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1.
Medicine (Baltimore) ; 98(48): e18113, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770235

RESUMO

The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03-1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01-2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48-1.13, P = .15).Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/mortalidade , Desnutrição/mortalidade , Deficiência de Vitamina D/mortalidade , Deficiência de Vitamina D/terapia , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Feminino , Fragilidade/sangue , Fragilidade/complicações , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Desnutrição/sangue , Desnutrição/complicações , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Vitaminas/uso terapêutico
2.
Medicina (Kaunas) ; 55(10)2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31581498

RESUMO

Background and Objectives: Relative energy deficiency in sport (RED-S) has been introduced as a broad-spectrum syndrome leading to possible dysfunction in numerous physiological systems, driven primarily by low energy availability (EA). Research in females has identified specific EA cut-points indicative of risk level for developing physiological and performance disturbances. Cut-points in males have yet to be evaluated. This study examined the prevalence of low EA in competitive (non-elite), recreationally trained (CRT) male endurance athletes. Materials and Methods: Subjects were 108 CRT (38.6 ± 13.8 y; 12.2 ± 5.4 h/wk training) male endurance athletes (runners, cyclists, triathletes) who completed a descriptive survey online via Qualtrics® and returned 3 day diet and exercise training records. EA was calculated from returned surveys and training records. Resting metabolic rate (RMR) and lean body mass (LBM) were estimated from self-reported survey data. Prevalence of risk group was categorized based on the female cut-points: at risk (AR) ≤30 kcal/kg LBM, moderate risk (MR) = 30-45 kcal/kg LBM, or no risk (NR) ≥45 kcal/kg LBM. Results: In this sample, 47.2% (n = 51) were classified as AR, 33.3% (n = 36) as MR, and 19.4% (n = 21) as NR for low EA. Cyclists had lower EA (26.9 ± 17.4 kcal/kg LBM, n = 45) than runners (34.6 ± 13.3 kcal/kg LBM, n = 55, p = 0.016) and all other sport categories (39.5 ± 19.1 kcal/kg LBM, n = 8, p = 0.037). Conclusions: The findings indicate this sample had a high prevalence of risk for low EA, at 47.2%. Only 19.4% of participants were at no risk, meaning ~80% of participants were at some degree of risk of experiencing low EA. Cyclists were at greater risk in this cohort of low EA, although why this occurred was unclear and is in need of further investigation. Future research should address whether the current female cut-points for low EA are appropriate for use in male populations.


Assuntos
Atletas , Desnutrição/epidemiologia , Corrida , Adulto , Estudos Transversais , Exercício , Humanos , Masculino , Desnutrição/sangue , North Carolina/epidemiologia , Necessidades Nutricionais , Prevalência , Fenômenos Fisiológicos da Nutrição Esportiva , Inquéritos e Questionários , Adulto Jovem
3.
Isr Med Assoc J ; 21(8): 546-551, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474018

RESUMO

BACKGROUND: The Bedouins living in southern Israel are a Muslim-Arab population that is transitioning from a nomadic lifestyle to life in permanent settlements. The population has unique characteristics that could affect hemoglobin A1c (HbA1c) measurements. The objective of this study was to describe the socio-demographic and unique morbidity characteristics of this community and their effect on HbA1c measurements. Consanguinity, especially among cousins in the Bedouin population, results in a high prevalence of autosomal recessive genetic diseases such as thalassemia (underestimate of HbA1c), hemoglobinopathies (underestimate and overestimate), Gilbert's disease, and glucose-6-phosphate dehydrogenase deficiency, an X-linked disorder, which can cause hyperbilirubinemia with an overestimate of HbA1c. Furthermore, nutritional deficiencies, autosomal recessive diseases, high birth rates, parasitic infections, and poverty can all cause high rates of anemia (iron and vitamin B12 deficiencies) that can raise HbA1c levels. Congenital dyserythropoietic anemia is found among Bedouin tribes in the Negev region and can lead to an underestimation of HbA1c levels. Pregnancy can also affect HbA1c levels. Medical teams working in the Bedouin community and in other Muslim populations with similar morbidity characteristics throughout the world should identify patients with medical conditions that can affect HbA1c measurements and be aware of possible measurement alternatives such as fructosamine and glycated albumin.


