Changes in nutritional status by recovery phase interventions would be a powerful determinant of cardiovascular prognosis in heart failure patients

Abstract Background Adequate nutrition has been proposed for better cardiovascular prognosis as well as fitness, although the impact of the “changes” in nutrition and fitness at recovery phase on the future prognosis has been unclear. Purpose We aimed to examine whether the change in nutritional level as a result of dietary intervention combined with exercise would determine patients' cardiovascular prognosis. Methods This study involved 398 consecutive patients who participated in phase II comprehensive cardiac rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion periods of CCR. Individual dietary guidance was periodically performed with exercise. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided in two groups according to the baseline GNRI and the change in GNRI (ΔGNRI) by the median, respectively, to compare their prognosis between groups. Then they were classified into four categories according to the median values of the changes in GNRI (ΔGNRI) and PVO2 (ΔPVO2) during CCR: “Both improved”, “Only GNRI improved”, “Only PVO2 improved” and “Both NOT improved”, to compare MACCE-free rate between categories. Results The rate of MACCE showed significant difference between categories (14%, 18%, 19% and 36%, p<0.001), which was approximately 2 times higher in “Both NOT improved” than the others. Kaplan-Meier analysis showed that according to the level of ΔGNRI, “higher ΔGNRI group” showed significantly higher in MACCE-free survival rate than “lower ΔGNRI group” (log rank p=0.010), whereas there was no significant difference according to the baseline GNRI (see figure). According to the categories divided by ΔGNRI and ΔPVO2, MACCE-free rate was significantly lower in “Both NOT improved” (log rank p<0.001) compared to the other categories. Cox proportional hazard regression analysis revealed that “both NOT improved” was an independent predictor of MACCE (hazard ratio, 2.1, 95% confident interval, 1.344–3.175, p<0.001). Conclusion Changes in nutritional level would determine patients' cardiovascular prognosis rather than the baseline nutritional level. Non-responders who showed no improvement in nutritional or fitness by interventions may result in a poor cardiovascular outcome. Funding Acknowledgement Type of funding source: None

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P1169NUTRITIONAL STATUS OF PATIENTS IN PERITONEAL DIALYSIS: TWO METHODS COMPARED

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1169 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Giuseppe Paribello ◽

Oto Di Gruttola ◽

Immacolata Gaia Paduano ◽

Silvia Migliaccio ◽

Gennaro Argentino ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Nutritional Status ◽

Eating Habits ◽

Risk Index ◽

Point Of View ◽

Nutritional Risk ◽

Dialysis Adequacy ◽

Number Of Patients ◽

Significant Difference ◽

Nutritional Risk Index

Abstract Background and Aims Nutritional status and survival are closely related: a state of undernutrition favors the onset of fatal and non-fatal events. This association becomes even more important in the dialysis patient in which a vicious circle is generated in which undernutrition worsens the basic condition. The issue of our study is to evaluate the nutritional status of patients on peritoneal dialysis (PD) comparing the two methods (CAPD-APD). Method We evaluated 36 PD patients whose characteristics are reassumed in Tab1. In these patients, dialysis adequacy was assessed by Kt/v and nutritional status through biochemical parameters and the following scores (Tab.2): • PCR (Protein catabolic rate) • PEW (Protein energy waste) • GNRI (Geriatric nutritional risk index) • CONUT (Controlling nutritional status score) Results The data collected shows that 29 patients have a dialysis adequacy compliant with that proposed by the international guidelines (Kt/v ≥ 1.7), of the 7 patients who do not achieve this adequacy 4 are in CAPD and 3 in APD. From a nutritional point of view we consider the ideal PCR of about 1.2 g/kg weight, but this value is difficult to reach by many patients; therefore, a value of at least 0.8 g/Kg/day is considered acceptable. This target is reached by 26 patients; of the 10 patients who do not reach it, 3 are in CAPD and 7 in APD. Analyzing the two methods separately, we can observe that in the CAPD patients the PCR is significantly higher (p <0.002). As regards GNRI, a score <92 is considered as an indicator of an unfavorable prognosis; in this case we can observe that only 3 patients have a score <92, all in APD without however a significant difference between the two methods (p <0.36). Taking into account the reference values for PEW (Tab2) we can highlight the difference between the two methods in the number of patients with a moderate/severe undernutrition status: 13 in APD vs 6 in CAPD. The same can be said for CONUT where an important state of undernutrition is observed in 4 patients in APD vs 1 single patient in CAPD. Conclusion The study shows how the combined use of multiple parameters is fundamental in managing of patients nutritional status in peritoneal dialysis. The overall analysis of the scores used has shown a greater risk of malnutrition in APD patients in which is necessary to monitor carefully nutritional status, eating habits and lifestyle.

