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1.
Biomed Environ Sci ; 34(5): 337-347, 2021 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-34059170

RESUMEN

Objective: Nutrition is closely related to the health of the elderly population. This study aimed to provide a comprehensive picture of the nutrition status of elderly Chinese and its related dietary, geographical, and socioeconomic factors. Methods: A total of 13,987 ≥ 60-year-old persons from the 2010-2013 Chinese National Nutrition and Health Survey were included to evaluate various aspects of malnutrition, including underweight, overweight or obesity, and micronutrient inadequacy. Results: Overall, the prevalence of obesity, overweight, and underweight was 12.4%, 34.8%, and 5.7%, respectively, with disparities both geographically and socioeconomically. The prevalence of underweight was higher among the older old (≥ 75 years), rural residents and those with low income, with low education status, and residing in undeveloped West areas. More than 75% of the elderly do not meet the Dietary Reference Intakes for vitamins A, B 1, B 2, and E, folate, calcium, selenium, potassium, biotin, and choline, with the prevalence of inadequate intake increasing with age for most nutrients. At the population level, the mean intakes of numerous food groups did not meet the recommendations by the Chinese Dietary Guideline. Conclusions: Obesity epidemic, inadequacy of micronutrient intake, and high prevalence of underweight and anemia in susceptible older people are the major nutrition challenges for the rapidly aging population in China.


Asunto(s)
Desnutrición/epidemiología , Sobrepeso/epidemiología , Delgadez/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Dieta/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Desnutrición/diagnóstico , Desnutrición/etiología , Micronutrientes/deficiencia , Persona de Mediana Edad , Estado Nutricional , Sobrepeso/diagnóstico , Sobrepeso/etiología , Factores de Riesgo , Factores Socioeconómicos , Delgadez/diagnóstico , Delgadez/etiología
2.
Hu Li Za Zhi ; 68(3): 7-14, 2021 Jun.
Artículo en Chino | MEDLINE | ID: mdl-34013500

RESUMEN

The gastrointestinal dysfunction and nutrient malabsorption associated with gastrointestinal tumors and related treatments may result in malnutrition in gastrointestinal (GI) cancer patients. Malnutrition has been associated with decreased treatment tolerance, poor quality of life, and increased mortality in this patient population. In this article, the relevant literature is reviewed and the factors, assessment tools, and management strategies related to malnutrition are summarized. In clinical care, healthcare providers should conduct early assessments of nutritional status and provide individualization nutritional counselling to promote treatment that effectively prolongs patient survival. This article may be used by nurses as a reference in caring for GI cancer patients.


Asunto(s)
Neoplasias Gastrointestinales , Desnutrición , Neoplasias Gastrointestinales/terapia , Humanos , Desnutrición/diagnóstico , Desnutrición/etiología , Desnutrición/terapia , Evaluación Nutricional , Estado Nutricional , Calidad de Vida
3.
BMC Geriatr ; 21(1): 319, 2021 05 17.
Artículo en Inglés | MEDLINE | ID: mdl-34001019

RESUMEN

BACKGROUND: Delirium is one of the most common complications in older surgical patients. Although previous studies reported that preoperative malnutrition was related with postoperative delirium (POD), there was lack of evidence to illustrate the relationship between malnutrition and emergency delirium (ED). The objective of this study was to investigate the relationship between preoperative malnutrition and ED in older patients undergoing noncardiac surgery. METHODS: The study was carried out in accordance with STROBE guidelines. This was a secondary analysis of a prospective cohort study. Older patients (65-90 years) who underwent noncardiac surgery under general anesthesia were enrolled in Peking University First Hospital. RESULTS: 915 patients were enrolled. The incidence of malnutrition was 53.6 % (490/915). The incidence of emergency delirium was 41.8 % (205/490) in malnutrition group and 31.5 % (134/425) in control group, P < 0.001. After adjusting confounding factors (i.e., age, cognitive impairment, American Society of Anesthesiologists classification (ASA), duration of surgery, pain score, low body temperature and allogeneic blood transfusion), malnutrition was not associated with increased risk of emergency delirium (OR = 1.055, 95 % CI 0.767-1.452, P = 0.742). CONCLUSIONS: Malnutrition was common in older patients undergoing non-cardiac surgery, but it's not related with emergence delirium after adjusted for confounders. TRIAL REGISTRATION: Chinese Clinical Trial Registry ( http://www.chictr.org.cn ) ( ChiCTR-OOC-17,012,734 ).


