ABSTRACT
Cachexia increases the risk of therapeutic failure and reduces the quality of life for cancer patients. Patients with nutritional risks should be referred to a dietitian. Nutritional interventions primarily include meal adaptation and oral nutritional supplements. When cachexia is more severe, artificial nutrition is indicated for patients with a KPS (Karnofsky Performance Status) of 40 or above and a life expectancy of more than 6 weeks. When the digestive system is functional, enteral nutrition is recommended. Parenteral nutrition shows the same benefits but requires close monitoring. The decision to stop artificial nutrition is influenced by the medical condition, the patient's wishes, and the socio-cultural context.
La cachexie augmente le risque d'échec thérapeutique et diminue la qualité de vie des patients atteints de cancer. Ceux présentant un risque nutritionnel doivent être adressés à un diététicien. Les interventions nutritionnelles comprennent en premier lieu l'adaptation des repas et les suppléments nutritionnels oraux. Lorsque la cachexie est plus sévère, une nutrition artificielle est indiquée chez les patients avec un score de performance de Karnofsky (KPS) égal ou supérieur à 40 et une espérance de vie de plus de 6 semaines. Quand le système digestif est fonctionnel, la nutrition entérale est recommandée. La nutrition parentérale montre les mêmes bénéfices mais nécessite une surveillance étroite. La décision de stopper la nutrition artificielle est influencée par la condition médicale, les souhaits du patient et le contexte socioculturel.
Subject(s)
Cachexia , Neoplasms , Humans , Cachexia/etiology , Cachexia/therapy , Quality of Life , Nutritional Support , Enteral Nutrition , Neoplasms/complications , Neoplasms/therapy , Nutritional StatusABSTRACT
BACKGROUND: Motor neuron disease (MND) invariably impacts on inspiratory muscle strength leading to respiratory failure. Regular assessment of sniff nasal inspiratory pressure (SNIP) and/or maximal mouth inspiratory pressure (MIP) contributes to early detection of a requirement for ventilatory support. OBJECTIVES: The aim of this study was to compare the feasibility, agreement, and performance of both tests in MND. METHODS: Patients with MND followed by a multidisciplinary consultation were prospectively included. Pulmonary follow-up included forced expiratory volumes, vital capacity (VC) seated and supine, MIP, SNIP, pulse oximetry, and daytime arterial blood gases. RESULTS: A total of 61 patients were included. SNIP and MIP could not be performed in 14 (21%) subjects; 74% of the subjects showed a decrease in MIP or SNIP at inclusion versus 31% for VC. Correlation between MIP and SNIP (Pearson's rho: 0.68, p < 0.001) was moderate, with a non-significant bias in favor of SNIP (3.6 cm H2O) and wide limits of agreement (-34 to 41 cm H2O). Results were similar in "bulbar" versus "non-bulbar" patients. At different proposed cut-off values for identifying patients at risk of respiratory failure, the agreement between MIP and SNIP (64-79%) and kappa values (0.29-0.53) was moderate. CONCLUSIONS: MIP and SNIP were equally feasible. There was no significant bias in favor of either test, but a considerable disparity in results between tests, suggesting that use of both tests is warranted to screen for early detection of patients at risk of respiratory failure and avoid over diagnoses. SNIP, MIP, and VC all follow a relatively linear downhill course with a steeper slope for "bulbar" versus "non-bulbar" patients.
Subject(s)
Amyotrophic Lateral Sclerosis/physiopathology , Maximal Respiratory Pressures/methods , Muscle Weakness/diagnosis , Respiratory Muscles/physiopathology , Aged , Aged, 80 and over , Amyotrophic Lateral Sclerosis/complications , Blood Gas Analysis , Dyspnea/etiology , Dyspnea/physiopathology , Dyspnea/therapy , Female , Forced Expiratory Volume , Humans , Inhalation , Male , Middle Aged , Muscle Strength , Muscle Weakness/etiology , Muscle Weakness/physiopathology , Muscle Weakness/therapy , Noninvasive Ventilation , Peak Expiratory Flow Rate , Respiratory Function Tests/methods , Vital CapacityABSTRACT
Epidemiological studies have shown that vitamin or trace-element deficiencies are frequent in the general population. Food intake can be incriminated, but various drugs may also precipitate micronutrient deficits. Indeed, the consequences of pharmacotherapy on micronutrients are yet modestly explored in clinical practice settings. We aim at sensitizing physicians on the impact of frequently used drugs on vitamins and trace-elements. High risk populations for micronutrient deficiencies and indications for substitution are discussed.
