Assessment of body composition and association with clinical outcomes in patients with lung and colorectal cancer

Objectives: To assess body composition in patients with non-small cell lung cancer (NSCLC) and colorectal cancer using whole body MRI and relate this to clinical outcomes. Methods: 53 patients with NSCLC (28 males, 25 females; mean age 66.9) and 74 patients with colorectal cancer (42 males, 32 females; mean age 62.9) underwent staging whole-body MRI scans which were post-processed to derive fat mass (FM), fat free mass (FFM) and skeletal muscle (SM) indices and SM fat fraction (FF). These were compared between the two cancer cohorts using two-sided t-tests and the chi-squared test. Measurements of body composition were correlated with outcomes including length of hospital stay, metastatic status and mortality. Results: Patients with NSCLC had significantly lower FFM (p = 0.0071) and SM (p = 0.0084) indices. Mean SM FF was greater in patients with NSCLC (p = 0.0124) and was associated with longer hospital stay (p = 0.035). There was no significant relationship between FM, FFM and SM indices and length of hospital stay, metastatic status or mortality. Conclusions: Patients with NSCLC had lower FFM and SM indices than patients with colorectal cancer and greater SMFF, indicating lower SM mass with fatty infiltration. These findings reflect differences in the phenotype of the two groups and suggest patients with lung cancer are more likely to require additional nutritional support. Advances in knowledge: Body composition differs between NSCLC and colorectal cancer. Patients with NSCLC have both a reduced SM mass and greater SM FF suggesting that they are more nutritionally deplete than patients with colorectal cancer.

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The relation between Malnutrition Universal Screening Tool (MUST), computed tomography–derived body composition, systemic inflammation, and clinical outcomes in patients undergoing surgery for colorectal cancer

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz230 ◽

2019 ◽

Vol 110 (6) ◽

pp. 1327-1334 ◽

Cited By ~ 6

Author(s):

Arwa S Almasaudi ◽

Stephen T McSorley ◽

Ross D Dolan ◽

Christine A Edwards ◽

Donald C McMillan

Keyword(s):

Colorectal Cancer ◽

Computed Tomography ◽

Body Composition ◽

Nutritional Status ◽

Hospital Stay ◽

Clinical Outcomes ◽

Universal Screening ◽

Screening Tool ◽

Length Of Hospital Stay ◽

Malnutrition Universal Screening Tool

ABSTRACT Background Nutritional status is an important factor affecting a patient's clinical outcomes. Early identification of patients who are at risk of malnutrition is important to improve clinical outcomes and reduce health cost. The Malnutrition Universal Screening Tool (MUST) has been recommended as part of the routine nursing assessment for all patients at hospital admission. Objective The aim of this study was to examine the association between nutritional status (MUST), systemic inflammatory response (SIR), body composition, and clinical outcomes in patients undergoing surgery for colorectal cancer. Methods The malnutrition risk was examined using MUST in patients admitted for surgery for colorectal cancer between March 2013 and June 2016. Preoperative computed tomography scans were used to define the body composition. The presence of SIR was evidenced by the modified Glasgow prognostic score and the neutrophil to lymphocyte ratio. Postoperative complications, severity of complication, length of hospital stay, and mortality were considered as outcome measures. Results The study included 363 patients (199 males, 164 females); 21% of the patients presented with a medium or high nutritional risk. There were significant associations between MUST and subcutaneous adiposity (P < 0.001), visceral obesity (P < 0.001), and low skeletal muscle index (P < 0.001). No statistically significant association was identified between MUST score and presence of any complication or severity of complication. On multivariate analysis, MUST remained independently associated with the length of hospital stay (OR: 2.17; 95% CI: 1.45, 3.26; P < 0.001). Kaplan–Meier survival curves showed an increased number of deaths for patients at medium or high risk of malnutrition (P < 0.001). This association was found to be independent of other confounding factors (HR: 1.45; 95% CI: 1.06, 1.99; P = 0.020). Conclusions MUST score is an independent marker of risk in those undergoing surgery for colorectal cancer and should remain a key part of preoperative assessment.

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Effects of early corticosteroid use in patients with severe coronavirus disease 2019

BMC Infectious Diseases ◽

10.1186/s12879-021-06221-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jong Hoon Hyun ◽

Moo Hyun Kim ◽

Yujin Sohn ◽

Yunsuk Cho ◽

Yae Jee Baek ◽

...

