Aim:
Sarcopenia and malnutrition are highly prevalent in older adults undergoing hemodialysis (HD) and are associated with negative outcomes. This study aimed to evaluate the role of sarcopenia and ...malnutrition combined on the nutritional markers, quality of life, and survival in a cohort of older adults on chronic HD.
Methods:
This was an observational, longitudinal, and multicenter study including 170 patients on HD aged >60 years. Nutritional status was assessed by 7-point-subjective global assessment (7p-SGA), body composition (anthropometry and bioelectrical impedance), and appendicular skeletal muscle mass (Baumgartner's prediction equation). Quality of life was assessed by KDQoL-SF. The cutoffs for low muscle mass and low muscle strength established by the 2019 European Working group on sarcopenia for Older People (EWGSOP) were used for the diagnosis of sarcopenia. Individuals with a 7p-SGA score ≤5 were considered malnourished, individuals with low strength or low muscle mass were pre-sarcopenic, and those with low muscle mass and low muscle strength combined as sarcopenic. The sample was divided into four groups: sarcopenia and malnutrition; sarcopenia and no-malnutrition; no-sarcopenia with malnutrition; and no-sarcopenia and no-malnutrition. Follow-up for survival lasted 23.5 (12.2; 34.4) months.
Results:
Pre-sarcopenia, sarcopenia, and malnutrition were present in 35.3, 14.1, and 58.8% of the patients, respectively. The frequency of malnutrition in the group of patients with sarcopenia was not significantly higher than in the patients without sarcopenia (66.7 vs. 51.2%;
p
= 0.12). When comparing groups according to the occurrence of sarcopenia and malnutrition, the sarcopenia and malnutrition group were older and presented significantly lower BMI, calf circumference, body fat, phase angle, body cell mass, and mid-arm muscle circumference. In the survival analysis, the group with sarcopenia and malnutrition showed a higher hazard ratio 2.99 (95% CI: 1.23: 7.25) for mortality when compared to a group with no-sarcopenia and no-malnutrition.
Conclusion:
Older adults on HD with sarcopenia and malnutrition combined showed worse nutritional parameters, quality of life, and higher mortality risk. In addition, malnutrition can be present even in patients without sarcopenia. These findings highlight the importance of complete nutritional assessment in patients on dialysis.
Background: Handgrip strength (HGS) is a marker of nutrition status. Many factors are associated with HGS. Age, height, body mass index, number of diagnoses, and number and type of drugs have been ...shown to modify the association between undernutrition and HGS. Nevertheless, other patient characteristics that could modify this association and its joint modifier effect have not been studied yet. Objective: To evaluate the association of inpatients’ HGS and undernutrition considering the potential modifier effect of cognitive status, functional activity, disease severity, anthropometrics, and other patient characteristics on HGS. Methods: A cross-sectional study was conducted in a university hospital. Sex, age, abbreviated mental test score, functional activity score, Charlson index, number of drugs, Patient-Generated Subjective Global Assessment (PG-SGA) score, body weight, mid-arm muscle circumference, adductor pollicis muscle thickness, body height, wrist circumference, hand length, and palm width were included in a linear regression model to identify independent factors associated with HGS (dependent variable). Results: The study sample was composed of 688 inpatients (18–91 years old). All variables included in the model were associated with HGS (β, –0.16 to 0.38; P ≤ .049) and explained 68.5% of HGS. Age, functional activity decline, Charlson index, number of drugs, PG-SGA score, body weight, and wrist circumference had a negative association with HGS. All other studied variables were positively associated with HGS. Conclusion: Nutrition status evaluated by PG-SGA was still associated with HGS after considering the joint effect of other patient characteristics, which reinforces the value of HGS as an indicator of undernutrition.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Despite the well-known benefits of the Mediterranean Diet (MedDiet), data on the sodium intake is scarce. This study aimed to quantify the association between sodium excretion and the adherence to ...the MedDiet in the elderly. A representative sample of 1500 Portuguese adults (≥65 years) was assessed (1321 were eligible for the present analysis). A 24 h urine sample was collected and analysed for creatinine and sodium. Excessive sodium intake was defined as above 2000 mg/day. The adherence to the MedDiet was assessed by the PREDIMED. A binary logistic regression model was conducted to evaluate the association between urinary sodium excretion and the adherence to the MedDiet. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Excessive sodium excretion was observed in 80.0% of men and 91.5% of women whereas a high adherence to the MedDiet was reported by 42.2% of women and 46.4% of men. After adjusting for confounders, excessive sodium excretion was associated with a high adherence to the MedDiet in men (OR = 1.94; 95% CI: 1.03-3.65) but not in women. These results show that the MedDiet can be an important source of sodium and highlight the need for implementing strategies to reduce sodium intake when following a MedDiet.
