NUTRITIONAL INDICATORS OF MALNUTRITION IN HOSPITALIZED PATIENTS

ABSTRACT BACKGROUND: Malnutrition is associated with clinical factors, including longer hospital stay, increased morbidity and mortality and hospital costs. OBJECTIVE: To investigate the prevalence of malnutrition using different nutritional indicators and to identify factors that contribute to malnutrition in hospitalized patients. METHODS: We investigated anthropometric, laboratory standards, nutritional risk screening (NRS), subjective global assessment (SGA), mini nutritional assessment and habitual energy consumption (HEC). Chi-square, Fisher’s exact test, Mann-Whitney test and univariate and multiple Cox regression analysis were used, at 5% significance level. RESULTS: It was found 21.01% of malnourished individuals by ASG; a total of 34.78% with nutritional risk according to NRS and 11.59% with low weight (BMI). There was no statistically significant difference in the prevalence of malnutrition by ASG (P=0.3344) and nutritional risk by NRS (P=0.2286), among the types of disorders. Patients with nutritional risk were of higher median age (64.5 vs 58.0 years; P=0.0246) and had lower median values of HEC (1362.1 kcal vs 1525 kcal, P=0.0030), of calf circumference (32.0 cm vs 33.5 cm, P=0.0405) of lymphocyte count (1176.5 cell/mm3 vs 1760.5 cell/ mm3, P=0.0095); and higher percentage of low body weight according to the BMI (22.9% vs 5.6%; P=0.0096). Lymphocyte count was associated with nutritional risk (P=0.0414; HR= 1.000; IC95%= 0.999; 1.000). CONCLUSION: NRS was more sensitive than other indicators in the diagnosis of malnutrition. Patients at risk were older and had lower HEC values, calf circumference, BMI and lymphocyte count. Low lymphocyte count was considered a factor associated with nutritional risk by the NRS.

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Short-form Mini-Nutritional Assessment with either BMI or calf circumference is effective in rating the nutritional status of elderly Taiwanese – results of a national cohort study

British Journal Of Nutrition ◽

10.1017/s0007114513000366 ◽

2013 ◽

Vol 110 (6) ◽

pp. 1126-1132 ◽

Cited By ~ 9

Author(s):

Alan C. Tsai ◽

Tsui-Lan Chang ◽

Jiun-Yi Wang

Keyword(s):

Nutritional Status ◽

Cox Regression ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

The Elderly ◽

Calf Circumference ◽

Cox Regression Analysis ◽

National Cohort

The present study was aimed to validate two normalised short-form (SF) Mini-Nutritional Assessments (MNA) that contained either BMI (Taiwan version 1, T1) or calf circumference (CC; Taiwan version 2, T2) for rating the nutritional status of elderly Taiwanese. Both versions adopted Taiwanese anthropometric cut-offs, but T2 further had the BMI item replaced by CC. We compared the ability of the two SF in rating the nutritional status of 2674 elderly Taiwanese in the 1999 ‘Taiwan Longitudinal Survey on Aging’ with their respective full versions. We evaluated the agreement between the SF and full scales with weighted κ and performed Cox regression analysis for the follow-up 4-year mortality according to nutritional status rated at baseline. The results showed that the agreements between the respective SF and the full MNA were good (weighted κ: 0·679 for T1 and 0·667 for T2). Both SF performed well in predicting follow-up 4-year mortality relative to the full MNA. In conclusion, MNA-T1-SF and -T2-SF have good consistency with the full MNA and have quite comparable abilities in rating the nutritional status of elderly Taiwanese. Both SF versions appear appropriate for functioning as stand-alone units for rating the nutritional status of the elderly in community-living settings or the general population.

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Factors associated with nutritional risk and appetite loss in long-aged older people

Revista de Nutrição ◽

10.1590/1678-9865202134e200308 ◽

2021 ◽

Vol 34 ◽

Author(s):

Mariana de Paula SANTANA ◽

Nadine Motta FIGUEIREDO ◽

Sergio CHOCIAY JUNIOR ◽

Tainá Aparecida SILVA ◽

Rosimeire Aparecida Manoel SEIXAS ◽

...