Assuntos
Anemia/etnologia , Hemoglobina A Glicada/análise , Hemoglobinopatias/etnologia , Desnutrição/etnologia , Complicações na Gravidez/etnologia , Anemia/sangue , Anemia/complicações , Árabes , Feminino , Hemoglobinopatias/sangue , Hemoglobinopatias/complicações , Humanos , Islamismo , Israel/etnologia , Masculino , Desnutrição/sangue , Desnutrição/complicações , Gravidez , Complicações na Gravidez/sangue , Reprodutibilidade dos Testes , Fatores Socioeconômicos
4.
Int Urol Nephrol ; 51(10): 1849-1854, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31485911

RESUMO

BACKGROUND: Increased levels of circulating heat shock protein 70 antibodies (anti-Hsp70) have been reported in hemodialysis (HD) patients. Since the anti-Hsp70 correlates with inflammation, it may associate with the malnutrition-inflammation score (MIS). The aim of this study was to determine whether the increased MIS score in HD patients are related to circulating levels of anti-Hsp70. METHOD: Ninety HD patients with an arteriovenous fistula, aged 30-65 years, who underwent three hemodialysis sessions a week for at least the past 3 months at a hemodialysis center were enrolled in this cross-sectional study. Patients were divided based on MIS score to two groups, and the clinical and biochemical variables were compared between them. MIS cutoff score of ≥ 5 indicated the presence of malnutrition. The association between categorized MIS and anti-Hsp70 was examined using regression models adjusted for diabetes mellitus, hemodialysis vintage, BMI, albumin, hs-CRP, IL6 and endotoxin levels as confounding factors. RESULTS: The univariate regression analysis revealed a significant association between MIS ≥ 5 and hemodialysis vintage, uric acid, hs-CRP, IL-6, endotoxin and serum anti-Hsp70 level. After adjusting the confounders, the association between MIS ≥ 5 and serum anti-Hsp70 level remained significant. CONCLUSION: These data support the role of serum anti-Hsp70 in the development of malnutrition in HD patients. However, further studies with body composition assessments and better generalizability are required to investigate the association between nutritional status and circulating anti-Hsp70 level in HD patients.


Assuntos
Autoanticorpos/sangue , Proteínas de Choque Térmico HSP70/imunologia , Inflamação/sangue , Inflamação/imunologia , Desnutrição/sangue , Desnutrição/imunologia , Diálise Renal , Adulto , Idoso , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Nutrients ; 11(8)2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31398886

RESUMO

Cellular pathways such as inflammation or oxidative stress are the cause and triggers of disease-related malnutrition (DRM), but the influence of these markers on endoplasmic reticulum (ER) stress is unknown. The objective of this study was to analyze the relationship between mitochondrial function and ER stress parameters in a DRM population. The study population was composed of 82 outpatient subjects, of whom 45 were diagnosed with DRM and 37 were confirmed to be normonourished according to the American Society for Parenteral and Enteral Nutrition ASPEN criteria. We evaluated anthropometrical and biochemical parameters, pro-inflammatory cytokines in serum. Oxidative and ER stress markers were analyzed in leukocytes. DRM patients showed significant reductions in albumin and transferrin concerning the normonourished group, and also displayed higher levels of hsCRP, IL6, and TNFα, and the soluble adhesion molecules VCAM-1 and ICAM-1. Besides, oxygen consumption and mitochondrial membrane potential were reduced and Radical Oxygen Species ROS production was enhanced in DRM patients. In the case of ER markers, protein and mRNA expression revealed that CHOP, ATF6, and the P-eIF2α signal were enhanced in malnourished patients compared to control subjects. Correlation studies supported a relationship between weight loss and increased inflammation, mitochondrial dysfunction, and compromised function of the ER. Our results demonstrate that ER stress signaling pathways are influenced by inflammation and mitochondrial function in the leukocytes of a DRM population.


Assuntos
Estresse do Retículo Endoplasmático/fisiologia , Retículo Endoplasmático/fisiologia , Leucócitos/fisiologia , Desnutrição/fisiopatologia , Estresse Oxidativo/fisiologia , Adulto , Idoso , Antropometria , Citocinas/sangue , Feminino , Humanos , Masculino , Desnutrição/sangue , Desnutrição/etiologia , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Pacientes Ambulatoriais
6.
Transplant Proc ; 51(6): 2009-2013, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399181