Summary Background & aims The reported frequency of disease-related malnutrition (DRM) for patients admitted to hospitals has been shown to be high, but an accurate estimate of the magnitude of its ...economic costs is lacking. The objective of this study was to determine the impact of DRM on hospitalization costs. Methods A probabilistic sample of 469 (50%) patients from two hospitals was recruited on a cross-sectional study. DRM was evaluated by the Nutritional Risk Screening-2002 instrument at hospital admission and hospitalization costs were calculated for each patient based on hospital length of stay and on the discharge diagnosis-related group (DRG) code. Estimates of the association between DRM and deviations from the mean cost within each DRG were carried out. Results Patients classified as nutritionally-at-risk accounted for 42% of the sample. Multivariate estimates of the determinants of cost deviation shows that the cost of treating a nutritionally-at-risk patient is 20% higher than the average of the respective DRG. Patients that are classified on DRG classes that have a higher relative weight are less likely to end up with hospitalization costs above the mean. Conclusions Considering this sample case-mix, DRM can represent an increase in costs of 19.3%, or between 200 and 1500€, with a confidence of 95%.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Aim
The impact of sarcopenia on hospitalisation has been under intense investigation; however, little is known about the association between sarcopenia and their costs among hospitalised patients. ...The aim of the present study was to quantify the association between sarcopenia and hospitalisation costs among older adults.
Methods
A cross‐sectional study was conducted in 201 hospitalised older adults in a general hospital. Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Muscle mass was assessed by anthropometric measurements, muscle strength through handgrip strength evaluation and physical performance by Timed Up and Go Test. Nutritional status was evaluated using the Mini Nutritional Assessment—Short Form (MNA‐SF), and hospital costs were assessed with the Diagnosis Related Groups (DRGs) system. Multivariable logistic regression models were fitted to quantify the association between sarcopenia and hospital costs. Increased hospital costs were considered when a patients′ cost was higher than the mean cost of an average patient (€2396.24).
Results
Within this sample, 10.4% sarcopenic, 43.8% at nutritional risk and 14.9% undernourished older adults were identified. After adjustment, sarcopenia (OR = 5.70, 95% CI 1.57–20.71) and low muscle strength (OR = 2.40, 95% CI 1.12–5.15) were associated with increased hospital costs.
Conclusions
Sarcopenia and low muscle strength at hospital admission were independently associated with increased hospital costs.
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BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Frailty and sarcopenia have been extensively studied in heart failure (HF) patients, but their coexistence is unknown. The aim of this work is to describe the coexistence of these conditions in a ...sample of HF outpatients and its association with the use of medication and left-ventricular ejection fraction.
Participants in this cross-sectional study were recruited from a HF outpatients' clinic in northern Portugal. Frailty phenotype was assessed according to Fried et al. Sarcopenia was evaluated according to the revised consensus of the European Working Group on Sarcopenia in Older People.
A total of 136 HF outpatients (33.8% women, median age 59 years) integrated this study. Frailty and sarcopenia accounted for 15.4% and 18.4% of the sample, respectively. Coexistence of frailty and sarcopenia was found in 8.1% of the participants, while 17.6% had only one of the conditions. In multivariable analysis (n = 132), increasing age (OR = 1.13;95%CI = 1.06,1.20), being a woman (OR = 65.65;95%CI = 13.50, 319.15), having heart failure with preserved ejection fraction (HFpEF) (OR = 5.61; 95%CI = 1.22, 25.76), and using antidepressants (OR = 11.05; 95%CI = 2.50, 48.82), anticoagulants (OR = 6.11; 95%CI = 1.69, 22.07), furosemide (OR = 3.95; 95%CI = 1.07, 14.55), and acetylsalicylic acid (OR = 5.01; 95%CI = 1.10, 22.90) were associated with increased likelihood of having coexistence of frailty and sarcopenia, while using statins showed the inverse effect (OR = 0.06; 95%CI = 0.01, 0.30).
The relatively low frequency of coexistence of frailty and sarcopenia signifies that each of these two conditions still deserve individual attention from health professionals in their clinical practice and should be screened separately. Being a woman, older age, having HFpEF, using anticoagulants, antidepressants, loop diuretics and acetylsalicylic acid, and not using statins, were associated with having concomitant frailty and sarcopenia. These patients can potentially benefit from interventions that impact their quality of life such as nutritional and mental health interventions and exercise training.
Immune checkpoint blockade with anti-PD-1 antibodies is showing great promise for patients with metastatic melanoma and other malignancies, but despite good responses by some patients who achieve ...partial or complete regression, many others still do not respond. Here, we sought peripheral blood T-cell biomarker candidates predicting treatment outcome in 75 stage IV melanoma patients treated with anti-PD-1 antibodies. We investigated associations with clinical response, progression-free survival (PFS) and overall survival (OS). Univariate analysis of potential biological confounders and known biomarkers, and a multivariate model, was used to determine statistical independence of associations between candidate biomarkers and clinical outcomes. We found that a lower than median frequency of peripheral PD-1+CD56+ T-cells was associated with longer OS (p = 0.004), PFS (p = 0.041) and superior clinical benefit (p = 0.009). However, neither frequencies of CD56-CD4+ nor CD56-CD8+ T-cells, nor of the PD-1+ fraction within the CD4 or CD8 subsets was associated with clinical outcome. In a multivariate model with known confounders and biomarkers only the M-category (HR, 3.11; p = 0.007) and the frequency of PD-1+CD56+ T-cells (HR, 2.39; p = 0.028) were identified as independent predictive factors for clinical outcome under PD-1 blockade. Thus, a lower than median frequency of peripheral blood PD-1+CD56+ T-cells prior to starting anti-PD-1 checkpoint blockade is associated with superior clinical response, longer PFS and OS of stage IV melanoma patients.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Mucosal and acral melanoma respond worse to immune checkpoint inhibitors (ICI) than cutaneous melanoma.
