Asia Pacific Journal of Clinical Nutrition/亞太地區臨床營養期刊
- Ahead-of-Print
HEC Press,正常發行
選擇卷期
- 期刊
Background and Objectives: Malnutrition in elderly individuals is extremely common. In China, Nutritional Risk Screening 2002 (NRS-2002) is often used to assess malnutrition in hospitalized elderly patients, although a gold standard for elderly outpatients is lacking. The Nutrition Screening Initiative Checklist (NSI) and Malnutrition Screening Tool (MST) have seldom been validated in elderly outpatients. This open, parallel, multi-center, cross-sectional study evaluated the performance of NRS-2002, the NSI, and the MST in estimating malnutrition risk in elderly outpatients. Methods and Study Design: This study included 986 elderly outpatients, with 53.2% being women, from five clinical teaching hospitals in Beijing. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the tools were estimated using a body mass index (BMI) of ＜18.5 kg/m^2 as a reference. Results: The mean (range) age of the patients was 69.6±6.8 (60-100) years. Overall, 4.3% had BMI ＜18.5 kg/m^2, 16.8% scored ≥3 points in NRS-2002, 9.8% scored ≥2 points in the MST, and 37.0% scored ≥3 points in the NSI. NRS-2002 had the highest sensitivity and the best AUC (0.934 vs. 0.642 for the NSI and 0.660 for the MST, p＜0.05), and the MST had the highest specificity. The sensitivity and specificity of the NSI were 0.64 and 0.64, respectively. Conclusions: NRS-2002 had the highest validity, and the MST had the highest specificity in estimating the risk of malnutrition in elderly outpatients. However, the accuracy of the NSI should be further verified with large samples.
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Background and Objectives: Little is known about nutritional status in patients with hepatocellular carcinoma (HCC) after multiple rounds of transarterial chemoembolization (TACE). We established a comprehensive nutritional index (CNI) and evaluated its prognostic value for overall survival (OS) and time to progression (TTP). Methods and Study Design: HCC patients (N=282) who underwent multiple TACE treatments were enrolled. CNI was established by principal component analysis based on body mass index, usual body weight percentage, hemoglobin, total lymphocyte count, and albumin; the cutoff value was determined by receiver operating characteristic curve and Youden index analysis. The correlation between CNI and treatment-related complications was analyzed with Spearman's method. The Kaplan-Meier method with log-rank test and Cox proportional hazards model were used to compare the prognostic values of CNI, prognostic nutritional index (PNI), and nutrition risk index (NRI) for OS and TTP. Results: Nutritional status declined after repeated TACE (p＜0.001). CNI (cutoff= 0.251) varied according to albumin-bilirubin grade, tumor size, and number of TACE treatments (p＜0.001 or 0.025) and was negatively correlated with rate of serious complications (r=−0.185, p=0.002). Patients with low CNI had shorter OS (p=0.014) and TTP (p=0.007); high CNI predicted longer OS (hazard ratio [HR], 0.72; 95% confidence interval [CI]: 0.52-1.00, p=0.048) and TTP (HR, 0.69; 95% CI: 0.50-0.94, p=0.019). Post-treatment PNI and NRI were unrelated to prognosis (p＞0.05). Conclusions: HCC patients have poor nutritional status after multiple TACE treatments, which predicts shorter OS and TTP. The prognostic performance of CNI is superior to those of PNI and NRI.
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Background and Objectives: The novel coronavirus disease (COVID-19) epidemic is spreading all over the world. With the number of cases increasing rapidly, the epidemiological data on the nutritional practice is scarce. In this study, we aim to describe the clinical characteristics and nutritional practice in a cohort of critically ill COVID-19 patients. Methods and Study Design: This is a multicenter, ambidirectional cohort study conducted at 11 hospitals in Hubei Province, China. All eligible critical COVID-19 patients in the study hospital intensive care units at 00:00, March 6th, 2020, were included. Data collection was performed via written case report forms. Results: A total of 44 patients were identified and enrolled, of whom eight died during the 28-day outcome follow- up period. The median interval between hospital admission and the study day was 24 (interquartile range, 13-26) days and 52.2% (23 of 44) of patients were on invasive mechanical ventilation. The median nutrition risk in critically ill (mNUTRIC) score was 3 (interquartile range, 2-5) on the study day. During the enrolment day, 68.2% (30 of 44) of patients received enteral nutrition (EN), while 6.8% (3 of 44) received parenteral nutrition (PN) alone. Nausea and aspiration were uncommon, with a prevalence of 11.4% (5 of 44) and 6.8% (3 of 44), respectively. As for energy delivery, 69.7% (23 of 33) of patients receiving EN and/or PN were achieving their prescribed targets. Conclusions: The study showed that EN was frequently applied in critical COVID-19 patients. Energy delivery may be suboptimal in this study requiring more attention.