Keyword(s):

Hospital Stay ◽

Clinical Outcomes ◽

Case Fatality ◽

Length Of Hospital Stay ◽

Corticosteroid Treatment ◽

Threshold Value ◽

Steroid Use ◽

Corticosteroid Administration ◽

Significant Difference ◽

Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

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NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Nutrients ◽

10.3390/nu13061781 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1781

Author(s):

Emanuele Rinninella ◽

Alberto Biondi ◽

Marco Cintoni ◽

Pauline Raoul ◽

Francesca Scialanga ◽

...

Keyword(s):

Body Composition ◽

Colorectal Surgery ◽

Elderly Patients ◽

Clinical Outcomes ◽

Cell Mass ◽

Length Of Hospital Stay ◽

Bioelectrical Impedance ◽

High Volume ◽

Analysis Data ◽

Perioperative Outcomes

Background: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. Methods: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into “NutriCatt + ERAS” (n = 166) or “standard ERAS” patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01–0.56; p = 0.009). Conclusions: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery.

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Resident involvement in laparoscopic procedures does not worsen clinical outcomes but may increase operative times and length of hospital stay

Surgical Endoscopy ◽

10.1007/s00464-015-4674-z ◽

2015 ◽

Vol 30 (9) ◽

pp. 3783-3791 ◽

Cited By ~ 18

Author(s):

Jennifer Jolley ◽

Daniel Lomelin ◽

Anton Simorov ◽

Carl Tadaki ◽

Dmitry Oleynikov

Keyword(s):

Hospital Stay ◽

Clinical Outcomes ◽

Length Of Hospital Stay ◽

Laparoscopic Procedures ◽

Resident Involvement

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Perceived patient burden and acceptability of whole body MRI for staging lung and colorectal cancer; comparison with standard staging investigations

British Journal of Radiology ◽

10.1259/bjr.20170731 ◽

2018 ◽

pp. 20170731 ◽

Cited By ~ 11

Author(s):

Ruth EC Evans ◽

Stuart A Taylor ◽

Sandra Beare ◽

Steve Halligan ◽

Alison Morton ◽

...

Keyword(s):

Colorectal Cancer ◽

Whole Body ◽

Whole Body Mri ◽

Patient Burden

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Whole body MRI is effective for identifying metastatic disease in colorectal cancer patients

BMJ ◽

10.1136/bmj.l5453 ◽

2019 ◽

pp. l5453

Author(s):

Rob Cook ◽

Peter Davidson ◽

Rosie Martin

Keyword(s):

Colorectal Cancer ◽

Diagnostic Accuracy ◽

Cancer Patients ◽

Metastatic Disease ◽

Health Technology ◽

Whole Body ◽

Newly Diagnosed ◽

Whole Body Mri ◽

Health Technology Assessment Programme ◽

Colorectal Cancer Patients

The studyTaylor S, Mallett S, Beare S et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol 2019;4:529-37.This project was funded by the NIHR Health Technology Assessment Programme (project number 10/68/01).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000797/identifying-metastatic-disease-in-colorectal-cancer-with-whole-body-mri

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P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis

European Heart Journal ◽

10.1093/eurheartj/ehz746.0454 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Seguchi ◽

K Sakakura ◽

K Yamamoto ◽

Y Taniguchi ◽

H Wada ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Propensity Score ◽

Hospital Stay ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Length Of Hospital Stay ◽

Hospital Death ◽

Very Elderly ◽

Hospital Outcomes

Abstract Background Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians. Methods We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38). Results Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01). Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase. Flow-chart Conclusions The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed. Acknowledgement/Funding None

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Effects of creatine loading and prolonged creatine supplementation on body composition, fuel selection, sprint and endurance performance in humans

Clinical Science ◽

10.1042/cs1040153 ◽

2003 ◽

Vol 104 (2) ◽

pp. 153-162 ◽

Cited By ~ 10

Author(s):

Luc J.C. van LOON ◽

Audrey M. OOSTERLAAR ◽

Fred HARTGENS ◽

Matthijs K.C. HESSELINK ◽

Rodney J. SNOW ◽

...