Asunto(s)
Delirio del Despertar , Desnutrición , Anciano , Anciano de 80 o más Años , Delirio del Despertar/diagnóstico , Delirio del Despertar/epidemiología , Humanos , Desnutrición/diagnóstico , Desnutrición/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Factores de Riesgo
4.
Clin Nutr ESPEN ; 43: 377-382, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34024543

RESUMEN

BACKGROUND AND AIM: We conducted the present study to investigate the nutritional status of critically ill COVID-19 patients and validate the GLIM criteria with respect to the SGA. METHODS: In this prospective cohort study, 109 ICU patients were assessed for malnutrition based on GLIM and SGA criteria. The relation between nutrition assessment tools and duration of hospitalization and mortality were also evaluated. The sensitivity and specificity of GLIM criteria concerning the detection of malnutrition was assessed based on the area under the curve. RESULTS: Malnutrition, according to the SGA and GLIM criteria, was found in 68 (62.4%) and 66 (61.5%) of our subjects. There was an optimal agreement between the GLIM criteria and the SGA criteria regarding malnutrition diagnosis (K = 0.85, P < 0.001). The area under curve for the GLIM was stratified based on the SGA results and was 0.927 (95% CI: 0.868-0.985) with a sensitivity and specificity of 92% and 93%, respectively. CONCLUSION: Malnutrition is frequently observed in critically ill COVID-19 patients. GLIM criteria is a valid tool and has a strong association with mortality and longer duration of ICU stay.


Asunto(s)
Enfermedad Crítica , Desnutrición/diagnóstico , Evaluación Nutricional , Estado Nutricional , Adulto , Anciano , Antropometría/métodos , Área Bajo la Curva , Índice de Masa Corporal , Femenino , Salud Global , Humanos , Liderazgo , Masculino , Desnutrición/complicaciones , Persona de Mediana Edad , Atrofia Muscular , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Pérdida de Peso
6.
BMC Infect Dis ; 21(1): 313, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794788

RESUMEN

BACKGROUND: Currently, the association of nutritional risk screening score with the development of nonventilator hospital-acquired pneumonia (NV-HAP) is unknown. This study investigated whether nutritional risk screening score is an independent predictor of NV-HAP. METHODS: This retrospective cohort study was conducted between September 2017 and June 2020 in a tertiary hospital in China. The tool of Nutritional Risk Screening 2002 (NRS-2002) was used for nutritional risk screening. A total score of ≥3 indicated a patient was "at nutritional risk." Logistic regression was applied to explore the association between the NRS score and NV-HAP. RESULTS: A total of 67,280 unique patients were included in the study. The incidence of NV-HAP in the cohort for the NRS < 3 and ≥ 3 NRS group was 0.4% (232/62702) and 2.6% (121/4578), respectively. In a multivariable logistic regression model adjusted for all of the covariates, per 1-point increase in the NRS score was associated with a 30% higher risk of NV-HAP (OR = 1.30; 95%CI:1.19-1.43). Similarly, patients with NRS score ≥ 3 had a higher risk of NV-HAP with an odds ratio (OR) of 2.06 (confidence interval (CI): 1.58-2.70) than those with NRS score < 3. Subgroup analyses indicated that the association between the NRS score and the risk of NV-HAP was similar for most strata. Furthermore, the interaction analyses revealed no interactive role in the association between NRS score and NV-HAP. CONCLUSION: NRS score is an independent predictor of NV-HAP, irrespective of the patient's characteristics. NRS-2002 has the potential as a convenient tool for risk stratification of adult hospitalized patients with different NV-HAP risks.


Asunto(s)
Neumonía Asociada a la Atención Médica/diagnóstico , Desnutrición/diagnóstico , Adulto , Anciano , China/epidemiología , Estudios de Cohortes , Femenino , Neumonía Asociada a la Atención Médica/complicaciones , Neumonía Asociada a la Atención Médica/epidemiología , Humanos , Incidencia , Masculino , Desnutrición/complicaciones , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo , Centros de Atención Terciaria
7.
Rozhl Chir ; 100(2): 60-65, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33910338

RESUMEN

Malnutrition is a significant negative factor for surgical patients in the entire perioperative period. However, this factor can be controlled and is easy to detect in the outpatient setting. Starting from May 1, 2020, surgeons have the possibility to prescribe sipping under certain conditions for a limited period of 4 weeks. Thereby they have become able to strongly impact any altered nutritional status both preoperatively and postoperatively. The authors describe scoring questionnaires used for the detection of malnutrition and required by health insurance companies. Additionally, prescribing conditions and potential mistakes in the outpatient setting are analysed.