RESUMO

BACKGROUND: The aim of the study was to investigate the serum concentration of cytokines and biochemical markers of malnutrition in correlation with frailty syndrome in patients qualified for lung transplantation (LTx). METHODS: The study population comprised 31 potential lung recipients, including 18 patients with idiopathic lung disease, 12 patients with chronic obstructive pulmonary disease, and 1 patient with bronchiectasis who qualified for a LTx. Cytokine serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits and the Luminex 200 platform (ProcartaPlex Hu Cytokine/Chemokine Panel 1A 34plex, Invitrogen, Carlsbad, Calif., United States). The patients were also asked to complete a questionnaire, the Clinical Frailty Scale. RESULTS: All patients were found to have higher cytokine concentrations (IL6, IL 2,IL18, IL23, IL 12p70, IL 10, IL 7). No statistically significant differences in the analyzed cytokines were noted when the men's results were compared to those of the women. There were no significant differences between patients who scored 6 vs 7 points on the Canadian Study of Health and Aging Function Scale. In comparing chronic obstructive pulmonary disease to idiopathic lung disease patients, no significant differences were observed in the analyzed cytokine values. Significant correlations were observed between the analyzed cytokines and age of the patients, C-reactive protein, triglycerides, transferrin, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. CONCLUSIONS: Our findings indicate that cytokines may not have a statistically significant effect on the parameters of the frailty syndrome. The results require further investigations on larger study groups. The findings suggest that the analyzed cytokines may play a proinflammatory role in the end stages of lung diseases, but further studies are needed to evaluate whether these cytokines could be used as biomarkers in this group of patients.


Assuntos
Citocinas/sangue , Fragilidade/sangue , Pneumopatias/sangue , Transplante de Pulmão/efeitos adversos , Desnutrição/sangue , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Canadá , HDL-Colesterol , Contraindicações de Procedimentos , Ensaio de Imunoadsorção Enzimática , Feminino , Fragilidade/complicações , Fragilidade/cirurgia , Humanos , Interleucina-10/sangue , Pulmão/fisiopatologia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Desnutrição/complicações , Desnutrição/cirurgia , Pessoa de Meia-Idade , Seleção de Pacientes , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/cirurgia , Triglicerídeos/sangue , Adulto Jovem
7.
Nutrients ; 11(9)2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31443557

RESUMO

The effect of inflammation on appetite and food intake has been rarely studied in humans. In this study, we examined the association of C-reactive protein (CRP), as an inflammatory marker, with appetite and food intake among older hospitalized patients. A total of 200 older individuals, who were consecutively admitted to a geriatric acute care ward, participated in this prospective observational study. Appetite was evaluated using the Edmonton Symptom Assessment System (ESAS) and the Simplified Nutritional Appetite Questionnaire (SNAQ), respectively. Food intake was measured according to plate diagram method and participants were categorized as having food intake <75% and ≥75% of meals served. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). In addition, serum CRP was analyzed and the levels >3.0 (mg/dL) were considered as moderate to severe inflammation. Of total population with mean age 81.4 ± 6.6 years (62.5% females), 51 (25.5%) had no inflammation and 88 (44.0%) and 61 (30.5%) had mild and moderate to severe inflammation, respectively. According to MNA-SF, 9.0% and 60.0% had normal nutritional status or a risk of malnutrition, respectively, whereas 31.0% were malnourished. Based on the SNAQ-appetite-question, 32.5% of the patients demonstrated poor and very poor appetite whereas 23.5% reported severe loss of appetite according to ESAS. Ninety-five (48.0%) of the participants had food intake <75% of the meals offered. Significant associations between SNAQ-appetite (p = 0.003) and ESAS-appetite (p = 0.013) scores and CRP levels were observed. In addition, significant differences were observed in CRP levels between intake ≥75% and <75% of meals served (p < 0.001). Furthermore, there were significant associations between appetite and nutritional status whereas malnourished older patients demonstrated a decreased appetite compared to those with normal nutritional status (p = 0.011). In a regression analysis, inflammation was the major independent risk factor for patients' appetite (p = 0.003) and food intake (p = 0.011) whereas other variables such as infection (p = 0.960), chronic inflammatory diseases (p = 0.371), age (p = 0.679) and gender (p = 0.447) do not show any impact on appetite. Our findings confirm that poor appetite and low food intake are associated with inflammation in older hospitalized patients, suggesting that inflammation may contribute an important aspect to the development of malnutrition in these patients.