Keyword(s):

Older Adults ◽

Weight Loss ◽

Depressive Symptoms ◽

Older People ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Perceived Health ◽

Nutritional Risk ◽

Calf Circumference ◽

Appetite Loss

ABSTRACT Objective To analyze the factors that are associated with the nutritional risk and appetite loss of long-aged older people with two assessment instruments. Methods A cross-sectional and quantitative study was developed in Três Lagoas, a city in the Brazilian state of Mato Grosso do Sul. The household data collection was conducted with 87 long-aged older adults (≥90 years) living in the community. The risk of malnutrition, malnutrition, and the risk of weight loss were the dependent variables, assessed by the Simplified Nutritional Appetite Questionnaire and by the Mini-Nutritional Assessment - Short Form. The association with independent sociodemographic, general health, psychological, cognitive, and physical variables was analyzed using logistic regressions. Results Most of the older adults were female (55.2%), with an average age of 93.3 years, and 1.4 years of schooling. According to the Simplified Nutritional Appetite Questionnaire, 34.5% of the older individuals were at risk of losing weight. As for the results of the Mini-Nutritional Assessment, 19.5% were classified as malnourished, and 39.1% at risk of malnutrition. A greater nutritional risk in both instruments was associated with the individual's poorer self-perceived health, lower calf circumference, and presence of depressive symptoms. The greater the number of medications used, the lower the chance of weight loss. The agreement between the two instruments was low. Conclusion There was an association connecting malnutrition and appetite/weight loss with lower calf circumference, worse self-perceived health status, and presence of depressive symptoms. These results can assist in interventions planning to reduce the nutritional risk and improve the life quality of older adults.

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Analysis of Related Factors of Depression and Malnutrition in Elderly Hospitalized Patients v1

10.17504/protocols.io.byqapvse ◽

2021 ◽

Author(s):

Yanmin Ju

Keyword(s):

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Electronic Medical Record System ◽

Hospitalized Patients ◽

Calf Circumference ◽

Related Factors ◽

Record System ◽

Prevalence Of Depression ◽

Elderly Inpatients ◽

Elderly Hospitalized Patients

SUMMARY: BACKGROUND: Depression and malnutrition are very common among elderly hospitalized patients and may lead to undesirable consequences. OBJECTIVE: To explore the correlation between depression and malnutrition through statistical methods to provide a theoretical basis for preventing the occurrence of depression and malnutrition in elderly hospitalized patients so as to improve their quality of life. METHODS: This is a retrospective analysis of 179 elderly inpatients in the Cadre Ward Unit of the First Hospital of Jilin University. Relevant data of the participants required for the study were obtained from the electronic medical record system and comprehensive geriatric assessment (CGA) database of the First Hospital of Jilin University. The correlation between depression and malnutrition was determined using logistic regression analysis. RESULTS: The percentage of included elderly inpatients without depression was 64.8%（median age=78.4 ± 10.3 years）, while the percentage of patients with depression was 35.2%（median age of 81.8 ± 8.4 years） . The prevalence of depression among the participants in the study was 35.2%, and the highest prevalence of depression combined with malnutrition was 58.9%, followed by 42.4% prevalence of depression combined with risk of malnutrition. After controlling for other relevant factors, the Mini Nutritional Assessment(MNA)(P=0.008,OR=0.821), albumin (P=0.005,OR=0.834) and calf circumference (P=0.004,OR=0.790) were independently associated with depression. CONCLUSION: There is a correlation between depression and malnutrition, and MNA, albumin and calf circumference are independent protective factors for depression, respectively. KEYWORDS:depression;malnutrition;elderly

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Nutritional status and screening tools to detect nutritional risk in hospitalized patients with hepatic echinococcosis

Parasite ◽

10.1051/parasite/2020071 ◽

2020 ◽

Vol 27 ◽

pp. 74

Author(s):

Zhan Wang ◽

Jin Xu ◽

Ge Song ◽

MingQuan Pang ◽

Bin Guo ◽

...

Keyword(s):

