Impact of Dietetic Intervention on Skin Autofluorescence and Nutritional Status in Persons Receiving Dialysis: A Proof of Principle Study

Abstract Background The prevalence of malnutrition amongst pancreatic cancer patients is widely reported. This is due to reduced nutritional intake, increased energy expenditure and increased nutrient losses secondary to malabsorption. A Whipple's procedure or pancreaticoduodenectomy is the only potentially curable intervention for pancreatic cancer patients. Malnutrition is associated with increased peri and post-operative complications including delayed wound healing, longer hospital admission and higher mortality rate. Dietetic prehabilitation is a proactive intervention to assess patients’ nutritional status in preparation for elective surgery and, through early dietetic intervention, has the potential to improve perioperative outcomes. This pilot study reviewed the severity of nutritional risk in both the pre and post-operative stages to understand the need for dietetic prehabilitation in this patient group. Methods All patients referred were nutritionally assessed as part of a dietetic cancer prehabilitation pathway, which includes pre-surgical nutritional assessment within one week of referral and early post discharge nutritional assessment. Nutritional assessment was carried out using the PG-SGA short form and patients were triaged as requiring either a universal, targeted or specialist dietetic intervention dependent on severity of nutritional risk. Patients who scored <4 were triaged as universal, and were low nutritional risk. Patients who scored 5-9 were triaged as targeted and were medium nutritional risk, and patients who scored >9 were triaged as specialist, and were high nutritional risk. Results 35 patients were referred for dietetic prehabilitation assessment. 71% of patients were triaged as requiring either a targeted or specialist prehabilitiation intervention. BMI ranged from 15.7kg/m² to 35.9kg/m² and median weight loss was 10.0%. 23 patients received early post surgical nutritional assessment, within 12 days of discharge from hospital. All 23 patients required targeted or specialist dietetic intervention. 22 patients reported post-operative weight loss, with a median weight loss of 7.5%. There was no correlation between pre-surgical and post-surgical nutritional risk. Conclusions Patients undergoing pancreaticoduodenectomy are at high nutritional risk in both the pre and post-operative periods. Patients without evidence of malnutrition in the pre-operative stage remain at high risk of malnutrition and the associated complications in the post operative stage. A prehabilitation programme can identify patients at nutritional risk and institute interventions to optimise perioperative nutritional status. Findings from this review will form the basis of a study examining the effects of a prehabilitation programme on outcomes following pancreaticoduodenectomy.

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Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002838 ◽

2021 ◽

pp. bmjspcare-2020-002838

Author(s):

Iain Phillips ◽

Lindsey Allan ◽

Adele Hug ◽

Naomi Westran ◽

Claudia Heinemann ◽

...

Keyword(s):

Lung Cancer ◽

Weight Loss ◽

Nutritional Status ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Symptom Burden ◽

Small Cell ◽

Nutritional Deficiencies ◽

Small Cell Lung ◽

Dietetic Intervention

IntroductionEuropean Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated the nutritional status of patients with non-small cell lung cancer (NSCLC) and the need for dietetic intervention.MethodsIn this observational cohort pilot study, patients with stage 3b and 4 NSCLC were assessed prior to starting first line systemic anticancer therapy (SACT) with a range of measurements and questionnaires. We report the outcomes related to the Patient Generated Subjective Global Assessment tool (PG-SGA),Results96 patients were consented between April 2017 and August 2019. The PG-SGA identified that 78% of patients required specialist nutritional advice; with 52% patients having a critical need for dietetic input and symptom management. Results were dominated by symptom scores. As a screening test, one or more symptoms or recent weight loss history had a sensitivity of 88% (95% CI 78.44% to 94.36%) and specificity of 95.24% (95% CI 76.18% to 99.88%) for need for dietetic intervention.ConclusionA large proportion of patients with NSCLC have a high symptom burden and are at risk of malnutrition prior to starting SACT and would benefit from dietetic review. It is imperative that oncologists and healthcare professionals discuss weight loss history and symptoms with lung cancer patients to correct nutritional deficiencies and resolve symptoms prior to starting treatment.