Asunto(s)
Desnutrición , Cirujanos , Humanos , Desnutrición/diagnóstico , Desnutrición/terapia , Estado Nutricional , Pacientes Ambulatorios , Encuestas y Cuestionarios
8.
Nutrients ; 13(3)2021 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-33802295

RESUMEN

The early years, between the ages of one and six, are a period of rapid physical, social and cognitive growth and a nutritionally adequate diet is an important factor for optimum development. We investigated the micronutrient adequacy and status of young US children aged 1-6 years (n = 9848) using 24-h dietary recall interviews completed by parents and caregivers participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2016. data. The proportion of the sample not meeting the Dietary Reference Intakes (DRI) increased with increasing age and was most pronounced for calcium. Despite adequate iron intake, 7.4% and 2.5% had signs of iron deficiency and anemia based on serum ferritin and hemoglobin levels, with younger children and WIC participants at most risk and Non-Hispanic Black children the least. Vitamin B6 intake was adequate, but 6.4% had serum pyridoxal-5-phosphate deficiency. For vitamin E, 69% had intakes below the estimated average requirement (EAR), yet serum deficiency was only detected in 0.9%. Vitamin D intake was inadequate for 87%, but true deficiency may be overestimated. Mean DHA intake was 24 mg/d, well below expert recommendations of 70-100 mg/day. Iron and vitamin B6 deficiency and inadequate calcium, fiber, choline, potassium and DHA intakes are a concern for a significant percentage of young children. The discrepancy between nutrient intakes and serum deficiency levels needs to be further investigated.


Asunto(s)
Dieta Saludable/estadística & datos numéricos , Ingestión de Alimentos/fisiología , Desnutrición/epidemiología , Micronutrientes/análisis , Micronutrientes/deficiencia , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Desnutrición/diagnóstico , Desnutrición/etiología , Encuestas Nutricionales , Estado Nutricional , Ingesta Diaria Recomendada , Estados Unidos/epidemiología
9.
Artículo en Inglés | MEDLINE | ID: mdl-33803339

RESUMEN

Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is not clear which nutritional screening measures may best diagnose malnutrition in these patients at early stages. This is of crucial importance given the urgency and rapid progression of the disease in vulnerable groups. Accordingly, this review examines the available literature for different nutritional screening approaches implemented among COVID-19 patients, with a special focus on elderly adults. After a literature search, we selected and scrutinized 14 studies assessing malnutrition among COVID-19 patients. The Nutrition Risk Screening 2002 (NRS-2002) has demonstrated superior sensitivity to other traditional screening measures. The controlling nutritional status (CONUT) score, which comprises serum albumin level, cholesterol level, and lymphocytes count, as well as a combined CONUT-lactate dehydrogenase-C-reactive protein score expressed a predictive capacity even superior to that of NRS-2002 (0.81% and 0.92% vs. 0.79%) in midlife and elder COVID-19 patients. Therefore, simple measures based on routinely conducted laboratory investigations such as the CONUT score may be timely, cheap, and valuable alternatives for identifying COVID-19 patients with high nutritional risk. Mini Nutritional Assessment (MNA) was the only measure used to detect residual malnutrition and high malnutrition risk in remitting patients-MNA scores correlated with hypoalbuminemia, hypercytokinemia, and weight loss. Older males with severe inflammation, gastrointestinal symptoms, and pre-existing comorbidities (diabetes, obesity, or hypertension) are more prone to malnutrition and subsequently poor COVID-19 prognosis both during the acute phase and during convalescence. Thus, they are in need of frequent nutritional monitoring and support while detecting and treating malnutrition in the general public might be necessary to increase resilience against COVID-19.


Asunto(s)
Desnutrición , Adulto , Anciano , Evaluación Geriátrica , Humanos , Masculino , Desnutrición/diagnóstico , Desnutrición/epidemiología , Evaluación Nutricional , Estado Nutricional , Medición de Riesgo
10.
BMC Geriatr ; 21(1): 256, 2021 04 17.
Artículo en Inglés | MEDLINE | ID: mdl-33865312