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Background and Objectives: Stress hyperglycemia is a common condition in critically ill patients. Inappropriate nutritional supplementation may worsen blood glucose control in these patients. The present study aimed to investigate the outcome of blood glucose control status when using various enteral formulas. Methods and Study Design: This retrospective study was conducted at the intensive care unit of a tertiary medical center in central Taiwan. Patients meeting the following inclusion criteria were enrolled in the study: age ≥20 years, respiratory failure requiring mechanical ventilation, and two consecutive blood glucose concentration measurements of ≥180 mg/dL. Demographic data, blood glucose samples, and hospital mortality were collected for analysis. Results: A total of 4,604 blood glucose samples from 48 patients were analyzed. Results demonstrated no significant difference in mortality rate or blood glucose control between patients fed semi-elemental formulas and those fed polymer formulas. Serum HbA1C of ＜7.5% was a risk factor for hospital mortality (OR: 0.18, 95% CI: 0.04-0.89). Enteral formulas containing less carbohydrate were associated with better blood glucose control. Conclusions: No significant difference in the outcome of blood glucose control was observed between patients fed semi-elemental formula and those fed polymer formula. To achieve better blood glucose control in critically ill patients, formulas with lower carbohydrate content should be considered.
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Background and Objectives: We conducted this meta-analysis about the effects of Souvenaid on cognition and functional abilities, with the hypothesis that Souvenaid may have beneficial effects in certain groups and the goal of finding the outcome measures, disease states, and so on, applicable for further clinical trials. Methods and Study Design: We searched Medline, Embase, Web of Science, CINAHL, and the Cochrane Library. Only double- blind randomized controlled trials were included. Outcome measurements were cognition, clinical global change, functional ability, and adverse events. The duration of treatment was not restricted, but trials performed in patients who did not have Alzheimer's disease (AD) were excluded. Results: This review using meta-analyses of 4 clinical trials showed that Souvenaid had no significant effects on cognition as measured by ADAS-Cog (MD=0.08, 95% CI=-0.71-0.88) and the neuropsychological test battery total scores (MD=0.05, 95% CI=-0,02-0.12), on global clinical function as measured by CDR-SB (MD=-0.21, 95% CI=-0.47-0.06), or on functional ability as measured by ADCS-ADL (MD=0.36, 95% CI=-0.54-1.25). There were no differences in any adverse events (OR=0.84, 95% CI=0.63-1.12) or in serious adverse events (OR=0.95, 95% CI=0.66-1.36). However, Souvenaid may benefit the domains of cognition that are affected by AD (attention, memory, and executive function), and it may have greater potential for benefits earlier rather than later in the disease. Conclusions: The results of current clinical trials do not suggest that Souvenaid has any beneficial effects on cognition, functional ability, or global clinical change. Further studies with outcome measures suitable in patients with early stages of AD will be needed.
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Background and Objectives: Percutaneous endoscopic gastrostomy (PEG) has been widely used since 1980 in enteral feeding of patients that are not able to be fed orally for a long time. The aim of this study is to evaluate the PEG indications, effectiveness and PEG related complications from a single center in Istanbul, Turkey. Methods and Study Design: 265 patients with PEG who were followed up by the clinical nutrition team of a university hospital between 2010-2018 were evaluated retrospectively. Nutritional Risk Screening-2002 (NRS-2002) test, anthropometric measurements, bioelectrical impedance analysis and laboratory data were used to evaluate the patients' nutritional status. Results: The most common indications for PEG were dementia (35.1%), amyotrophic lateral sclerosis (22.6%), stroke (15.8%), and cancer (14%). The mean body weight of the patients was increased after PEG (63.5±12.2 vs 62.0±12.7 kg). Mid upper arm circumference and calf circumference of the patients increased after PEG (27.5±2.5 vs 25.4±3.1 cm and 32.2±7.9 vs 29.6±5.9 cm, respectively). Serum albumin of the patients was increased significantly after PEG (3.34±0.69 g/dL to 3.64±0.65 g/dL) without any significant change in serum CRP. Subgroup analyses showed a significant increase in the mean serum albumin of patients with dementia after PEG (3.23±0.67 g/dL to 3.54±0.58 g/dL). Local insertion site infection occurred in 15 patients (5.6%) and only 3 patients had systemic inflammatory symptoms after local infection (1.1%). Conclusions: The results of our study showed that long-term enteral feeding with PEG is an effective and safe method that provides improvement in nutritional status.