Nutritional Status ◽

Nutritional Assessment ◽

Short Form ◽

Risk Index ◽

Mini Nutritional Assessment ◽

Hospitalized Patients ◽

Screening Tools ◽

Nutritional Risk ◽

Nutritional Screening ◽

Nrs 2002

Background: Echinococcosis is a chronic consumptive liver disease. Little research has been carried out on the nutritional status of infected patients, though liver diseases are often associated with malnutrition. Our study investigated four different nutrition screening tools, to assess nutritional risks of hospitalized patients with echinococcosis. Methods: Nutritional Risk Screening 2002 (NRS 2002), Short Form of Mini Nutritional Assessment (MNA-SF), Malnutrition Universal Screening Tool (MUST), and the Nutrition Risk Index (NRI) were used to assess 164 patients with alveolar echinococcosis (AE) and 232 with cystic echinococcosis (CE). Results were then compared with European Society for Clinical Nutrition and Metabolism (ESPEN) criteria for malnutrition diagnosis. Results: According to ESPEN standards for malnutrition diagnosis, 29.2% of CE patients and 31.1% of AE patients were malnourished. The malnutrition risk rates for CE and AE patients were as follows: NRS 2002 – 40.3% and 30.7%; MUST – 51.5% and 50.9%; MNA-SF – 46.8% and 44.1%; and NRI – 51.1% and 67.4%. In patients with CE, MNA-SF and NRS 2002 results correlated well with ESPEN results (k = 0.515, 0.496). Area-under-the-curve (AUC) values of MNA-SF and NRS 2002 were 0.803 and 0.776, respectively. For patients with AE, NRS 2002 and MNA-SF results correlated well with ESPEN (k = 0.555, 0.493). AUC values of NRS 2002 and MNA-SF were 0.776 and 0.792, respectively. Conclusion: This study is the first to analyze hospitalized echinococcosis patients based on these nutritional screening tools. Our results suggest that NRS 2002 and MNA-SF are suitable tools for nutritional screening of inpatients with echinococcosis.

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83 The prognostic significance of peripheral blood biomarkers in patients with advanced non-small cell lung cancer treated with pembrolizumab: a clinical study

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0083 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A91-A91

Author(s):

Kira MacDougall ◽

Muhammad Niazi ◽

Jeff Hosry ◽

Sylvester Homsy ◽

Alexander Bershadskiy

Keyword(s):

Peripheral Blood ◽

Lymphocyte Count ◽

Advanced Nsclc ◽

Cox Regression ◽

Absolute Lymphocyte Count ◽

Blood Biomarkers ◽

Cox Regression Analysis ◽

Start Date ◽

Kaplan Meier ◽

Significant Difference

BackgroundPembrolizumab is an anti-programmed cell death protein 1 (PD-1) antibody used for the treatment of advanced non-small cell lung carcinoma (NSCLC). Systemic inflammation has long been associated with poor outcomes in many types of solid tumors.1 Peripheral blood biomarkers such as absolute lymphocyte count (ALC) and absolute neutrophil count to absolute lymphocyte count ratio (ANC/ALC) serve as surrogate markers of inflammation. The aim of this study is to investigate ALC and ANC/ALC in patients with advanced NSCLC receiving pembrolizumab and determine if there is a correlation between these biomarkers and overall survival (OS).MethodsA total of 240 patients with advanced NSCLC treated with pembrolizumab at Northwell Health hospital centers were included. The ALC and ANC/ALC were examined at initiation of pembrolizumab and after 6 weeks on treatment. The prognostic role of these peripheral blood biomarkers on OS were examined with Kaplan-Meier curves and a multivariable cox regression analysis.ResultsOf the 240 patients, the majority were male (52%), with a median age of 67 years (interquartile range [IQR] 59–73 years), had a diagnosis of adenocarcinoma (76%), with stage IV disease (82%). PDL-1 expression was >50% in 44% of the patients. The median time on treatment with pembrolizumab was 5.7 months [IQR: 2.7–12.5]. The median ALC and ANC/ALC were significantly lower at 6 weeks of pembrolizumab compared to the start date of treatment (1.38 vs. 1.4, p<0.001) and (3.6 vs. 4.6, p<0.001) respectively. An ALC greater than 1.4 was associated with an increased OS (figure 1), at 6 weeks after initiation of pembrolizumab (p=0.046), but not at the start of treatment (p=0.095). An ANC/ALC less than 5 was associated with improved OS (figure 2), both at initiation of pembrolizumab (p=0.003) and at 6 weeks after initiation of treatment (p = 0.028). Likewise, after adjusting for potential cofounders with a multivariate analysis (table 1), a baseline ANC/ALC of 5 or higher had a significantly increased risk of death (hazards ratio (HR)=1.84; 95% confidence interval (CI), 1.21–2.79; p=0.004), compared with patients with a lower ratio.ConclusionsHigh ALC at time of diagnosis as well as low ANC/ALC at baseline and at 6 weeks on treatment correlated with an increased OS in patients with advanced NSCLC treated with pembrolizumab. These findings represent a readily available predictive biomarker for oncologists and may help with risk stratification and strategizing treatment plans.Abstract 83 Figure 1Kaplan-Meier survival estimates between groups with different ALC at the start date of pembrolizumab and at 6 weeks after initiation of pembrolizumab. There is a statistically significant difference in OS between patients with ALC < 1.4 and patients with ALC ≥ 1.4 at 6 weeks after initiation of pembrolizumab (p = 0.046), but not at the start of treatment (p = 0.095).Abstract 83 Figure 2Kaplan-Meier survival estimates between groups with different ANC/ALC ratio at the start date of pembrolizumab and at 6 weeks after initiation of pembrolizumab. There is a statistically significant difference in OS between patients with ANC/ALC < 5 and patients with ALC ≥ 5, both at the start date of pembrolizumab (p = 0.003) and at 6 weeks after initiation of pembrolizumab (p = 0.028).Abstract 83 Table 1Multivariable cox regression analysis for association of baseline peripheral blood biomarkers and overall survival.Legend: HR, hazards ratio; CI, confidence interval; CNS, central nervous system, ANC/ALC, absolute neutrophil count to absolute lymphocyte count ratio; PDL-1, programmed death-1 ligand 1; ECOG, Eastern Cooperative Oncology Group performance scale.Ethics ApprovalThe study was approved by Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital’s IRB #: 19–0922ReferenceMantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436–44.