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P2528Responsiveness to nutritional intervention would impact on future cardiovascular prognosis in poor fitness patients

European Heart Journal ◽

10.1093/eurheartj/ehz748.0857 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Ehara ◽

K Shibata ◽

M Kameshima ◽

H Fujiyama ◽

M Terai ◽

...

Keyword(s):

Exercise Intervention ◽

Risk Index ◽

Peak Oxygen Uptake ◽

Cardiopulmonary Exercise Test ◽

Nutritional Risk ◽

Exercise Interventions ◽

Fitness Level ◽

Cardiovascular Prognosis ◽

Significant Difference ◽

Nutritional Risk Index

Abstract Purpose Nutritional improvement has been proposed for long-term cardiovascular prognosis as well as fitness recovery. We aimed to examine whether “responsiveness” to nutritional and exercise interventions would impact patients' cardiovascular prognosis even patients in low baseline fitness level. Methods We included 254 consecutive patients who participated in the phase II comprehensive cardiovascular rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion phases of CCR. Nutritional guidance was periodically performed individually during CCR. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided into “low fitness” and “normal fitness” groups based on the median of baseline PVO2. Each group was further classified into four categories according to the changes in VO2 and GNRI during CCR: “Both NOT improved”, “Only GNRI improved”, “Only PVO2 improved”, and “Both improved”. Results Cox proportional regression analysis showed that the category of “both NOT improved” was an independent predictor for cardiovascular risk among the baseline low fitness group (Hazard ratio: 4.5, p=0.007); whereas no significant difference among the normal fitness group. Kaplan-Meier analysis revealed that the event-free survival rate was significantly lower in the “both NOT improved” category (log rank p=0.002) among the baseline low fitness group (figure); whereas no significant difference among the normal fitness group. GNRI/PVO2 improvement vs. prognosis Conclusion Responsiveness to nutritional and exercise intervention could be a predictive factor of cardiovascular prognosis even in low fitness patients.

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Serum Thiamine Values in End-Stage Renal Disease Patients under Maintenance Hemodialysis

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000242 ◽

2015 ◽

Vol 85 (5-6) ◽

pp. 348-355 ◽

Cited By ~ 2

Author(s):

Masamitsu Ubukata ◽

Nobuyuki Amemiya ◽

Kosaku Nitta ◽

Takashi Takei

Keyword(s):

Thiamine Deficiency ◽

Risk Index ◽

Nutritional Risk ◽

Maintenance Hemodialysis ◽

Dialysis Patients ◽

Significant Difference ◽

Nutritional Risk Index ◽

Serum Aspartate Aminotransferase ◽

Stage Renal Disease ◽

End Stage

Abstract. Objective: Hemodialysis patients are prone to malnutrition because of diet or many uremic complications. The objective of this study is to determine whether thiamine deficiency is associated with regular dialysis patients. Methods: To determine whether thiamine deficiency is associated with regular dialysis patients, we measured thiamine in 100 patients undergoing consecutive dialysis. Results: Average thiamine levels were not low in both pre-hemodialysis (50.1 ± 75.9 ng/mL; normal range 24 - 66 ng/mL) and post-hemodialysis (56.4 ± 61.7 ng/mL). In 18 patients, post-hemodialysis levels of thiamine were lower than pre-hemodialysis levels. We divided the patients into two groups, the decrease (Δthiamine/pre thiamine < 0; - 0.13 ± 0.11) group (n = 18) and the increase (Δthiamine/pre thiamine> 0; 0.32 ± 0.21)) group (n = 82). However, there was no significance between the two groups in Kt/V or type of dialyzer. Patients were dichotomized according to median serum thiamine level in pre-hemodialysis into a high-thiamine group (≥ 35.5 ng/mL) and a low-thiamine group (< 35.4 ng/mL), and clinical characteristics were compared between the two groups. The low-thiamine value group (< 35.4 ng/ml; 26.8 ± 5.3 ng/ml) exhibited lower levels of serum aspartate aminotransferase and alanine aminotransferase than the high-thiamine value group (≥ 35.4 ng/ml; 73.5 ± 102.5 ng/ml) although there was no significance in nutritional marker, Alb, geriatric nutritional risk index , protein catabolic rate and creatinine generation rate. Conclusion: In our regular dialysis patients, excluding a few patients, we did not recognize thiamine deficiency and no significant difference in thiamine value between pre and post hemodialysis.