Assuntos
Apetite , Ingestão de Alimentos , Comportamento Alimentar , Hospitalização , Inflamação/psicologia , Pacientes Internados/psicologia , Desnutrição/psicologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Avaliação Geriátrica , Humanos , Inflamação/sangue , Inflamação/diagnóstico , Mediadores da Inflamação/sangue , Masculino , Desnutrição/sangue , Desnutrição/diagnóstico , Estado Nutricional , Estudos Prospectivos , Fatores de Risco
10.
Anim Sci J ; 90(7): 857-869, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31099142

RESUMO

This experiment evaluated the effects of subnutrition during early gestation on hematology in cows (Bos Taurus) and on hematological, metabolic, endocrine, and vitality parameters in their calves. Parda de Montaña and Pirenaica dams were inseminated and assigned to either a control (CONTROL, 100% requirements) or a nutrient-restricted group (SUBNUT, 65%) during the first third of gestation. Dam blood samples were collected on days 20 and 253 of gestation, and calf samples were obtained during the first days of life. Pirenaica dams presented higher red series parameters than Parda de Montaña dams, both in the first and the last months of gestation. During early pregnancy, granulocyte numbers and mean corpuscular hemoglobin were lower in Pirenaica-SUBNUT than in Pirenaica-CONTROL cows. Calves from the SUBNUT cows did not show a physiological reduction in red series values in early life, suggesting later maturation of the hematopoietic system. Poor maternal nutrition affected calf endocrine parameters. Newborns from dystocic parturitions showed lower NEFA concentrations and weaker vitality responses. In conclusion, maternal nutrition had short-term effects on cow hematology, Pirenaica cows showing a higher susceptibility to undernutrition; and a long-term effect on their offspring endocrinology, SUBNUT newborns showing lower levels of IGF-1 and higher levels of cortisol.


Assuntos
Fenômenos Fisiológicos da Nutrição Animal , Animais Recém-Nascidos/sangue , Bovinos/sangue , Bovinos/metabolismo , Desnutrição/sangue , Desnutrição/veterinária , Complicações na Gravidez/veterinária , Prenhez/sangue , Fenômenos Fisiológicos da Nutrição Pré-Natal/fisiologia , Animais , Feminino , Granulócitos , Hemoglobinas , Hidrocortisona/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Contagem de Leucócitos , Desnutrição/fisiopatologia , Gravidez
11.
Nutrients ; 11(4)2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31010058

RESUMO

We examined the effect of high fat oral nutritional supplement (HFS) on the nutritional status, oral intake, and serum metabolites of postoperative pancreaticobiliary cancer patients. Pancreaticobiliary cancer patients were voluntarily recruited. The HFS group received postoperative oral high fat supplementation (80% of total calories from fat; n = 12) until discharge; the control group (non-HFS; n = 9) received none. Dietary intake, anthropometry, blood chemistry, nutritional risk index (NRI), and serum metabolites analyzed by liquid chromatography tandem mass spectrometry were evaluated. Overall, cumulative caloric supply via parental and oral/enteral routes were not different between groups. However, oral fat intake, caloric intake, and NRI scores of the HFS group were higher than those of the non-HFS group with increased oral meal consumption. Oral caloric, fat, and meal intakes correlated with NRI scores. Metabolomics analysis identified 195 serum metabolites pre-discharge. Oral fat intake was correlated with 42 metabolites relevant to the glycerophospholipid pathway. Oral high fat-specific upregulation of sphingomyelin (d18:1/24:1), a previously reported pancreatic cancer-downregulated metabolite, and lysophosphatidylcholine (16:0) were associated with NRI scores. Provision of HFS in postoperative pancreatic cancer patients may facilitate the recovery of postoperative health status by increasing oral meal intake, improving nutritional status, and modulating serum metabolites.


Assuntos
Gorduras na Dieta/uso terapêutico , Suplementos Nutricionais , Desnutrição/prevenção & controle , Metaboloma , Estado Nutricional , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Administração Oral , Idoso , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/sangue , Gorduras na Dieta/farmacologia , Ingestão de Energia , Comportamento Alimentar , Feminino , Humanos , Lisofosfatidilcolinas/sangue , Masculino , Desnutrição/sangue , Desnutrição/etiologia , Metaboloma/efeitos dos fármacos , Pessoa de Meia-Idade , Necessidades Nutricionais , Pancreatectomia/efeitos adversos , Neoplasias Pancreáticas/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Esfingomielinas/sangue
12.
Blood Purif ; 47 Suppl 2: 3-11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943483

RESUMO

BACKGROUND/AIM: In maintenance hemodialysis (MHD), protein-energy malnutrition and chronic inflammation can be critical and are two of the main causes of mortality. METHOD: We compared the change in nutrition and inflammatory conditions between younger and older MHD patients during a 2-year period. Furthermore, using Kaplan-Meier analysis, we evaluated the correlations between changes in each parameter and any adverse events. RESULT: During the observational period, body mass index (BMI) and serum albumin levels decreased significantly in older patients. In Kaplan-Meier analysis, patients who showed a decline in BMI had an associated elevated risk for cerebro-cardiovascular disease and hospitalization. Moreover, patients who showed a decline in albumin also had an associated higher risk for infectious disease and hospitalization. CONCLUSION: This study revealed that the downward trend in nutritional status was prominent in elderly patients. Furthermore, changes in nutritional and inflammatory conditions during MHD were associated with adverse events in MHD patients.