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Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture

British Journal Of Nutrition ◽

10.1017/s0007114512003686 ◽

2012 ◽

Vol 109 (9) ◽

pp. 1657-1661 ◽

Cited By ~ 40

Author(s):

David N. Gumieiro ◽

Bruna P. M. Rafacho ◽

Andrea F. Gonçalves ◽

Suzana E. Tanni ◽

Paula S. Azevedo ◽

...

Keyword(s):

Hip Fracture ◽

Cox Regression ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Nutritional Risk ◽

Pathological Fractures ◽

Nrs 2002 ◽

American Society ◽

American Society Of Anesthesiologists ◽

Nutritional Risk Screening

The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.

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Malnutrition is associated with increased mortality in older adults regardless of the cause of death

British Journal Of Nutrition ◽

10.1017/s0007114517000435 ◽

2017 ◽

Vol 117 (4) ◽

pp. 532-540 ◽

Cited By ~ 46

Author(s):

Lisa Söderström ◽

Andreas Rosenblad ◽

Eva Thors Adolfsson ◽

Leif Bergkvist

Keyword(s):

Older Adults ◽

At Risk ◽

Cause Of Death ◽

Cox Regression ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Cox Proportional Hazards ◽

Assessment Instrument ◽

Nutritional Risk ◽

Laboratory Findings

AbstractMalnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged ≥65 years admitted to hospital in 2008–2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24–30), at risk of malnutrition (score 17–23·5) or malnourished (score <17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55·1 % were at risk of malnutrition, and 9·4 % of the participants were malnourished. During a median follow-up of 5·1 years, 839 participants (47·5 %) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2·43 and 1·32); mental or behavioural disorders (HR 5·73 and 5·44); diseases of the nervous (HR 4·39 and 2·08), circulatory (HR 1·95 and 1·57) or respiratory system (HR 2·19 and 1·49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2·23 and 1·43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.

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Evaluation of the risk factors on time to phlebitis- and nonphlebitis-related failure when peripheral venous catheters were replaced as clinically indicated

The Journal of Vascular Access ◽

10.1177/1129729820924553 ◽

2020 ◽

pp. 112972982092455

Author(s):

H Selcuk Ozger ◽

Merve Yasar ◽

Rahşan Başyurt ◽

Figen Bucak ◽

Murat Dizbay

Keyword(s):

Risk Factors ◽

Cox Regression ◽

Survival Rates ◽

Venous Catheter ◽

Logrank Test ◽

Significance Level ◽

Cox Regression Analysis ◽

Catheter Survival ◽

Peripheral Venous Catheter ◽

Significant Difference

Background: This study aimed to determine the frequency of peripheral venous catheter–related complications and the risk factors that have an impact on the time of peripheral venous catheter failure when they were replaced as clinically indicated. Methods: This was a prospective observational study. The demographic and clinical characteristics of the patients, as well as the catheter specifications, were recorded. All the catheters were followed-up at 12-h intervals for the development of complications. Two different peripheral venous catheters were used in the study. The catheter dwell times were estimated using Kaplan–Meier analysis. The logrank test was utilized to investigate the catheter dwell times by univariate analyses. Variables with a significance level of less than 0.20 were taken into Cox regression analysis. Results: Our results revealed that phlebitis and nonphlebitis complications occurred more frequently within the first 96 h. No significant difference was observed in the occurrence time of phlebitis, nonphlebitis, and composite failures. The use of a locally manufactured catheter, unsuccessful first attempt, poor skin integrity, after-hours’ insertion, the use of sterile gauze dressing were all associated with shorter catheter survival rates. Conclusion: We observed no difference on the time to phlebitis or nonphlebitis symptoms with clinically indicated replacement of peripheral venous catheters. We found a significant difference in survival rates between locally manufactured and imported peripheral venous catheters. Our identified risk factors should be taken into account to reduce peripheral venous catheter–related complications and to increase dwell time.