Keyword(s):

Body Composition ◽

Creatine Supplementation ◽

Time Trial ◽

Oxidative Capacity ◽

Substrate Utilization ◽

Cycle Ergometer ◽

Fat Free Mass ◽

Whole Body ◽

Total Creatine ◽

Trial Performance

Most research on creatine has focused on short-term creatine loading and its effect on high-intensity performance capacity. Some studies have investigated the effect of prolonged creatine use during strength training. However, studies on the effects of prolonged creatine supplementation are lacking. In the present study, we have assessed the effects of both creatine loading and prolonged supplementation on muscle creatine content, body composition, muscle and whole-body oxidative capacity, substrate utilization during submaximal exercise, and on repeated supramaximal sprint, as well as endurance-type time-trial performance on a cycle ergometer. Twenty subjects ingested creatine or a placebo during a 5-day loading period (20g·day-1) after which supplementation was continued for up to 6 weeks (2g·day-1). Creatine loading increased muscle free creatine, creatine phosphate (CrP) and total creatine content (P<0.05). The subsequent use of a 2g·day-1 maintenance dose, as suggested by an American College of Sports Medicine Roundtable, resulted in a decline in both the elevated CrP and total creatine content and maintenance of the free creatine concentration. Both short- and long-term creatine supplementation improved performance during repeated supramaximal sprints on a cycle ergometer. However, whole-body and muscle oxidative capacity, substrate utilization and time-trial performance were not affected. The increase in body mass following creatine loading was maintained after 6 weeks of continued supplementation and accounted for by a corresponding increase in fat-free mass. This study provides definite evidence that prolonged creatine supplementation in humans does not increase muscle or whole-body oxidative capacity and, as such, does not influence substrate utilization or performance during endurance cycling exercise. In addition, our findings suggest that prolonged creatine ingestion induces an increase in fat-free mass.

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Variation in length of hospital stay after lung cancer surgery in the Netherlands†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy074 ◽

2018 ◽

Vol 54 (3) ◽

pp. 560-564 ◽

Cited By ~ 7

Author(s):

Erik M von Meyenfeldt ◽

Geertruid M H Marres ◽

Eric van Thiel ◽

Ronald A M Damhuis

Keyword(s):

Lung Cancer ◽

The Netherlands ◽

Hospital Stay ◽

Lung Cancer Surgery ◽

Length Of Hospital Stay ◽

Cancer Surgery

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The Impact of Perioperative Glutamine-supplemented Parenteral Nutrition on Outcomes of Patients Undergoing Abdominal Surgery: A Meta-analysis of Randomized Clinical Trials

The American Surgeon ◽

10.1177/000313481307900527 ◽

2013 ◽

Vol 79 (5) ◽

pp. 506-513 ◽

Cited By ~ 10

Author(s):

Chao Yue ◽

Weiliang Tian ◽

Wei Wang ◽

Qian Huang ◽

Risheng Zhao ◽

...

Keyword(s):

Clinical Trials ◽

Abdominal Surgery ◽

Parenteral Nutrition ◽

Hospital Stay ◽

Clinical Outcomes ◽

Nitrogen Balance ◽

Infectious Complication ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

The Impact

The objective of this study was to evaluate the impact of perioperative glutamine-supplemented parenteral nutrition (GLN-PN) on clinical outcomes in patients undergoing abdominal surgery. MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. Eligible studies were randomized controlled trials (RCTs) that compared the effect of GLN-PN and standard PN on clinical outcomes in patients undergoing abdominal surgery. Clinical outcomes of interest were postoperative mortality, length of hospital stay, morbidity of infectious complication, and cumulative nitrogen balance. Statistical analysis was conducted by RevMan 5.0 software from the Cochrane Collaboration. Sixteen RCTs with 773 patients were included in this meta-analysis. The results showed a significant decrease in the infectious complication rates of patients undergoing abdominal surgery receiving GLN-PN (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.32 to 0.72; P = 0.0004). The overall effect indicated glutamine significantly reduced the length of hospital stay in the form of alanyl-glutamine (weighted mean difference [WMD], -3.17; 95% CI, -5.51 to -0.82; P = 0.008) and in the form of glycyl-glutamine (WMD, -3.40; 95% CI, -5.82 to -0.97; P = 0.006). A positive effect in improving postoperative cumulative nitrogen balance was observed between groups (WMD, 7.40; 95% CI, 3.16 to 11.63; P = 0.0006), but no mortality (RR, 1.52; 95% CI, 0.21 to 11.9; P = 0.68). Perioperative GLN-PN is effective and safe to shorten the length of hospital stay, reduce the morbidity of postoperative infectious complications, and improve nitrogen balance in patients undergoing abdominal surgery.

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