Assuntos
Inflamação/etiologia , Desnutrição/etiologia , Diálise Renal/efeitos adversos , Fatores Etários , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Progressão da Doença , Feminino , Humanos , /etiologia , Inflamação/sangue , Estimativa de Kaplan-Meier , Masculino , Desnutrição/sangue , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos , Diálise Renal/mortalidade , Albumina Sérica Humana/análise
13.
J Vasc Surg ; 70(2): 569-579.e4, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30922758

RESUMO

BACKGROUND: Malnutrition is frequent among vascular surgery patients, given their age, chronic comorbidities, and poor functional status, and it is believed to increase their operative risk. We aimed to assess the combined use of recent significant weight loss (>10% body mass) and serum albumin levels as a nutritional status index to predict outcomes. METHODS: We analyzed vascular surgery data from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2012; N = 238,082) to compare operative death (in-hospital and 30-day operative death) across eight nutritional status groups based on weight loss (yes/no) and albumin category: very low albumin level (VL-Alb; <2.50 g/dL), low albumin level (L-Alb; 2.50-3.39 g/dL), normal albumin level (N-Alb; 3.40-4.39 g/dL), and high albumin level (H-Alb; 4.40-5.40 g/dL). Risk-adjusted odds ratios (AOR) with 95% confidence intervals were estimated by multivariable logistic regression (N-Alb [no weight loss], reference). RESULTS: The study population included 113,936 patients for whom albumin level was available (age, 67 ± 13 years; 60.2% male). Operative death was documented in 5160 (4.53%) patients. The eight-category nutritional status was more predictive of operative death than age alone (C statistic, 0.74 vs 0.63). A high discrimination multivariable model for operative death was derived (C statistic, 0.851). Low albumin level was associated with increased death that worsened in case of weight loss: VL-Alb + WL, AOR = 3.83 (3.03-4.83); VL-Alb, AOR = 3.36 (3.06-3.69); L-Alb + WL, AOR = 2.46 (1.98-3.05); and L-Alb, AOR = 1.99 (1.84-2.15). Weight loss was associated with increased death even if albumin level was normal: N-Alb + WL, AOR = 1.77 (1.34-2.35); and H-Alb + WL, AOR = 1.91 (0.69-5.31). H-Alb was protective (AOR = 0.65 [0.55-0.76]). CONCLUSIONS: Nutritional status predicts outcomes of vascular surgery. Serum albumin level and weight loss should be incorporated in patients' risk stratification.


Assuntos
Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Albumina Sérica Humana/metabolismo , Procedimentos Cirúrgicos Vasculares , Perda de Peso , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Bases de Dados Factuais , Feminino , Humanos , Masculino , Desnutrição/sangue , Desnutrição/mortalidade , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
14.
Nutrients ; 11(3)2019 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-30832404

RESUMO

Multiple studies on the dynamics of inflammatory cytokines in patients with anorexia nervosa (AN) have been published, although results are not consistent among reports. Thus the pathophysiologic roles of these cytokines are not clear. We performed an exploratory analysis that included (1) comparisons of plasma interleukin-18 (IL-18) concentrations between patients with AN (n = 21) and healthy controls (n = 39), and (2) correlations between body mass index (BMI) and IL-18 concentrations in both groups, exploring the relationship between malnourishment and IL-18. Plasma IL-18 levels were significantly decreased in patients with AN compared with controls. Plasma IL-18 levels correlated to BMI in controls, but not in patients with AN. These results suggest that a decline in plasma IL-18 levels in patients with AN is not only due to malnourishment, but other pathophysiologic changes as well. IL-18 has a role in the brain's reaction to sadness and chronic stress. Therefore, decreased levels of IL-18 may commonly occur in patients with chronic AN.