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Prognosis in Head and Neck Cancer: Importance of Nutritional and Biological Inflammatory Status

Otolaryngology ◽

10.1177/01945998211004592 ◽

2021 ◽

pp. 019459982110045

Author(s):

Nicolas Saroul ◽

Mathilde Puechmaille ◽

Céline Lambert ◽

Achraf Sayed Hassan ◽

Julian Biau ◽

...

Keyword(s):

Head And Neck Cancer ◽

Prognostic Factors ◽

Inflammatory Response ◽

Nutritional Status ◽

Head And Neck ◽

Neck Cancer ◽

Risk Index ◽

Nutritional Risk ◽

Inflammatory Status ◽

Nutritional Risk Index

Objectives To determine the importance of nutritional status, social status, and inflammatory status in the prognosis of head and neck cancer. Study Design Single-center retrospective study of prospectively collected data. Setting Tertiary referral center. Methods Ninety-two consecutive patients newly diagnosed for cancer of the upper aerodigestive tract without metastases were assessed at time of diagnosis for several prognostic factors. Nutritional status was assessed by the nutritional risk index, social status by the EPICES score, and inflammatory status by the systemic inflammatory response index. The primary endpoint was overall survival. Results In multivariable analysis, the main prognostic factors were the TNM classification (hazard ratio [HR] = 3.34, P = .002, for stage T3-4), malnutrition as assessed by the nutritional risk index (HR = 3.64, P = .008, for severe malnutrition), and a systemic inflammatory response index score ≥1.6 (HR = 3.32, P = .02). Social deprivation was not a prognostic factor. Conclusion Prognosis in head and neck cancer is multifactorial; however, malnutrition and inflammation are important factors that are potentially reversible by early intervention.

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Abstract 12880: Malnutrition Assessed by Geriatric Nutritional Risk Index Provides the Long-term Prognostic Information in Patients Admitted for Acute Decompensated Heart Failure, Regardless of Reduced or Preserved Left Ventricular Ejection Fraction; A Comparison With Prognostic Nutritional Index and CONUT Score

Circulation ◽

10.1161/circ.132.suppl_3.12880 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Takahisa Yamada ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

Yusuke Iwasaki ◽

...

Keyword(s):

Nutritional Status ◽

Serum Albumin ◽

Risk Index ◽

Left Ventricular ◽

Nutritional Risk ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Nutritional Index ◽

Nutritional Risk Index ◽

Conut Score

Backgrounds: Malnutrition is associated with increased mortality risk in patients (pts) with acute decompensated heart failure(ADHF). Nutritional status is assessed by several indices, such as Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score. However, there is no information available on the comparison of prognostic significance of these indices in ADHF pts, relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF). Methods and Results: We studied 303 consecutive pts admitted for ADHF and discharged alive (HFrEF(LVEF<50%);n=163, HFpEF(LVEF≥50%);n=140). Nutritional status was evaluated at the discharge by GNRI calculated as follows: 14.89 • serum albumin (g/dl) + 41.7 • BMI/22, PNI calculated as follows: 10 • serum albumin (g/dl) + 0.005 • total lymphocyte count (/ml) and CONUT score calculated by serum albumin, total cholesterol levels and lymphocyte count. During a follow-up period of 5.0±4.3 yrs, 75 pts had cardiovascular death (CVD). At multivariate Cox analysis, GNRI (p<0.0001) was significantly associated with CVD, independently of systolic blood pressure, serum sodium level and eGFR, although PNI and CONUT score showed a significant association with CVD at univariate analysis. ROC analysis revealed that GNRI of 88 was a fair discriminator for CVD (AUC 0.70(95%CI 0.63-0.77), p<0.0001). In group with HFrEF, CVD was significantly more frequently observed in pts with than without low GNRI <88 (48% vs 25%, p<0.0001, adjusted HR 3.5[1.8-6.6]). Furthermore, in group with HFpEF, pts with low GNRI had the significantly increased risk, compared to those with high GNRI>88 (36% vs 10%, p<0.0001, adjusted HR 3.8[1.4-10.2]). Conclusion: Malnutrition assessed by Geriatric Nutritional Index provides more valuable long-term prognostic information than PNI and CONUT score in pts admitted for ADHF, regardless of HFrEF or HFpEF.

