Relationship Between Nutrition Intake and Outcome After Subarachnoid Hemorrhage: Results From the International Nutritional Survey

2021 ◽  
Vol 36 (10) ◽  
pp. 1141-1148
Author(s):  
Neeraj Badjatia ◽  
Alice Ryan ◽  
H. Alex Choi ◽  
Gunjan Y. Parikh ◽  
Xuran Jiang ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Multicenter Study ◽  
Cox Regression ◽  
Caloric Intake ◽  
Nutritional Risk ◽  
Artificial Nutrition ◽  
Nutrition Survey ◽  
Nutrition Risk ◽  
Time To Initiation ◽  
Nutrition Intake

Background: A previous study suggested an association between low caloric intake(CI), negative nitrogen balance, and poor outcome after subarachnoid hemorrhage(SAH). Objective of this multinational, multicenter study was to investigate whether clinical outcomes vary by protein intake(PI) or CI in SAH patients adjusting for the nutritional risk as judged by the modified NUTrition Risk in the Critically Ill (mNUTRIC) score. Methods: The International Nutrition Survey(INS) 2007-2014 was utilized to describe the characteristics, outcomes and nutrition use. A subgroup of patients from 2013 and 2014(when NUTRIC score was captured) examined the association between CI and PI and time to discharge alive(TTDA) from hospital using Cox regression models, adjusting for nutrition risk classified by the mNUTRIC score as low(0-4) or high(5-9). Results: There were 489 SAH patients(57% female with a mean ± SD age 57.5 ± 13.9 years, BMI of 25.9 ± 5.3 kg/m2 and APACHE-2 score 19.4 ± 7.0. Majority(85%) received enteral nutrition(EN) only, with a time to initiation of EN of 35.4 ± 35.2 hours. 64% had EN interrupted. Patients received a CI of 14.6 ± 7.1 calories/kg/day and PI 0.7 ± 0.3 grams/kg/day corresponding to 59% and 55% of total prescribed CI and PI respectively. In the 2013 and 2014 subgroup there were 226 SAH patients with a mNUTRIC score of 3.4 ± 1.8. Increased CI and PI were associated with faster TTDA among high mNUTRIC patients(HR per 20% of prescription received = 1.34[95% CI,1.03 -1.76] for CI and 1.44[1.07 -1.93] for PI), but not low mNUTRIC patients(CI: HR = 0.95[0.77 -1.16] PI:0.95[0.78 -1.16]). Conclusions: Results from this multicenter study found that SAH patients received under 60% of their prescribed CI and PI. Further, achieving greater CI and PI in hi risk SAH patients was associated with improved TTDA. mNUTRIC serves to identify SAH patients that benefit most from artificial nutrition and efforts to optimize protein and caloric delivery in this subpopulation should be maximized.

scholarly journals The Modified NUTRIC score (mNUTRIC) is Associated with Increased 28-day Mortality in Critically Ill COVID-19 Patients: Internal Validation of a Prediction Model.

2021 ◽  
Author(s):  
Matteo Luigi Giuseppe Leoni ◽  
Elisa Moschini ◽  
Maurizio Beretta ◽  
Marco Zanello ◽  
Massimo Nolli
Keyword(s):  
Risk Assessment ◽  
Prediction Model ◽  
Critically Ill ◽  
Cox Regression ◽  
High Sensitivity ◽  
Nutritional Risk ◽  
Internal Validation ◽  
Nutrition Risk ◽  
Reactive Protein ◽  
High Prevalence

Abstract BackgroundHigh prevalence of malnutrition was found in critically ill COVID-19 patients. The modified Nutrition Risk in the Critically ill (mNUTRIC) score is frequently used for nutritional risk assessment in intensive care unit (ICU) COVID-19 patients. The aim of this study was to investigate the role of mNUTRIC score to predict 28-day mortality in critically ill COVID-19 patients admitted to ICU. Methods A cohort of consecutive COVID-19 critically ill patients admitted to ICU was retrospectively evaluated and the nutritional risk was assessed with the use of mNUTRIC score. A multivariable Cox regression model to predict 28-day mortality was therefore developed including the mNUTRIC as a covariate. Internal validation was performed using the bootstrap resampling technique to reduce possible bias in the estimated risks. The performance of the prediction model was assessed via calibration and discrimination. ResultsA total of 98 critically ill COVID-19 patients with a median age of 66 years (56-73 IQR), 81 (82.7%) males were included in this study. A high nutritional risk (mNUTRIC ≥5 points) was observed in 41.8% of our critically ill COVID-19 patients while a low nutritional risk (mNUTRIC <5 points) was observed in 58.2%. Forty-five patients (45.9%) died within 28 days after ICU admission. In multivariable model after internal validation, mNUTRIC ≥5 (optimism adjusted HR 2.38, 95% CI 1.08-5.25, p=0.02) and high-sensitivity C-reactive protein values (CRP) (optimism adjusted HR 1.02, 95% CI 1.01-1.07, p=0.005) were independent predictors of 28-day mortality. ConclusionsA high prevalence of malnutrition as revealed by mNUTRIC was found in our critically ill COVID-19 patients once admitted in ICU. After adjustment for covariables, mNUTRIC ≥5 and CRP levels were independently associated with 28-day mortality in critically ill COVID-19 patients. The final model revealed good discrimination and calibration. Nutritional risk assessment is essential for the management of critically ill COVID-19 patients as well as for outcome prediction.