Assuntos
Anorexia Nervosa/sangue , Interleucina-18/sangue , Desnutrição/sangue , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/fisiopatologia , Índice de Massa Corporal , Estudos de Casos e Controles , Citocinas/sangue , Feminino , Humanos , Japão , Desnutrição/psicologia , Adulto Jovem
15.
Nutr Clin Pract ; 34(3): 340-348, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30908744

RESUMO

Preoperative risk stratification has long been developed as a strategy to predict postoperative outcomes and potentially alter or optimize comorbidities and modifiable risk. Malnutrition is among the most common potentially modifiable risk factors and the strongest predictor of poor postsurgical outcomes. Historically, malnutrition has been difficult to address for healthcare providers because of the lack of a cohesive definition. Adding to the confusion has been the use of serum levels of albumin and prealbumin as biomarkers for malnutrition; many fail to understand that these visceral proteins are only valid as markers of nutrition status while at homeostasis. Surgical need is often driven by both sterile and non-sterile inflammation, but during this pathologic mechanism, hepatic reprioritization shunts visceral protein synthesis, rendering albumin and prealbumin invalid as biomarkers for malnutrition. Ultimately, understanding these limitations and embracing better indicators of malnutrition will improve preoperative risk stratification.


Assuntos
Avaliação Nutricional , Pré-Albumina/análise , Período Pré-Operatório , Albumina Sérica/análise , Biomarcadores/sangue , Humanos , Inflamação/sangue , Desnutrição/sangue , Desnutrição/complicações , Complicações Pós-Operatórias , Fatores de Risco , Sensibilidade e Especificidade
16.
World J Gastroenterol ; 25(5): 600-607, 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30774274

RESUMO

BACKGROUND: Zinc is a key element in numerous proteins and plays an important role in essential cell functions such as defense against free radicals and DNA damage repair. Chronic pancreatitis (CP) is a chronic inflammation with progressive fibrosis of pancreas ultimately resulting in pancreatic exocrine insufficiency (PEI), which is associated with malnutrition. Studies analyzing zinc levels in patients with CP are sparse and lead to conflicting results. AIM: To investigate serum zinc levels in patients with CP of various etiologies. METHODS: Between October 2015 and March 2018, patients with a diagnosis of CP were identified and recruited from the Pancreatic Outpatient Clinic at the Karolinska University Hospital in Stockholm, Sweden. Demographic, clinical and laboratory data were analyzed. Etiology of CP was determined according to the M-ANNHEIM classification system into the following etiological subcategories: alcohol consumption, nicotine consumption, hereditary factors, efferent pancreatic duct factors and immunological factors. Pancreatic exocrine function was defined as normal (fecal elastase 1 > 200 µg/g), mildly reduced (100-200 µg/g) and severely reduced (fecal elastase 1 < 100 µg/g). RESULTS: A total of 150 patients were included in the analysis. Zinc deficiency (< 11 µmol/L) was present in 39 (26.0%) of patients: 22 females and 17 males. In the group of patients with zinc deficiency, 76.7% of patients had an exocrine pancreatic insufficiency (FE-1 < 200 µg/g). Older age was significantly associated with low zinc levels. Following a univariate analysis, patients aged 60-69 and patients ≥ 70 years of age had a significantly higher prevalence of zinc deficiencies compared to patients < 40 years of age [OR: 3.8, 95%CI (1.08-13.4); P = 0.04]; [OR 6.26, 95%CI (1.94-20.2), P > 0.002]. Smoking and number of pack-years were additionally associated with low zinc levels. The risk of zinc deficiency in current smokers and smokers with ≥ 20 pack-years was approximately three times higher compared to those who had never smoked. Gender, body mass index, etiology of CP, presence of diabetes mellitus, levels of glycated hemoglobin (HbA1c), bone mineral density, alcohol intake and presence of PEI were not associated with low zinc levels. CONCLUSION: Zinc deficiency is common in patients with CP and is significantly associated with age ≥ 60, smoking and the number of pack-years, but not with PEI.


Assuntos
Insuficiência Pancreática Exócrina/epidemiologia , Desnutrição/epidemiologia , Pancreatite Crônica/sangue , Fumar/epidemiologia , Zinco/deficiência , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Insuficiência Pancreática Exócrina/sangue , Insuficiência Pancreática Exócrina/metabolismo , Insuficiência Pancreática Exócrina/patologia , Fezes/enzimologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Desnutrição/sangue , Desnutrição/etiologia , Pessoa de Meia-Idade , Pâncreas/metabolismo , Pâncreas/patologia , Elastase Pancreática/análise , Pancreatite Crônica/complicações , Pancreatite Crônica/metabolismo , Pancreatite Crônica/patologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem , Zinco/sangue
17.
J Arthroplasty ; 34(5): 1013-1024, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30745081