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Background and Objectives: The present study aimed to determine the correlation between Controlling Nutritional Status (CONUT) score and prognosis in gastric cancer patients undergoing total gastrectomy. Methods and Study Design: The clinical data of 245 gastric cancer patients who underwent total gastrectomy in Peking University, First Hospital between January 1st 2005 and December 30th 2015 were retrospectively collected. According to the CONUT level, they were divided into high CONUT (＞3) group and low CONUT (≤3) group. The relationship between CONUT and the disease-free survival (DFS) and overall survival (OS) were analyzed by statistical analysis. Results: The results showed that the optimal cutoff value for CONUT to predict the 5-year survival was 3 and CONUT had a higher area under the ROC curve (AUC) for 5-year disease free survival (DFS) and overall survival (OS) prediction. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that high CONUT correlated with shorter DFS in non-elderly (＜65) patients and shorter DFS and OS in elderly (≥65) patients. Conclusions: High CONUT was significantly correlated with older age, advanced TNM-stage, higher Ki-67 and pathological subtype. Patients with high pre-operative high CONUT levels should be given more observation and constant follow-up after surgery.
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Background and Objectives: To investigate the efficacy of beclomethasone and aminophylline combined with enteral nutrition in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) and the associated effects of these drugs on patient nutritional status and immune function. Methods and Study Design: In total, 115 elderly patients with COPD were included and were randomized into an enteral nutrition (EN) group and a control (CON) group. Aminophylline, in combination with beclomethasone, was administered to the CON group, whereas aminophylline and beclomethasone in combination with EN was administered to the EN group. Results: Patients in the EN group showed significant improvement in partial pressure of carbon dioxide, forced expiratory volume in 1 sec/ expiratory forced vital capacity, and partial pressure of oxygen than those in the CON group. The levels of IgM, IgG, and IgA as well as the number of CD4+/CD8+ and CD4+/CD3+ T cells were higher in the EN group than those in the CON group (p＜0.05); the EN group also exhibited higher levels of inflammatory cytokines, such as tumor necrosis factor-α and interleukin (IL)-1β (p＜0.05), and lower levels of IL-6 than the CON group. In addition, patients in the EN group showed a significant increase in serum total protein, albumin, and transferrin levels than those in the CON group (p＜0.05). Conclusions: Elderly patients with COPD showed a marked response to a regimen of beclomethasone, aminophylline, and EN, which significantly improved their immune function and nutritional status.
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Background and Objectives: To evaluate the effects of a Ready to Hang (RTH), pectin-containing enteral nutrition on gastrointestinal symptoms and nutrition status. Methods and Study Design: An open-label, randomized, prospective controlled study. Thirty hospitalized patients with tube feeding for 9 days or more. Intervention: A pectin-containing enteral formula (Hine E-Gel®) or a standard polymeric formula (Ensure®) was administered for 1 week. Administration methods: Administered via a nasogastric tube 4 times per day (every 6 hours), 30 minutes per administration. Results: There was no significant difference in the frequency of diarrhea or the nutritional indicators. An additional survey was conducted of 50 nurses who were involved in the administration of the study products. Most respondents replied that the RTH, pectin-containing formula was easier to use and that the duties related to its administration were decreased. Conclusions: The pectin-containing formula was not detectably superior to the standard polymeric formula in terms of gastrointestinal symptoms. The use of RTH may simplify medical care and enable efficient management.
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Background and Objectives: This study aimed to assess the association of folate, vitamin B-12 and vitamin B-6 from diet and supplements with diabetes and prediabetes in U.S. adults. Methods and Study Design: We used data from the National Health and Nutrition Examination Survey (NHANES) 2007-2016 to conduct this cross-sectional study. Diabetes and prediabetes status were based on self‐report, medication use, fasting plasma glucose levels (FPG), haemoglobin A1c (HbA1c) levels and the two hours plasma glucose (PG) value during a 75-g oral glucose tolerance test (OGTT). Logistic regression models and restricted cubic spline models were used to evaluate the associations between dietary folate, vitamin B-12, vitamin B-6 and diabetes. Results: After adjustment for the potential confounders, compared with the lowest quartile, the ORs (odds ratios) with 95%CIs (confidence intervals) of diabetes for the highest quartile intakes of folate and vitamin B-6 were 0.65 (0.47-0.90) and 0.61 (0.42-0.89), the OR with 95% CI of diabetes for the third quartile of dietary vitamin B-12 was 0.76 (0.60-0.97). Further excluded participants with diabetes history, the ORs with 95% CI of newly diagnosed diabetes were 0.60 (0.39-0.94), 0.84 (0.58-1.23), and 0.65 (0.43-0.98) for the third quartile of dietary folate, vitamin B-12 and vitamin B-6, respectively. A linear inverse relationship was found between vitamin B12 and diabetes, and a nonlinear inverse relationship was found between dietary folate, dietary vitamin B6 and diabetes. Conclusions: Our study suggested that folate, vitamin B-12 and vitamin B-6 intake were inversely associated with the risk of diabetes in US adults.