RESUMEN

BACKGROUND: Readmission is related to high cost, high burden, and high risk for mortality in geriatric patients. A scoring system can be developed to predict the readmission of older inpatients to perform earlier interventions and prevent readmission. METHODS: We followed prospectively inpatients aged 60 years and older for 30 days, with initial comprehensive geriatric assessment (CGA) on admission in a tertiary referral centre. Patients were assessed with CGA tools consisting of FRAIL scale (fatigue, resistance, ambulation, illness, loss of weight), the 15-item Geriatric Depression Scale, Mini Nutritional Assessment short-form (MNA-SF), the Barthel index for activities of daily living (ADL), Charlson Comorbidity Index (CCI), caregiver burden based on 4-item Zarit Burden Index (ZBI), and cognitive problem with Abbreviated Mental Test (AMT). Demographic data, malignancy diagnosis, and number of drugs were also recorded. We excluded data of deceased patients and patients transferred to other hospitals. We conducted stepwise multivariate regression analysis to develop the scoring system. RESULTS: Thirty-day unplanned readmission rate was 37.6 %. Among 266 patients, 64.7 % of them were malnourished, and 46.5 % of them were readmitted. About 24 % were at risk for depression or having depressed mood, and 53.1 % of them were readmitted. In multivariate analysis, nutritional status (OR 2.152, 95 %CI 1.151-4.024), depression status (OR 1.884, 95 %CI 1.071-3.314), malignancy (OR 1.863 95 %CI 1.005-3.451), and functional status (OR 1.584, 95 %CI 0.885-2.835) were included in derivation of 7 score system. The scoring system had maximum score of 7 and incorporated malnutrition (2 points), depression (2 points), malignancy (2 points), and dependent functional status (1 point). A score of 3 or higher suggested 82 % probability of readmission within 30 days following discharge. Area under the curve (AUC) was 0.694 (p = 0.001). CONCLUSIONS: Malnutrition, depression, malignancy and functional problem are predictors for 30-day readmission. A practical CGA-based 7 scoring system had moderate accuracy and strong calibration in predicting 30-day unplanned readmission for older patients.


Asunto(s)
Desnutrición , Readmisión del Paciente , Actividades Cotidianas , Anciano , Depresión/diagnóstico , Depresión/epidemiología , Evaluación Geriátrica , Humanos , Desnutrición/diagnóstico , Desnutrición/epidemiología , Persona de Mediana Edad , Evaluación Nutricional , Estado Nutricional , Estudios Prospectivos , Factores de Riesgo
11.
BMC Geriatr ; 21(1): 265, 2021 04 21.
Artículo en Inglés | MEDLINE | ID: mdl-33882869

RESUMEN

BACKGROUND: Although pressure ulcers, malnutrition, poor oral health and falls are common among older persons, causing deteriorated health status, they have not been studied altogether among older persons receiving different types of municipal health care. The aim of this study was to determine the prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls among older persons aged ≥65 years receiving municipal health care in southern Sweden. METHODS: A retrospective cross-sectional study (n = 12,518 persons aged ≥65 years) using data from the national quality registry Senior Alert was conducted. The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was calculated based on categorical data from the instruments available in Senior Alert. T-tests, chi-square test, the Mantel- Haenszel test and logistic regression models were performed. RESULTS: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was 27.9, 56.3, 34.2 and 74.5% respectively. Almost 90% of the older persons had at least one health risk. The prevalence of risk for pressure ulcers, poor oral health and falls was significantly higher in dementia care units compared to short term nursing care, home health care and nursing homes. The prevalence of risk for malnutrition was significantly higher among older persons staying in short term nursing care compared to other types of housing. The odds of having a risk for malnutrition were higher in short term nursing care compared to other types of housing. The oldest age group of 95-106 years had the highest odds of having a risk for falls. The presence of multiple health risks in one subject were more common in dementia homes compared to nursing homes and home health care but not compared to short term nursing care. CONCLUSION: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was high, implying that these health risks are a great concern for older persons receiving municipal health care. A comprehensive supporting preventive process to prevent all the investigated health risks among older persons receiving municipal health care is recommended.