as well as
amplifications are supposed to be associated with hyperprogression on ICI in diverse ...cancers. We therefore investigated the response of metastatic acral and mucosal melanoma to ICI in regard to
or
amplifications and melanoma type.
We conducted a query of our melanoma registry, looking for patients with metastatic acral or mucosal melanoma treated by ICI. Whole exome sequencing, FISH and immunohistochemistry on melanoma tissue could be performed on 45 of the total cohort of 51 patients. Data were correlated with patients` responses to ICI and survival.
22 out of 51 patients had hyperprogressive disease (an increase in tumor load of >50% at the first staging). Hyperprogression occurred more often in case of
or
amplification or <1% PD-L1 positive tumor cells. Nevertheless, this association was not significant. Interestingly, the anorectal melanoma type and the presence of liver metastases were significantly associated with worse survival.
So far, we found no reliable predictive marker for patients who develop hyperprogression on ICI, specifically with regard to
or
amplifications. Nevertheless, patients with anorectal melanoma, liver metastases or melanoma with amplified
seem to have an increased risk of not benefitting from ICI.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
To characterise the nutritional status and to identify malnutrition-associated variables of older adults living in Portuguese nursing homes.
Cross-sectional study. Data on demographic and ...socio-economic characteristics, self-reported morbidity, eating-related problems, nutritional status, cognitive function, depression symptoms, loneliness feelings and functional status were collected by trained nutritionists through a computer-assisted face-to-face structured interview followed by standardised anthropometric measurements. Logistic regression was used to identify factors associated with being at risk of malnutrition/malnourished.
Portuguese nursing homes.
Nationally representative sample of the Portuguese population aged 65 years or over living in nursing homes.
A total of 1186 individuals (mean age 83·4 years; 72·8 % women) accepted to participate. According to the Mini Nutritional Assessment, 4·8 (95 % CI 3·2, 7·3) % were identified as malnourished and 38·7 (95 % CI 33·5, 44·2) % were at risk of malnutrition. These percentages increased with age and were significantly higher for women. Logistic regression showed (OR; 95 % CI) that older adults reporting no or little appetite (6·5; 2·7, 15·3), those revealing symptoms of depression (2·6; 1·6, 4·2) and those who were more dependent in their daily living activities (4·7; 2·0, 11·1) were also at higher odds of being malnourished or at risk of malnutrition.
Malnutrition and risk of malnutrition are prevalent among nursing home residents in Portugal. It is crucial to routinely screen for nutritional disorders, as well as risk factors such as symptoms of depression and lower functional status, to prevent and treat malnutrition.
•The MDP is described as a model of healthy eating for a successful ageing.•Over the last decades, adhrence to the MDP has been declining.•A higher education level was strongly associated with ...adherence to the Mediterranean dietary pattern.•57% of this sample did not adhere to the Mediterranean diet.
The aim of this study was to evaluate adherence to the Mediterranean dietary pattern (MDP) and its associated factors in older Portuguese adults.
A cross-sectional observational study was designed. In the context of the Nutrition UP 65 study, a national cluster sample of 1407 Portuguese individuals ≥65 y of age was analyzed. Adherence to the MDP was evaluated with the Portuguese version of the Prevention with Mediterranean Diet tool. The association between an individual's characteristics and adherence to the MDP was analyzed through hierarchical logistic regression analysis.
In this study, 43% of participants adhered to the MDP (n = 609). Higher educational level (odds ratio OR, 2.38; 95% confidence interval CI, 1.54–3.69), living in the center (OR, 1.35; 95% CI, 1.01–1.79), being married or living in a common-law marriage (OR, 1.54; 95% CI, 1.20–1.97), and body mass index (ORpreobese, 1.52; 95% CI, 1.02–2.25) were related with increased odds of adherence to the MDP. Otherwise, lower adherence to the MDP was found for participants who were ≥80 y of age (OR, 0.70; 95% CI, 0.52–0.94), who lived in Madeira (OR, 0.35; 95% CI, 0.14–0.89) and Azores (OR, 0.28; 95% CI, 0.08–0.99), who rated their health as moderate (OR, 0.65; 95% CI, 0.50–0.84) or as bad or very bad (OR, 0.63; 95% CI, 0.45–0.90), and those who reported six or more comorbidities (OR, 0.62; 95% CI, 0.39–0.97).
Of the sample, 57% did not adhere to the Mediterranean diet. Potentially modifiable factors associated with lower adherence to the MDP were lower educational and health status.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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