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Geriatric nutritional risk index as a predictor of complications and long-term outcomes in patients with gastrointestinal malignancy: a systematic review and meta-analysis

Cancer Cell International ◽

10.1186/s12935-020-01628-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hailun Xie ◽

Shuangyi Tang ◽

Lishuang Wei ◽

Jialiang Gan

Keyword(s):

Postoperative Complications ◽

Meta Analysis ◽

Risk Index ◽

Nutritional Risk ◽

Long Term Outcomes ◽

Gastrointestinal Malignancy ◽

Free Survival ◽

Nutritional Risk Index ◽

The Impact

Abstract Background The effect of the geriatric nutritional risk index (GNRI) on the prognosis of patients with gastrointestinal malignancy remains unclear. The aim of our study was to systematically explore the value of the GNRI in evaluating postoperative complications and long-term outcomes in gastrointestinal malignancy. Methods A systematic literature search was conducted using electronic databases to report the impact of the GNRI on postoperative complications and long-term outcomes of patients with gastrointestinal malignancies as of August 2020. The hazard ratio (HR) with a 95% confidence interval (CI) was used to evaluate the impact of the GNRI on long-term outcomes. The risk ratio (RR) with 95% CI was used to assess the impact of the GNRI on postoperative complications. Result A total of nine studies with 2,153 patients were enrolled in our meta-analysis. The results suggested that a low GNRI was correlated with poor overall survival of patients with gastrointestinal malignancy (HR = 1.94, 95% CI 1.65–2.28, p < 0.001). Patients with a low GNRI had a higher risk of complications than patients with a high GNRI (OR = 2.19, 95% CI 1.57–3.05, p < 0.001). In addition, patients with a low GNRI had shorter relapse-free survival (HR = 2.45, 95% CI 1.50–4.00, p < 0.001) and disease-free survival (HR = 1.84, 95% CI 1.23–2.76, p = 0.003) than those with a high GNRI. However, the GNRI was not an independent factor affecting cancer-specific survival (HR = 1.60, 95% CI 0.91–2.82, p = 0.101). Conclusion Based on existing evidence, the GNRI was a valuable predictor of complications and long-term outcomes in patients with gastrointestinal malignancy.

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Preoperative Nutritional Status and Its Consequences on Abdominal Surgery in Wolaita Zone, Southern Ethiopia: An Institution-Based Observational Study

Journal of Nutrition and Metabolism ◽

10.1155/2020/2324395 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Leila Hussen ◽

Elazar Tadesse ◽

Dereje Yohannes Teferi

Keyword(s):

Wound Healing ◽

Observational Study ◽

Nutritional Status ◽

Abdominal Surgery ◽

Nutritional Assessment ◽

Risk Index ◽

Nutritional Risk ◽

Southern Ethiopia ◽

Increased Risk ◽

Nutritional Risk Index

This study aimed to determine the prevalence of malnutrition and its association with wound healing and length of hospitalization among patients undergoing abdominal surgery admitted to hospitals in the Wolaita zone in southern Ethiopia. Methods. An institution-based prospective observational study was conducted in three hospitals in the Wolaita zone from August to October 2016. All eligible individuals aged between 19 and 55 years were recruited in this study. Anthropometric and biochemical analyses, such as serum albumin (Alb) and total lymphocyte count (TLC), were taken for nutritional assessment during the preoperative period. Quantitative variables were compared using Student’s t test. Cox’s regression was employed to determine which variables were possible risk factors for poor wound healing. Results. A total of 105 patients aged 19 to 55 with a mean age (±SD) of 34 ± 9.6 years were included, and the prevalence of preoperative malnutrition was 27.6%, 87%, according to BMI and nutritional risk index, respectively. Poor wound healing was significantly associated with underweight patients (BMI < 18.5 kg/m2) (AHR: 6.5 : 95%CI: 3.312.9), postoperative weight loss (AHR: 4.9; 95%CI: 2.8–8.5), and nutritional risk index (NRI) less than 97.5 (AHR 1.8; 95% CI: 1.09–3.1). Conclusion. The prevalence of malnutrition is high in our study setup; this is associated with an increased risk of adverse postoperative outcomes. Therefore, our results emphasize the need of routine preoperative nutritional assessment, optimizing nutritional status of patients and postoperative nutritional support.