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Mangelernährung bei geriatrischen Traumapatienten

Osteologie/Osteology ◽

10.1055/s-0037-1620029 ◽

2014 ◽

Vol 23 (01) ◽

pp. 5-10

Author(s):

E.C. Bliemel ◽

R. Aigner ◽

C. Rolfes ◽

S. Ruchholtz ◽

B. Buecking ◽

...

Keyword(s):

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Nutritional Risk ◽

Risk Screening ◽

Prädiktive Validität ◽

Nutritional Risk Screening

ZusammenfassungDie Inzidenz von Mangelernährung geriatrischer Patienten wird im Allgemeinen mit über 50 % angegeben. Mangelernährung bei geriatrischen Traumapatienten rangiert im Kollektiv der proximalen Femurfrakturen zwischen 30 und 50 %. Insgesamt erscheinen sowohl die angegebenen Häufigkeiten als auch die angewandten Messinstrumente inhomogen. Malnutrition führt zu einer Verschlechterung der Wundheilung, einer längeren postoperativen Immobilität, einem verlängerten Krankenhausaufenthalt sowie zu einer Steigerung der Mortalität. Unter Hinzuziehung bestehender Leitlinien erreichen das Mini Nutritional Assessment (MNA) sowie das Nutritional Risk Screening (NRS) eine ausreichende prädiktive Validität in diesem geriatrischen Patientengut, um ein Screening auf Mangelernährung durchzuführen. Bezüglich möglicher therapeutischer Interventionen ist die Studienlage limitiert: Vorhandene Studien zeigen oft eine geringe Patientenzahl und demente Patienten, die besonders häufig mangelernährt sind, wurden häufig ausgeschlossen. Eine Leitlinie explizit für dieses spezielle Patientengut existiert aktuell nicht. Ein suffizientes Screening des Ernährungszustandes sowie Daten zur Durchführbarkeit und Effizienz einer kurzfristigen perioperativen Nahrungsergänzung könnten einen wichtigen Beitrag zur Stabilisierung dieser oft multimorbiden und fragilen Patienten leisten.

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Predictive Model for Live Birth at 12 Months After Starting In-Vitro Fertilization Treatment

MedPharmRes ◽

10.32895/ump.mpr.2.2.5 ◽

2018 ◽

Vol 2 (2) ◽

pp. 5-20

Author(s):

Vu Ho ◽

Toan Pham ◽

Tuong Ho ◽

Lan Vuong

Keyword(s):

In Vitro Fertilization ◽

Live Birth ◽

Cox Regression ◽

Financial Burden ◽

Oocyte Retrieval ◽

Operating Characteristics ◽

Vitro Fertilization ◽

Cox Regression Analysis ◽

Significant Difference

IVF carries a considerable physical, emotional and financial burden. Therefore, it would be useful to be able to predict the likelihood of success for each couple. The aim of this retrospective cohort study was to develop a prediction model to estimate the probability of a live birth at 12 months after one completed IVF cycle (all fresh and frozen embryo transfers from the same oocyte retrieval). We analyzed data collected from 2600 women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) at a single center in Vietnam between April 2014 and December 2015. All patients received gonadotropin-releasing hormone (GnRH) antagonist stimulation, followed by fresh and/or frozen embryo transfer (FET) on Day 3. Using Cox regression analysis, five predictive factors were identified: female age, total dose of recombinant follicle stimulating hormone used, type of trigger, fresh or FET during the first transfer, and number of subsequent FET after the first transfer. The area under the receiver operating characteristics curve for the final model was 0.63 (95% confidence interval [CI] 0.60‒0.65) and 0.60 (95% CI 0.57‒0.63) for the validation cohort. There was no significant difference between the predicted and observed probabilities of live birth (Hosmer-Lemeshow test, p > 0.05). The model developed had similar discrimination to existing models and could be implemented in clinical practice.

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