scholarly journals Relationship between Nutrition Intake and 28-Day Mortality Using Modified NUTRIC Score in Patients with Sepsis

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1906 ◽  
Author(s):  
Dae Hyun Jeong ◽  
Sang-Bum Hong ◽  
Chae-Man Lim ◽  
Younsuck Koh ◽  
Jarim Seo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Retrospective Cohort ◽  
Nutritional Support ◽  
Medical Intensive Care Unit ◽  
Nutritional Risk ◽  
Nutrition Risk ◽  
Nutrition Intake ◽  
Medical Intensive Care ◽  
The Relationship

In critically ill patients, malnutrition is known to increase morbidity and mortality. We investigated the relationship between nutritional support and 28-day mortality using the modified NUTrition RIsk in the Critically ill (NUTRIC) score in patients with sepsis. This retrospective cohort study included patients with sepsis admitted to the medical intensive care unit (ICU) between January 2011 and June 2017. Nutritional support for energy and protein intakes at day 7 of ICU admission were categorized into <20, 20 to <25, and ≥25 kcal/kg and <1.0, 1.0 to <1.2, and ≥1.2 g/kg, respectively. NUTRIC scores ≥4 were considered to indicate high nutritional risk. Among patients with low nutritional risk, higher intakes of energy (≥25 kcal/kg) and protein (≥1.2 g/kg) were not significantly associated with lower 28-day mortality. In patients with high nutritional risk, higher energy intakes of ≥25 kcal/kg were significantly associated with lower 28-day mortality compared to intakes of <20 kcal/kg (adjusted hazard ratio (aHR): 0.569, 95% confidence interval (CI): 0.339–0.962, p = 0.035). Higher protein intakes of ≥1.2 g/kg were also significantly associated with lower 28-day mortality compared to intakes of <1.0 g/kg (aHR: 0.502, 95% CI: 0.280–0.900, p = 0.021). Appropriate energy (≥25 kcal/kg) and protein (≥1.2 g/kg) intakes during the first week may improve outcomes in patients with sepsis having high nutritional risk.

scholarly journals Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Francisco G. Yanowsky-Escatell ◽  
Areli L. Ontiveros-Galindo ◽  
Kevin J. Arellano-Arteaga ◽  
Luis M. Román-Pintos ◽  
Carlos A. Andrade-Castellanos ◽  
...  
Keyword(s):  
Risk Factor ◽  
Observational Study ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Nutritional Risk ◽  
Retrospective Observational Study ◽  
Nutrition Risk ◽  
Cox Regression Analysis

Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. Methods. We conducted this retrospective observational study in critically ill patients with COVID-19. Patients’ characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. Results. Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147–15.425, p = 0.030 ). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219–3.252, p = 0.006 ). Conclusion. The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.

scholarly journals New screening tool for neonatal nutritional risk in China: a validation study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042467
Author(s):  
Mei Zhou ◽  
Yuwei Li ◽  
Huaying Yin ◽  
Xianhong Zhang ◽  
Yan Hu
Keyword(s):  
Validation Study ◽  
Head Circumference ◽  
Predictive Value ◽  
Screening Tool ◽  
Nutritional Risk ◽  
Risk Level ◽  
Spearman Correlation ◽  
Nutrition Risk ◽  
Sensitivity Specificity ◽  
Nutritional Risk Screening