Asunto(s)
Desnutrición , Úlcera por Presión , Accidentes por Caídas , Anciano , Anciano de 80 o más Años , Estudios Transversales , Atención a la Salud , Humanos , Desnutrición/diagnóstico , Desnutrición/epidemiología , Salud Bucal , Úlcera por Presión/diagnóstico , Úlcera por Presión/epidemiología , Prevalencia , Estudios Retrospectivos , Suecia/epidemiología
12.
Nutrients ; 13(4)2021 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-33921875

RESUMEN

Appetite loss is a common phenomenon in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD). We aimed to (i) adapt and validate a Spanish language version of the Council on Nutrition Appetite Questionnaire (CNAQ) and (ii) to identify psychological and biological factors associated with diminished appetite. We recruited 242 patients undergoing HD from four hemodialysis centers to validate the Spanish-translated version of the CNAQ. In another set of 182 patients from three HD centers, the Appetite and Diet Assessment Tool (ADAT) was used as the gold standard to identify a cut-off value for diminished appetite in our adapted questionnaire. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Distorted Thoughts Scale (DTS), Dialysis Malnutrition Score (DMS), anthropometric, values and laboratory values were also measured. Seven items were preserved in the adapted appetite questionnaire, with two factors associated with flavor and gastric fullness (Cronbach's alpha = 0.758). Diminished appetite was identified with a cut-off value ≤25 points (sensitivity 73%, specificity 77%). Patients with diminished appetite had a higher proportion of females and DMS punctuation, lower plasmatic level of creatinine, blood urea nitrogen, and phosphorus. Appetite score correlated with BDI score, BAI score and DTS. Conclusions: This simple but robust appetite score adequately discriminates against patients with diminished appetite. Screening and treatment of psychological conditions may be useful to increase appetite and the nutritional status of these patients.


Asunto(s)
Apetito , Desnutrición/diagnóstico , Evaluación Nutricional , Diálisis Renal/efectos adversos , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antropometría , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Desnutrición/etiología , Persona de Mediana Edad , Estado Nutricional , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Traducciones , Adulto Joven
13.
Nutrients ; 13(4)2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33916049

RESUMEN

Patients with cancer deal with problems related to physical, psychological, social, and emotional functions. The aim was to investigate malnutrition defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria in relation to health-related quality of life, anxiety, and depression in patients with head and neck cancer. This was a prospective observational research study with 273 patients followed at the start of treatment, seven weeks, and one year. Data collection included nutritional status and support, and the questionnaires: European Organization for Research and Treatment of Cancer Head and neck cancer module (EORTC QLQ-H&N35) and the Hospital Anxiety and Depression Scale (HADS). Malnutrition was defined using the GLIM criteria. The study showed that patients with malnutrition had significantly greater deterioration in their health-related quality of life at seven weeks. On a group level, health-related quality of life was most severe at this time point and some scores still implied problems at one year. Significantly, more patients reported anxiety at the start of treatment whereas significantly more patients reported depression at seven weeks. Over the trajectory of care, the need for support often varies. Psychosocial support is imperative and at the end of treatment extra focus should be put on nutritional interventions and managing treatment-related symptoms to improve nutritional status and health-related quality of life. In the long-term, head and neck cancer survivors need help to find strategies to cope with the remaining sequel.


Asunto(s)
Ansiedad/patología , Depresión/patología , Neoplasias de Cabeza y Cuello/complicaciones , Desnutrición/diagnóstico , Calidad de Vida , Anciano , Ansiedad/etiología , Depresión/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Apoyo Social
14.
Nutrients ; 13(4)2021 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-33924630

RESUMEN

Nutritional risk screening (NRS) is not yet established in many clinical settings. This study aimed to evaluate the efficacy of two NRS tools; the Paediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), compared to the global dietitians' clinical judgment. The goal of this study was also to estimate the prevalence of nutritional risk in Greek paediatric patients. Overall, 1506 children, 1-16 years, from paediatric and surgical wards of two Greek hospitals were included. NRS was performed using PYMS and STAMP based either on World Health Organization (WHOGC) or Hellenic growth charts (HGC). The first 907 children were also referred to dietitians who categorized children in low, medium and high nutritional risk according to their global clinical judgment. PYMS, either based on WHOGC or HGC, showed better agreement with dietitians' feedback (kPYMS_WHO = 0.47; 95%CI: 0.41-0.52, kPYMS_HGC = 0.48; 95%CI: 0.43-0.53) compared to STAMP (kSTAMP_WHO = 0.28; 95%CI: 0.23-0.33, kSTAMP_HGC = 0.26; 95%CI: 0.21-0.32). PYMS also showed the best diagnostic accuracy compared to STAMP in paediatrics and surgical wards separately. Moreover, the PYMS showed similar sensitivity to the STAMP (WHOGC: 82% vs. 84.4%), but a higher positive predictive value (WHOGC: 58.2 vs. 38.7). Using PYMS, high and medium malnutrition risk was observed at 14.9%, and 13.1% of children, respectively. Almost 28% of hospitalised children were at nutritional risk. Children in hospitals should be screened with effective and feasible NRS tools such as PYMS.