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Impact of Nutritional Status on Peritonitis in CAPD Patients

Peritoneal Dialysis International ◽

10.1177/089686080702700110 ◽

2007 ◽

Vol 27 (1) ◽

pp. 42-47 ◽

Cited By ~ 40

Author(s):

Narayan Prasad ◽

Amit Gupta ◽

Raj K. Sharma ◽

Archna Sinha ◽

Ramesh Kumar

Keyword(s):

Nutritional Status ◽

Serum Albumin ◽

Serum Albumin Level ◽

Risk Index ◽

Univariate Analysis ◽

Albumin Level ◽

Calorie Intake ◽

Cox Regression Analysis ◽

Nutritional Risk Index ◽

The Impact

Objective To determine the impact of nutritional status on peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in a developing country. Methods 56 patients with end-stage renal disease on CAPD were randomly selected for this study. These patients were assessed for nutritional status and peritonitis episodes. Nutritional parameters were assessed by anthropometry, diet, body mass index (BMI), Nutritional Risk Index (NRI), serum albumin level, and Subjective Global Assessment (SGA). Based on SGA, patients were categorized into either group 1 (malnutrition, n = 31) or group 2 (normal nutritional status, n = 25). Peritonitis was considered the primary outcome and was compared between the two groups. Results Demographic profiles, Kt/V, creatinine clearance, and mean follow-up of the two groups were similar. Number of peritonitis episodes was significantly higher in patients with malnutrition (25/31) compared to patients with normal nutritional status (4/25) ( p = 0.001). Mean peritonitis rate per patient per year was also significantly higher in patients with malnutrition (0.99 ± 1.07) compared to patients with normal nutritional status (0.18 ± 0.42) ( p = 0.007). On univariate analysis, malnutrition based on SGA ( p = 0.009), NRI ( p = 0.02), serum albumin level ( p = 0.005), and calorie intake ( p = 0.006) was a significant predictor of peritonitis. On multivariate Cox regression analysis, only SGA ( p = 0.001, odds ratio 0.08, 95% confidence interval 0.02 – 0.36) was found to be a significant predictor of peritonitis. On general linear model, the observed power of prediction of peritonitis was 0.96 based on SGA. On Kaplan–Meier survival analysis, peritonitis-free survival in patients with normal nutrition (42 months) was significantly higher compared to patients with malnutrition (21 months) based on SGA (log rank p = 0.003). Conclusion We conclude that peritonitis rate is high in patients with malnutrition and that malnutrition indices, especially SGA, can predict the peritonitis rate in CAPD patients.

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Abstract 12986: Geriatric Nutritional Risk Index Provides the Additional Long-term Prognostic Information to Gwtg Heart Failure Risk Score in Acute Decompensated Heart Failure Patients With and Without Reduced LVEF

Circulation ◽

10.1161/circ.142.suppl_3.12986 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Takahisa Yamada ◽

Tetsuya Watanabe ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

...

Keyword(s):

Heart Failure ◽

Nutritional Status ◽

Risk Score ◽

Risk Index ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Prognostic Information ◽

Poor Outcome ◽

Nutritional Risk Index

Backgrounds: The Get with The Guidelines (GWTG) heart failure (HF) risk score was developed in the GWTG inpatient HF registry to predict in-hospital mortality and has been recently reported to be associated with post-discharge long-term outcomes. Malnutrition is associated with poor outcome in ADHF patients. However, there is no information available on the long-term prognostic significance of the combination of GWTG-HF risk score and malnutrition in patients admitted for ADHF, relating to reduced left ventricular ejection fraction (LVEF). Methods: We studied 303 ADHF patients discharged with survival (HFrEF(LVEF<40%); n=180, HFpEF(LVEF≥40%;n=123). At the admission, we evaluated GWTG-HF score and nutritional status. Variables required for the GWTG-HF risk score were race, age, systolic blood pressure, heart rate, serum levels of blood urea nitrogen and sodium, and the presence of chronic obstructive pulmonary disease. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89 · serum albumin (g/dl) + 41.7 · BMI/22, and malnutrition was defined as GNRI<92. The study endpoint was cardiovascular-renal poor outcome (CVR), defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. Results: During a follow-up period of 4.2±3.3 yrs, 86 patients had CVR. At multivariate Cox analysis, GWTG-HF risk score and GNRI were significantly and independently associated with CVR, in both HFrEF and HFpEF groups. The patients with both greater GWTG-HF score (>median value=35) and malnutrition had a significantly increased risk of CVR than those with either and none of them ([HFrEF] 60% vs 32% vs 16%, p<0.0001, [HFpEF] 45% vs 18% vs 12%, p<0.0001, respectively) Conclusion: Malnutrition assessed by GNRI would provide the additional long-term prognostic information to GWTG-HF risk score in patients admitted for ADHF, irrespective of the presence of reduced LV function.

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