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Early and intensive dietetic intervention on the nutritional status of nasopharyngeal cancer (NPC) patients undergoing radiotherapy (RT)

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.09.789 ◽

2020 ◽

Vol 40 ◽

pp. 667

Author(s):

J. Sit ◽

X.K.S. Yuen ◽

V. Yu

Keyword(s):

Nutritional Status ◽

Nasopharyngeal Cancer ◽

Dietetic Intervention

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P0714RELATIONSHIP BETWEEN BIOLOGICAL AGE ESTIMATED BY SKIN AUTOFLUORESCENCE, CHRONOLOGICAL AGE, AND MORTALITY IN CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0714 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Hokuto Morohoshi ◽

Ken Iseri ◽

Lu Dai ◽

Thomas Ebert ◽

Anna Witasp ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Nutritional Status ◽

Mortality Risk ◽

Biological Age ◽

Chronological Age ◽

Skin Autofluorescence ◽

Risk Of Death ◽

Inflammatory Status ◽

All Cause Mortality

Abstract Background and Aims While chronological age associates with increased risk of death, there is a quest for markers of biological age in chronic kidney disease (CKD) that better reflect accumulation of tissue and cellular damage, which could contribute to shorter life span. Skin autofluorescence (SAF) is a biomarker for accumulation of advanced glycation end products in skin that associate with chronological age and with factors that may increase mortality risk. However, the predictive capacity of SAF for mortality has not been fully elucidated in CKD. We have investigated the relationship between biological age calculated by SAF, chronological age and all-cause mortality in patients with CKD stage 5. Method In a cohort of 199 CKD5 patients (non-dialysis CKD5, n=100, hemodialysis, n=27 and peritoneal dialysis, n=72; median age 66 years, 34% females, 21% diabetes (DM), 20% cardiovascular disease (CVD), and 34% malnourished), we calculated biological age by a formula based on SAF measurements using the AGE Reader. Framingham risk score, coronary artery calcium score, the heart rate-corrected augmentation index, body composition, nutritional status, handgrip strength, and various biochemical markers (hemoglobin, albumin, creatinine, intact-parathyroid hormone, triglyceride, cholesterol, HDL-cholesterol, high-sensitivity C-reactive protein (hsCRP), and interleukin (IL)-6) were recorded at baseline. During median follow-up of 38 months, 34 patients died, and 51 patients underwent renal transplantation. We analyzed spline curves showing sub-distribution hazard risk (sHR) for all-cause mortality with biological age calculated by SAF and chronological age by the Fine and Gray competing risk analysis. Results There was a significant association between biological age calculated by SAF and chronological age (rho=0.48; p<0.001). IL-6 and hsCRP were positively associated both with biological age according to SAF measurement (IL-6: rho=0.34, p<0.001; n=155 and hsCRP: rho=0.31, p<0.001; n=199) and chronological age (IL-6: rho=0.47, p<0.001; n=155 and hsCRP: rho=0.40, p<0.001; n=199). The multivariate spline curve showing sHR for all-cause mortality associated positively with chronological age (sHR: 1.04, p=0.035) and biological age calculated by SAF (sHR: 1.01, p=0.048) when adjusted for sex, DM, CVD, nutritional status, 1-standard deviation increase of hsCRP, and CKD5 groups. Conclusion All-cause mortality risk increased linearly with higher chronological age and SAF-estimated biological age - and with similar magnitude of sHR for the two - suggesting that prediction of mortality risk based on SAF is not superior compared to chronological age in CKD. We conclude that biological age calculated by SAF and chronological age are equally robust predictors of clinical outcomes in CKD; however, both indices are influenced by the inflammatory status.

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Effectiveness of Dietetic Intervention on Nutritional Status and Hydration Status in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2012.04.611 ◽

2012 ◽

Vol 31 (2) ◽

pp. A89

Author(s):

H.M. LAM ◽

I.Y.M. KAN ◽

J.Y.F. LOK

Keyword(s):

Peritoneal Dialysis ◽

Nutritional Status ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Hydration Status ◽

Dietetic Intervention

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SP692IMPACT OF NUTRITIONAL STATUS ON SKIN AUTOFLUORESCENCE IN HAEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx155.sp692 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii371-iii371

Author(s):

Daniela Viramontes Horner ◽

Nicholas Selby ◽

Maarten Taal

Keyword(s):

Nutritional Status ◽

Skin Autofluorescence

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Nutritional status as a prognostic factor in advanced head and neck cancer

Clinical Otolaryngology ◽

10.1046/j.1365-2273.1998.0165g.x ◽

1998 ◽

Vol 23 (4) ◽

pp. 376-376

Author(s):

Quak ◽

Van Bokhorst ◽

Klop ◽

Van Leeuwen ◽

Snow

Keyword(s):

Head And Neck Cancer ◽

Prognostic Factor ◽

Nutritional Status ◽

Head And Neck ◽

Neck Cancer ◽

Advanced Head

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Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000275 ◽

2017 ◽

Vol 87 (1-2) ◽

pp. 10-16 ◽

Cited By ~ 1

Author(s):

Salah Gariballa ◽

Awad Alessa

Keyword(s):

Nutritional Status ◽

Inductively Coupled Plasma ◽

Older Patients ◽

Controlled Trial ◽

Prognostic Indicators ◽

Hospitalised Patients ◽

Increased Risk ◽

Co Morbidity ◽

The Impact ◽

Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

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