Asunto(s)
Desnutrición/epidemiología , Tamizaje Masivo/métodos , Evaluación Nutricional , Niño , Preescolar , Estudios Transversales , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Grecia/epidemiología , Hospitalización , Humanos , Masculino , Desnutrición/diagnóstico , Desnutrición/fisiopatología , Estado Nutricional/fisiología , Prevalencia , Estudios Prospectivos , Medición de Riesgo/métodos , Factores de Riesgo
15.
BMC Pediatr ; 21(1): 158, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794826

RESUMEN

BACKGROUND: Weight for length z-score (WLZ) < - 3 is currently used to define severe acute malnutrition (SAM) among infants. However, this approach has important limitations for infants younger than 6 months of age as WLZ cannot be calculated using WHO growth standards if infant length is < 45 cm. Moreover, length for age z-score (LAZ) and weight for length z-score (WLZ) are least reliable measures, with high chances of variation, and less chances of detecting undernutrition in under 6 months infants. The objective of the current analysis was to compare WLZ with WAZ and LAZ in a cohort of Indian infants in predicting the deaths between 6 weeks and 6 months of age. METHODS: The data was from an individually randomized trial conducted in slums of Delhi, India in which infants' weight and length were measured at 6 weeks of age (at the time of the first immunization visit). Vital status of the infants was documented from 6 weeks to 6 months of age. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for WAZ < -3, WLZ < -3, and LAZ < -3 for deaths between 6 weeks and 6 months of age. The receiver operating characteristics curve was calculated for each of the above anthropometric indicators. RESULTS: For deaths occurring between 6 weeks to 6 months of age, the specificity ranged between 85.9-95.9% for all three anthropometric indicators. However, the sensitivity was considerably higher for WAZ; it was 64.6% for WAZ < -3, 39.1% for LAZ < -3, and 25.0% for WLZ < -3. WAZ < -3 had higher area under curve (0.75; 95% CI: 0.68, 0.82) and hence, better discriminated deaths between 6 weeks and 6 months of age than WLZ < -3. The adjusted relative risk (RR 10.6, 95% CI 5.9, 18.9) and the population attributable fraction (PAF 57.9, 95% CI 38.8, 71.0%) of mortality was highest for WAZ < -3. CONCLUSIONS: We found WAZ < -3 at 6 weeks of age to be a better predictor of death in the 6 weeks to 6 months of life in comparison to WLZ < -3 and LAZ < -3 and propose that it should be considered to diagnose SAM in this age group.


Asunto(s)
Desnutrición , Desnutrición Aguda Severa , Antropometría , Análisis de Datos , Humanos , India/epidemiología , Lactante , Desnutrición/diagnóstico , Desnutrición Aguda Severa/diagnóstico
16.
Nutrients ; 13(4)2021 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-33916385

RESUMEN

Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients' overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients' nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.


Asunto(s)
Desnutrición/terapia , Neoplasias/terapia , Apoyo Nutricional/métodos , Sarcopenia/terapia , Síndrome Debilitante/terapia , Antineoplásicos/uso terapéutico , Composición Corporal/inmunología , Quimioterapia Adyuvante/métodos , Impedancia Eléctrica , Humanos , Desnutrición/diagnóstico , Desnutrición/etiología , Neoplasias/complicaciones , Neoplasias/inmunología , Neoplasias/mortalidad , Evaluación Nutricional , Estado Nutricional/inmunología , Supervivencia sin Progresión , Calidad de Vida , Sarcopenia/diagnóstico , Sarcopenia/etiología , Síndrome Debilitante/diagnóstico , Síndrome Debilitante/etiología
17.
Nutrients ; 13(4)2021 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-33920134

RESUMEN

Patients with cirrhosis often develop malnutrition and micronutrient deficiencies, leading to a worse prognosis and increased mortality. Our main goal was to assess the prevalence of micronutrient deficiencies in patients with decompensated cirrhosis. This was a prospective single-center study including 125 consecutive patients hospitalized for acute decompensation of cirrhosis (mostly of alcoholic etiology). A blood test including trace elements and vitamins was performed on admission. The main micronutrient deficiencies observed were vitamin D (in 94.5%), vitamin A (93.5%), vitamin B6 (60.8%) and zinc (85.6%). Patients in Child-Pugh class C had lower levels of vitamin A (p < 0.0001), vitamin E (p = 0.01) and zinc (p < 0.001), and higher levels of ferritin (p = 0.002) and vitamin B12 (p < 0.001) than those in Child-Pugh class A and B. Patients with a higher model of end-stage liver disease (MELD) score had lower levels of vitamin A (p < 0.0001), vitamin E (p < 0.001), magnesium (p = 0.01) and zinc (p = 0.001), and higher levels of ferritin (p = 0.002) and vitamin B12 (p < 0.0001). Severe hepatic insufficiency correlated with lower levels of zinc, vitamin E and vitamin A, and higher levels of vitamin B12 and ferritin.