ObjectiveA neonatal nutritional risk screening tool (NNRST) was developed by using Delphi and analytic hierarchy processes in China. We verified the accuracy of this tool and analysed whether it effectively screened neonates with nutritional risk.DesignProspective validation study.Setting and participantsIn total, 338 neonates who were admitted to the neonatal unit of Children’s Hospital of Chongqing Medical University from May–July 2016 completed the study. Nutritional risk screening and length and head circumference measurements were performed weekly. Weight was measured every morning, and other relevant clinical data were recorded during hospitalisation.Main outcome measuresWe evaluated the sensitivity, specificity, validity, reliability, and positive and negative predictive value of the screening tool. Various characteristics of neonates in different risk groups were analysed to determine the rationality of the nutritional risk classification.ResultsThe sensitivity, specificity, and positive and negative predictive values were 85.11%, 91.07%, 60.61% and 97.43%, respectively. The criterion validity was texted by the Spearman correlation analysis (r=0.530) and independent samples non-parametric tests (p=0.000). The content validity (Spearman correlation coefficient) was 0.321–0.735. The inter-rater reliability (kappa value) was 0.890. Among the neonatal clinical indicators, gestational age, birth weight, length, admission head circumference, admission albumin, admission total proteins, discharge weight, discharge length and head circumference decreased with increasing nutrition risk level; the length of stay and the rate of parenteral nutrition support increased with increasing nutrition risk level. In the comparison of complications during hospitalisation, the incidence of necrotising enterocolitis and congenital gastrointestinal malformation increased with increasing nutrition risk level.ConclusionThe validation results for the NNRST are reliable. The tool can be used to preliminarily determine the degree of neonatal nutritional risk, but its predictive value needs to be determined in future large-sample studies.Trial registration numberChiCTR2000033743.

Reflections of Dietary Studies With Children in the Ten-State Nutrition Survey of 1968-1970

PEDIATRICS ◽  
1975 ◽  
Vol 56 (2) ◽  
pp. 320-326
Author(s):  
Charles U. Lowe ◽  
Gilbert Forbes ◽  
Stanley Garn ◽  
George M. Owen ◽  
Nathan J. Smith ◽  
...  
Keyword(s):  
Total Energy ◽  
Energy Intake ◽  
Total Energy Intake ◽  
Nutritional Risk ◽  
Nutrition Survey ◽  
Biochemical Evidence ◽  
Selection Of

Physical (anthropometric) and biochemical evidence of malnutrition or of " nutritional risk" among children in the Ten-State Nutrition Survey reflected primarily an inadequacy of total energy intake and not improper selection of foods or "unbalanced" diets. Thus, the quantity of food—not the quality—was the major dietary problem highlighted by the Ten-State Nutrition Survey.

Abstract P320: Dietary Flavonoid Intake and Ischemic Stroke

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Margarethe Goetz ◽  
Viola Vaccarino ◽  
Terry Hartman ◽  
Bill McClellan ◽  
Aaron Anderson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cox Regression ◽  
Statistical Significance ◽  
Caloric Intake ◽  
Population Based ◽  
Total Flavonoid ◽  
Total Flavonoids ◽  
Inverse Association ◽  
Flavonoid Intake ◽  
Dietary Flavonoid

Introduction: Diets rich in plant-based foods have been associated with lower stroke risk. Plant-based foods contain a variety of potentially cardioprotective compounds, including flavonoids. We assessed the hypothesis that total flavonoid and flavonoid subclass intakes are associated with incident ischemic stroke in a population-based cohort oversampled for non-Hispanic blacks and Stroke Belt residents. Methods: Between 2003 and 2007, REGARDS enrolled black and white Americans age ≥ 45 years. Participants were 20,413 men and women who completed a Block 98 food frequency questionnaire (FFQ) and without stroke at baseline. Total flavonoid and flavonoid subclass (anthocyanidin, flavan-3-ol, flavanone, flavonol, flavone, proanthocyanidin and isoflavone) intakes were estimated using the food consumption reported by the FFQ and the flavonoid contents of each food using USDA databases. Incident strokes were captured by participant report and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident stroke using Cox regression models using the first quintile as the referent. Tests for trend used the quintile medians. Results: Adjusting for age and caloric intake, there was a statistically significant inverse association between total flavonoid intake and ischemic stroke (Q5 v Q1: HR=0.68; 95% CI=0.51, 0.90; p-trend=0.04) however, this association weakened after additional adjustment for demographic, socioeconomic and health behavior factors as well as self-reported CHD at baseline (Q5 v Q1: HR=0.77; 95% CI=0.58, 1.03; p-trend=0.31). A similar pattern was seen for flavanones (age, energy adjusted HR=0.74; 95% CI= 0.57, 0.95; p-trend=0.02; fully adjusted HR= 0.82; 95%CI=0.65, 1.05; p-trend=0.06). Effect estimates for total flavonoids, flavanones, proanthocyanidins, and isoflavones, suggested a protective, though nonlinear association with risk reduction emerging at the second quintile, though these did not achieve statistical significance (total flavonoids, fully adjusted HR (95% CI): Q2= 0.80 (0.61, 1.04); Q3= 0.85 (0.65, 1.11); Q4=0.92 (0.70, 1.19); Q5= 0.77 (0.58, 1.03)). Total flavonoid and flavanone intake were significantly associated with IS in fully adjusted models in women (total: Q5 v Q1 HR=0.62; 95% CI= 0.41, 0.94; p-trend=0.15; flavanones HR=0.65; 95% CI=0.44, 0.95; p-trend=0.03) but not in men (total: Q5 v Q1 HR=0.95; 95% CI= 0.63, 1.42; flavanones HR=0.80; 95% CI=0.58, 1.09; p-interaction=0.67). There was no effect modification by race or region of residence. Conclusion: Total dietary flavonoids and flavanones are associated with a reduction in risk of incident ischemic stroke, particularly in women. The emergence of a protective effect at the second quintile for total flavonoids, flavanones, proanthocyanidins and isoflavones is consistent with previous studies of dietary flavonoid intake and CVD mortality.