RESUMO

BACKGROUND: Malnutrition continues to be prevalent in the general population. A variety of studies have correlated poor nutritional status with reduced perioperative outcomes. However, the correlation between serologic malnutrition and arthroplasty outcomes has not been systematically evaluated. The purpose of this study was to determine if serologic malnutrition has a correlation with postoperative wound infection, as well as other complications, after total joint arthroplasty. METHODS: A systematic review of the literature was performed to identify studies that reported on outcomes for patients who were malnourished and had undergone a total hip or knee arthroplasty. RESULTS: Twenty studies were included for review. Based on the quality of the evidence of the different studies, the balance between desirable/undesirable outcomes and the values of patients, there was a strong recommendation that preoperative serologic markers of malnutrition are significantly associated with inferior postoperative outcomes. All 20 studies analyzed albumin as a marker for malnutrition. Eleven (55%) studies used the total lymphocyte count, and 6 (30%) studies reported transferrin as a marker for malnutrition. Among 20 studies, 18 (90%) studies reported a correlation with at least one serological marker and poor postoperative outcomes. Finally, patients with an albumin level <3.5 dg/L were more likely to develop a postoperative wound complication (odds ratio: 2.176; 95% confidence interval: 1.916-2.471). CONCLUSIONS: There is strong evidence that serologic malnutrition was associated with increased risk of poor postoperative outcome across all total joint replacement interventions.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Artropatias/cirurgia , Desnutrição/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Biomarcadores/sangue , Humanos , Artropatias/complicações , Desnutrição/sangue , Desnutrição/complicações , Período Pré-Operatório , Fatores de Risco
18.
Turk J Med Sci ; 49(1): 327-335, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30761853

RESUMO

Background/aim: Fetuin-A, a circulating inhibitor of calcification, is a marker of inflammatory-nutritional state. We evaluated the association between serum fetuin-A levels and vascular calcification, intima-media thickness, and nutritional and inflammatory markers in different stages of chronic kidney disease (CKD). Materials and methods: CKD patients were sampled for calcium-phosphate parameters and nutritional and inflammatory markers [highly sensitive C-reactive protein (hs-CRP)], and serum fetuin-A levels. Intima-media thicknesses of the common carotid arteries (CIMT) were measured. Peripheral artery calcification scores were obtained. Results: A total of 238 patients were included in the study. Fetuin-A levels in patients with end-stage renal disease were significantly lower than those in patients with stage-3 and stage-4 CKD (stage-5 vs. stage-4, P < 0.001; stage-5 vs. stage-3, P < 0.001). Fetuin-A was negatively correlated with creatinine (P < 0.001), Ca × P product (P < 0.001), hs-CRP (P = 0.01), vascular calcification score (P < 0.001), and CIMT (P < 0.001), and positively correlated with BMI (P < 0.001, r = 0.30) and serum albumin (P < 0.001). Conclusion: Lower levels of fetuin-A were associated with higher vascular calcification scores, CIMT, hs-CRP levels, and lower BMI and albumin. Fetuin-A deficiency may be a key element for MIAC syndrome.


Assuntos
Inflamação , Insuficiência Renal Crônica , alfa-2-Glicoproteína-HS/análise , Adulto , Idoso , Aterosclerose/sangue , Aterosclerose/complicações , Aterosclerose/epidemiologia , Calcinose/sangue , Calcinose/complicações , Calcinose/epidemiologia , Feminino , Humanos , Inflamação/sangue , Inflamação/complicações , Inflamação/epidemiologia , Masculino , Desnutrição/sangue , Desnutrição/complicações , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Síndrome
19.
Nutrients ; 11(1)2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-30634546