Asunto(s)
Enfermedad Hepática en Estado Terminal/diagnóstico , Cirrosis Hepática/complicaciones , Desnutrición/epidemiología , Micronutrientes/deficiencia , Anciano , Enfermedad Hepática en Estado Terminal/sangre , Enfermedad Hepática en Estado Terminal/etiología , Femenino , Humanos , Cirrosis Hepática/sangre , Cirrosis Hepática/diagnóstico , Masculino , Desnutrición/sangre , Desnutrición/diagnóstico , Desnutrición/etiología , Micronutrientes/sangre , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad
18.
Nutrients ; 13(4)2021 Apr 12.
Artículo en Inglés | MEDLINE | ID: mdl-33921207

RESUMEN

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.


Asunto(s)
Artritis Reumatoide/complicaciones , Fragilidad/diagnóstico , Desnutrición/diagnóstico , Calidad de Vida , Actividades Cotidianas/psicología , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/psicología , Cognición , Femenino , Anciano Frágil/psicología , Fragilidad/etiología , Fragilidad/psicología , Hospitalización , Humanos , Masculino , Desnutrición/etiología , Desnutrición/psicología , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Evaluación Nutricional , Estado Nutricional , Índice de Severidad de la Enfermedad
19.
Nutr Clin Pract ; 36(2): 275-281, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33734477

RESUMEN

Iatrogenic malnutrition and underfeeding are ubiquitous in intensive care units (ICUs) worldwide for prolonged periods after ICU admission. A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide nutrition care. If we are to ultimately overcome current fundamental challenges to effective ICU nutrition delivery, we must all adopt routine objective, longitudinal measurement of energy targets via indirect calorimetry (IC). Key evidence supporting the routine use of IC in the ICU includes (1) universal societal ICU nutrition guidelines recommending IC to determine energy requirements; (2) data showing predictive equations or body weight calculations that are consistently inaccurate and correlate poorly with measured energy expenditure, ultimately leading to routine overfeeding and underfeeding, which are both associated with poor ICU outcomes; (3) recent development and worldwide availability of a new validated, accurate, easy-to-use IC device; and (4) recent data in ICU patients with coronavirus disease 2019 (COVID-19) showing progressive hypermetabolism throughout ICU stay, emphasizing the inaccuracy of predictive equations and marked day-to-day variability in nutrition needs. Thus, given the availability of a new validated IC device, these findings emphasize that routine longitudinal IC measures should be considered the new standard of care for ICU and post-ICU nutrition delivery. As we would not deliver vasopressors without accurate blood pressure measurements, the ICU community is only likely to embrace an increased focus on the importance of early nutrition delivery when we can consistently provide objective IC measures to ensure personalized nutrition care delivers the right nutrition dose, in the right patient, at the right time to optimize clinical outcomes.


Asunto(s)
/complicaciones , Calorimetría Indirecta/normas , Cuidados Críticos/normas , Desnutrición/diagnóstico , Evaluación Nutricional , /fisiopatología , Calorimetría Indirecta/métodos , Cuidados Críticos/métodos , Resultados de Cuidados Críticos , Enfermedad Crítica/terapia , Metabolismo Energético , Humanos , Unidades de Cuidados Intensivos , Desnutrición/prevención & control , Desnutrición/virología , Terapia Nutricional/métodos , Terapia Nutricional/normas , Necesidades Nutricionales , Estado Nutricional
20.
Orv Hetil ; 162(13): 504-513, 2021 03 28.
Artículo en Húngaro | MEDLINE | ID: mdl-33774601

