Undernutrition is associated with mortality, exacerbation, and poorer quality of life in patients with chronic obstructive pulmonary disease: A systematic review with meta-analysis of observational studies.

Impaired nutrition status is recognized as a risk factor for worse clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate how undernutrition is diagnosed, its prevalence, and whether there is an association between this condition and clinical outcomes in patients with COPD. The search for this systematic review of observational studies (PROSPERO: CRD42020191888) was performed in the PubMed, Embase, and Scopus databases, with no date or language restrictions. The studies had to report data on the diagnosis of undernutrition and its association with mortality, exacerbation, length of hospital stay, or quality of life in adult patients with COPD. A meta-analysis with a random-effects model was performed to combine data. Forty-nine studies were included (20 of them classified as having a low risk of bias), and the most common diagnostic method of undernutrition was body mass index (BMI) (n = 36). The pooled prevalence of undernutrition was equal to 20% (95% CI, 0.15-0.25; I² = 100%), and it was associated with mortality (risk ratio = 1.97; 95% CI, 1.55-2.50; I² = 98%), exacerbation (risk ratio = 1.73; 95% CI, 1.03-2.91; I² = 96%), and poorer quality of life (mean difference = 8.25; 95% CI, 5.40-11.10; I² = 79%). For all outcomes, the certainty of evidence was very low. In conclusion, undernutrition is prevalent and is associated with poorer outcomes in patients with COPD. However, undernutrition is mainly diagnosed by BMI, which underreports its prevalence, and the certainty of the evidence is very low.

Reduced Handgrip Strength in Hospital Admission Predicts Prolonged Hospital Stay and Death but Is Not Accurate to Identify Malnutrition: A Longitudinal Study of Reduced Handgrip Strength in Hospitalized Patients.

BACKGROUND: Malnourished patients present impairment of functionality due to loss of strength and muscle mass. However, the validity of handgrip strength (HGS) in identifying malnutrition and its association with clinical outcomes in hospitalized patients requires investigation. AIMS: Evaluate the accuracy of HGS in identifying malnutrition, its association with clinical outcomes, and the change in HGS in the first 2 weeks of hospitalization. METHODS: A prospective cohort study with adult/elderly patients. Subjective Global Assessment (SGA) was applied in the first 48 hours for malnutrition diagnosis, and HGS was measured in this moment and after 7 and 14 days of hospital admission. HGS <20 kg for females and <30 kg for males was considered reduced. Outcomes of interest were prolonged hospital stay (LOS) and in-hospital death. RESULTS: Six hundred patients (55.75 ± 14.78 years, 51.5% males) were included, 34.0% of them were malnourished (SGA-B or SGA-C), and 37.2% presented reduced HGS. The concordance between reduced HGS and SGA in malnutrition diagnosis was weak (κ = 0.192), and accuracy was not satisfactory (area under the receiver operating characteristic curve = 0.599 [95% CI, 0.551-0.648]). HGS did not change during the hospitalization. Reduced HGS increased by 1.2 times (95% CI, 1.03-1.40) the odds for prolonged LOS and 9.11 times (95% CI, 1.13-73.60) the risk of death. CONCLUSION: Reduced HGS did not present satisfactory accuracy to identify malnutrition, and HGS did not change during the first 14 days of hospitalization, but was associated with prolonged LOS and in-hospital death.

Subjective Global Assessment Can Be Performed in Critically Ill Surgical Patients as a Predictor of Poor Clinical Outcomes.

BACKGROUND: There is limited evidence on the applicability of subjective global assessment (SGA) in critically ill patients, despite its good performance in diagnosing undernutrition in clinical and surgical patients. Our aim was to evaluate the association between SGA and anthropometric measures and the performance of SGA in predicting clinical outcomes and mortality in critically ill surgical patients. METHODS: This observational prospective study was carried out with patients admitted to the surgical intensive care unit (SICU) of a Brazilian hospital. Nutrition assessment comprised anthropometric measures (weight and height for body mass index [BMI] calculation, mid-arm circumference [MAC] and calf circumference [CC]), and the SGA. Patients were followed up until hospital discharge for measurement of the following outcomes: length of stay (LOS), SICU LOS, and hospital mortality. RESULTS: This study included 76 surgical patients admitted to an SICU (64.9% males; 87% white ethnicity; mean age, 60.36 ± 16.24 years). According to the SGA, the prevalence of undernutrition was 60.5% (moderate undernutrition = 38.2%; severe undernutrition = 22.4%), and well-nourished 39.0%. Patients with severe undernutrition had lower values of current weight, BMI, MAC, and CC compared with well-nourished patients. The presence of undernutrition increased the risk of LOS >31 days by 2.57 (1.38-4.77) times, but it was not associated with mortality. CONCLUSIONS: Patients with severe undernutrition had lower current weight, BMI, MAC, and CC compared with well-nourished patients. Undernutrition did not increase the risk of death; however, it did increase the relative risk for a longer hospital stay by 2.5.