RESUMO

BACKGROUND: Hypovitaminosis D is a frequent condition in elderly subjects. Vitamin D adequacy is best determined by measurement of the 25-hydroxyvitamin D-25(OH)D-concentration in the serum. An inverse association exists between 25(OH)D and cardiovascular, infectious, glucose metabolism, cognitive disorders, and all-cause mortality. Whether 25(OH)D is a marker of organ diseases is still under debate. We aimed to investigate whether comorbidities were associated with serum 25(OH)D levels in geriatric inpatients. METHODS: This is a retrospective study, including 237 subjects consecutively admitted to an acute care geriatric unit, with available data of 25(OH)D serum concentrations. 25(OH)D serum levels were defined according to the following cutoffs: 50⁻30 ng/mL (125⁻75 nmol/L): optimal range; 30⁻20 ng/mL (75⁻50 nmol/L): insufficiency; 20⁻10 ng/mL (5⁻25 nmol/L): deficiency; and <10 ng/mL (<25 nmol/L): severe deficiency. Comorbidity was assessed using the Cumulative Illness Rating Scale-Geriatric (CIRS-G). Two summary measures were obtained, the Illness Severity Index (CIRS-SI) and the Comorbidity Index (CIRS-CI). RESULTS: 177 (74.68%) women and 60 (25.32%) men with mean age of 85 ± 6 years old were enrolled. The majority of subjects (68.6%) were at risk of malnutrition. Overall, the burden of comorbidity was 1.87 ± 1.33 for CIRS-CI and 1.18 ± 0.40 for CIRS-SI. 25(OH)D serum concentrations were 10.58 ± 7.68 ng/mL, with 98.7% of subjects having vitamin D below 30 ng/mL and 56.6% with severe deficiency. An inverse correlation was found between 25(OH)D and both CIRS-SI (r: -0.312; p < 0.0001) and CIRS-CI (r: -0.306; p < 0.0001). Independent of multiple covariates an inverse association between both CIRS-SI (p < 0.0001) and CIRS-CI (p < 0.0001) and 25(OH)D was confirmed. Both CIRS-SI (r = 0.251, p < 0.0001) and CIRS-CI (r = 0.137, p = 0.016) were positively correlated with the length of hospital stay. An inverse correlation was confirmed between serum 25(OH)D concentrations and CRP (r = -0.142; p = 0.041). CRP, in turn, positively correlated with CIRS-SI (r = 0.209, p = 0.003) and CIRS-CI (r = 0.158, p = 0.023). Both CIRS-SI (r = 0.251, p < 0.0001) and CIRS-CI (r = 0.137, p = 0.016) were positively correlated with the length of hospital stay. CONCLUSIONS: In hospitalized very old subjects, a higher comorbidity burden is associated with lower 25(OH)D serum levels. Hypovitaminosis D was correlated with higher inflammatory status, which, together with the comorbidities burden, negatively influenced the length of hospital stay.


Assuntos
Biomarcadores/sangue , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Cognição/efeitos dos fármacos , Comorbidade , Feminino , Avaliação Geriátrica , Hospitalização , Humanos , Tempo de Internação , Masculino , Desnutrição/sangue , Avaliação Nutricional , Hormônio Paratireóideo/sangue , Estudos Retrospectivos , Fatores de Risco , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue
20.
Nutrients ; 11(1)2019 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-30642010

RESUMO

BACKGROUND: Zinc is an essential nutrient for all forms of life and its deficiency affects the normal growth and development of human beings. OBJECTIVE: The main aim was to investigate zinc nutritional status by serum zinc concentration (SZC) and dietary zinc intake and their association in cystic fibrosis (CF) patients. METHODS: A cross-sectional study was conducted in CF patients. Anthropometric measurements and respiratory and pancreatic tests were conducted. Hypozincemia was determined by SZC while using atomic absorption spectrophotometry and dietary zinc deficiency by prospective 72-h dietary surveys. RESULTS: Mean SZC (87.2 ± 16.7 µg/dL) and dietary zinc intake (97 ± 26.9% Dietary Reference Intake) were normal. Three of 17 patients with CF (17.6%) had hypozincemia and four (23.5%) had a dietary zinc deficiency. No patient with dietary zinc deficiency had hypozincemia. A positive and significant association was observed between SZC and Z-score of BMI-for-age (p = 0.048) and weight-for-height (p = 0.012) and between dietary zinc intake and energy intake (EI, p = 0.036) and Z-score of weight-for-high (p = 0.029). CONCLUSION: SZC was associated with the nutritional status, expressed as BMI (Body Mass Index) and weight-for-height Z score, and dietary zinc intake with EI and weight-for-height Z-score. No patient with hypozincemia had dietary zinc deficiency. This situation should alert us to a marginal zinc deficiency and it may explain why there were no overlapping cases between the two groups. We suggest that probably 41% of the cases in this study would be at elevated risk of zinc deficiency and a zinc supplementation may be considered.


Assuntos
Fibrose Cística/sangue , Estado Nutricional , Zinco/sangue , Adolescente , Índice de Massa Corporal , Peso Corporal , Proteína C-Reativa/metabolismo , Criança , Estudos Transversais , Dieta , Feminino , Humanos , Masculino , Desnutrição/sangue , Estudos Prospectivos , Adulto Jovem , Zinco/administração & dosagem , Zinco/deficiência
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