scholarly journals Trajectories of Mediterranean Diet Adherence and Risk of Hypertension in China: Results from the CHNS Study, 1997–2011

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 2014 ◽  
Author(s):  
Min Gao ◽  
Fengbin Wang ◽  
Ying Shen ◽  
Xiaorou Zhu ◽  
Xing Zhang ◽  
...  
Keyword(s):  
Mediterranean Diet ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Nutrition Survey ◽  
Cox Regression Analysis ◽  
Incident Hypertension ◽  
Diet Adherence ◽  
Mediterranean Diet Adherence

Evidence indicates that longitudinal changes in dietary patterns may predict variations in blood pressure (BP) and risk of incident hypertension. We aimed to identify distinct trajectories in the levels of Mediterranean diet adherence (MDA) in China and explore their association with BP levels and hypertension risk using the China Health and Nutrition Survey 1997–2011 data. Three levels of MDA were constructed. The trajectories in these levels were constructed using group-based trajectory modeling. A Cox proportional hazards model was used to measure the association between MDA trajectory groups and the risk of incident hypertension after adjusting for covariates. Finally, 6586 individuals were included. Six distinct MDA trajectory groups were identified: persistently low and gradual decline; rapidly increasing and stabilized; persistently moderate; slightly increasing, steady, and acutely descending; slightly decreasing and acutely elevated; and persistently high. The systolic BP and diastolic BP were significantly lower in trajectory groups with rapidly increasing and stabilized MDA; slightly increasing, steady, and acutely descending MDA; and persistently high MDA. Cox regression analysis showed that the risks of developing hypertension were relatively lower in the group with slightly increasing, steady, and acutely descending MDA (hazard ratio (HR) = 0.17, 95% confidence interval (CI): 0.09–0.32) and the group with rapidly increasing and stabilized MDA (HR = 0.32, 95% CI: 0.23–0.42), but the risk was the highest in the trajectory with persistently moderate MDA (HR = 0.96, 95% CI: 0.84–1.08). In conclusion, MDA in China was categorized into six distinct trajectory groups. BP was relatively lower in trajectory groups with initially high or increasing MDA levels. Greater MDA was significantly associated with a lower risk of developing hypertension.

scholarly journals Comparison of Feeding Efficiency and Hospital Mortality between Small Bowel and Nasogastric Tube Feeding in Critically Ill Patients at High Nutritional Risk

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2009
Author(s):  
Wei-Ning Wang ◽  
Chen-Yu Wang ◽  
Chiann-Yi Hsu ◽  
Pin-Kuei Fu
Keyword(s):  
Small Bowel ◽  
Enteral Nutrition ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Energy Intake ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Nutritional Risk ◽  
Nutrition Risk ◽  
Achievement Rate

Nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h for patients at high nutritional risk. However, whether small bowel enteral nutrition (SBEN) should be routinely used instead of NGEN to improve hospital mortality remains unclear. We retrospectively analyzed 113 critically ill patients with modified Nutrition Risk in Critically Ill (mNUTRIC) score ≥ 5 and feeding volume < 750 mL/day in the first week of their stay in the intensive care unit (ICU). Age, sex, mNUTRIC score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were matched in the SBEN (n = 48) and NGEN (n = 65) groups. Through a univariate analysis, factors associated with hospital mortality were SBEN group (hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.31–1.00), Simplified Organ Failure Assessment (SOFA) score on day 7 (HR, 1.12; 95% CI, 1.03–1.22), and energy intake achievement rate < 65% (HR, 2.53; 95% CI, 1.25–5.11). A multivariate analysis indicated that energy intake achievement rate < 65% on the third follow-up day (HR, 2.29; 95% CI, 1.12–4.69) was the only factor independently associated with mortality. We suggest initiation of SBEN on the seventh ICU day before parenteral nutrition initiation for critically ill patients at high nutrition risk.

Home artificial nutritional support: the value of the British Artificial Nutrition Survey

2001 ◽  
Vol 20 ◽  
pp. 61-66 ◽  
Author(s):  
M ELIA ◽  
R STRATTON ◽  
C HOLDEN ◽  
N MEADOWS ◽  
A MICKLEWRIGHT ◽  
...  
Keyword(s):  
Nutritional Support ◽  
Artificial Nutrition ◽  
Nutrition Survey
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