METHOD: 432 cancer patients were recruited for this cross-sectional study at point of admission to a tertiary referral hospital for cancer treatment. Patient-generated subjective global assessment (PG-SGA) assessed nutritional status. Functional assessment of cancer therapy- general (FACT-G) quantified QoL. Relationship between PG-SGA and QoL was assessed by Spearman correlation. PG-SGA outcomes were compared against FACT-G scores employing Mann-Whitney test. Bivariate Linear Regression Model was employed to investigate influences of sociodemographic, clinical and nutritional status upon QoL. RESULTS: 37.5% of participants were malnourished or at risk. 39% were illiterate and 54.6% had family income lower than minimum wage. Malnourished patients showed lower FACT-G scores (76.8 vs. 84.7; p = 0.000). Poor nutritional diagnosis was inversely correlated with all QoL domains. Bivariate regression analysis showed that lower PG-SGA scores (ßo = - 1.00; p = 0.000) contributed to FACT-G score deterioration, the male gender showed better QoL scores, and other clinical and sociodemographic variables did not show relationship. CONCLUSION: Poorer nutritional status was significantly associated with worsened physical, social, emotional and functional well-being QoL domains in elderly cancer patients. Poorer nutritional status is an independent risk factor for worsened QoL. Future policies aimed at particularly vulnerable populations may improve QoL and health outcomes.