RESUMEN

Összefoglaló. Bevezetés: A tumorsebészetben a malnutritio független rizikófaktor. A kockázatcsökkentés egyik fontos eleme a perioperatív tápláltsági állapot felmérésén alapuló klinikai táplálás. Az irodalomban jól dokumentált az idoben végzett rizikószurés fontossága, de ennek módja, különösen hazai környezetben, kidolgozatlanabb. Célkituzés: A malnutritio szempontjából esendobb csoportot alkotó onkológiai sebészeti betegek azonosíthatóságának igazolása, a szurési metódus vizsgálata. Módszer: 2016. október és 2018. november között öt kórcsoportban (emlo, máj, pancreas, mellkas, gyomor-bél rendszer) az igazolt vagy gyanított malignitás, illetve gyulladásos bélbetegség miatt mutétre váró betegeket telemedicina-módszerrel kerestük fel. A rizikócsoportokat (nincs rizikó - alultápláltság valószínusítheto - súlyos alultápláltság) a sebész és dietetikus által közösen vezetett 'Nutritional Risk Score 2002' (NRS 2002) szuro pontrendszerrel állapítottuk meg. Az NRS 2002 pontértékeket a posztoperatív lefolyással vetettük össze (kórházi tartózkodás, 30 napon belüli szövodmények Clavien-Dindo szerinti osztályozása). Prospektív vizsgálatunkban 1556 beteg szerepel. Eredmények: Az emlosebészeti betegek (n = 314) 95,2%-a rizikómentes. A májreszekcióra várók (n = 79) 43%-a valószínuleg vagy biztosan alultáplált. A hasnyálmirigymutétre elojegyzett betegek (n = 122) 81,2%-a emelt rizikójú. A kuratív célú pancreasreszekción átesett betegek pontértéke alacsonyabb, mint a palliatív mutétben részesüloké (p>0,05). A tüdoreszekcióra váró (n = 219) betegeknél 40,7% került emelt rizikócsoportba. Az emelkedett NRS 2002 érték magasabb szövodményaránnyal járt (p<0,05). Béltraktust érinto mutétek (n = 822) esetén a betegek 71,2%-a valószínuleg vagy biztosan súlyosan alultáplált. Az elorehaladott tumorok és a szövodmények egyaránt eros összefüggést mutattak az NRS 2002 értékkel (p<0,01). Következtetés: Az NRS 2002 szuromódszer prediktív értékkel bír mind a tumorstádium, mind a szövodmények tekintetében. Módszerünkkel idoben felismerheto a fokozott rizikót jelento betegcsoport, így a pontérték alapján célzott mesterséges táplálás tervezheto. Orv Hetil. 2021; 162(13): 504-513. INTRODUCTION: Malnutrition is an independent risk factor in oncologic surgery. Perioperative screening and aimed clinical nutrition are key elements in risk reduction. The importance of timely screening has been well published, but its method is underdeveloped, especially in Hungary. OBJECTIVE: Evaluation of a malnutrition screening method to identify patients at risk in oncologic surgery. METHOD: Patients were enrolled from October 2016 to November 2018 in five groups (breast, liver, pancreas, thoracic and gastrointestinal surgery). All patients awaiting surgery for suspected or proven malignancy or for inflammatory bowel disease were screened preoperatively via telephone (telemedicine). Probability for malnutrition (no risk - suspicion for malnutrition - severe malnutrition) was jointly assessed by surgeon and dietitian using Nutritional Risk Score 2002 (NRS 2002). Screening results were compared to the postoperative course (including length of stay and 30-day morbidity/mortality using Clavien-Dindo classification). A total of 1556 patients were identified prospectively. RESULTS: 95.2% of breast surgery patients (n = 314) were not at risk. Malnutrition was suspected or detected in 43% of patients awaiting liver resection (n = 79). Increased risk is present in 81.2% of pancreatic surgery cases (n = 122). Pancreas resections with curative intent were associated with lower scores than in palliative operations (p>0.05). 40.7% of the 219 patients scheduled for lung resection had increased malnutrition risk. Higher NRS 2002 resulted in increased morbidity rate (p<0.05). Surgery on the intestines was performed on 822 cases. 71.2% of them had suspected or severe malnutrition. Presence of advanced cancer and complication rate showed strong relations with increased NRS 2002 (p<0.01). CONCLUSION: Screening with NRS 2002 has predictive value on both tumor stage and complications. Our method is sound to identify patients at malnutrition risk in time, and thus an aimed clinical nutrition therapy can be planned. Orv Hetil. 2021; 162(13): 504-513.


Asunto(s)
Desnutrición , Tamizaje Masivo , Neoplasias , Atención Perioperativa , Femenino , Humanos , Hungría , Desnutrición/diagnóstico , Tamizaje Masivo/métodos , Neoplasias/cirugía , Valor Predictivo de las Pruebas , Factores de Riesgo
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