Various nutritional therapies have been proposed in rheumatoid arthritis, particularly diets rich in ω-3 fatty acids, which may lead to eicosanoid reduction. Our aim was to investigate the effect of ...potentially anti-inflammatory diets (Mediterranean, vegetarian, vegan, ketogenic) on pain. The primary outcome was pain on a 10 cm visual analogue scale. Secondary outcomes were C-reactive protein levels, erythrocyte sedimentation rate, health assessment questionnaire, disease activity score 28, tender/swollen joint counts, weight, and body mass index. We searched MEDLINE (OVID), Embase (Elsevier), and CINAHL for studies published from database inception to 12 November 2021. Two authors independently assessed studies for inclusion, extracted study data, and assessed the risk of bias. We performed a meta-analysis with all eligible randomized controlled trials using RevMan 5. We used mean differences or standardized mean differences and the inverse variance method of pooling using a random-effects model. The search retrieved 564 unique publications, of which we included 12 in the systematic review and 7 in the meta-analysis. All studies had a high risk of bias and the evidence was very low. The main conclusion is that anti-inflammatory diets resulted in significantly lower pain than ordinary diets (-9.22 mm; 95% CI -14.15 to -4.29;
= 0.0002; 7 RCTs, 326 participants).
Inflammation is a key driver of malnutrition during illness and is often accompanied by metabolic effects, including insulin resistance and reduction of appetite. However, it still remains unclear if ...inflammation influences the response to nutritional support among patients with disease-related malnutrition.
To examine whether patients' baseline inflammatory status is associated with the effect of nutritional support on 30-day mortality.
This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized clinical trial conducted in 8 Swiss hospitals from April 2014 to February 2018. A total of 1950 participants who had C-reactive protein measurements at the time of admission were included in this secondary analysis. Data analysis was conducted between June and July 2019.
Hospitalized patients at risk for malnutrition were randomly assigned to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group).
The primary end point was 30-day mortality. Based on C-reactive protein levels at admission, patients were stratified into groups with low, moderate, or high inflammation (<10 mg/L, 10-100 mg/L, and >100 mg/L, respectively).
A total of 1950 patients (median interquartile range age, 75 65-83 years; 1025 52.6% men) were included; 533 (27.3%) had low levels of inflammation, 894 (45.9%) had moderate levels of inflammation, and 523 (26.8%) had high levels of inflammation. Compared with the control group, patients receiving nutritional support showed a significant reduction in 30-day mortality, regardless of C-reactive protein level (adjusted odds ratio, 0.61; 95% CI, 0.43-0.86; P = .005). In the subgroup of patients with high inflammation, there was no beneficial effect of nutritional support (adjusted odds ratio, 1.32; 95% CI, 0.70-2.50; P = .39), providing evidence that inflammation has a significant modifying association (P for interaction = .005).
Based on this secondary analysis of a multicenter randomized trial, a patient's admission inflammatory status was associated with their response to nutritional support. If validated in future clinical trials, nutritional support may need to be individualized based on a patient's initial presentation and markers of inflammation. These results may also help to explain some of the heterogeneity in treatment effects of nutrition seen in previous critical care trials.
ClinicalTrials.gov Identifier: NCT02517476.
Background
Food insecurity has been defined as “
limited access to food, at the level of individuals or households, due to lack of money or other resources
” and may increase the nutritional risk, ...which in turn leads to poor health, development of chronic diseases, poor psychological and cognitive functioning, and substandard academic achievements. There is limited data on the importance of food insecurity in a rich country such as Switzerland.
Methods
This is a cross-sectional analysis of data from a structured survey in an elderly population of Switzerland. The data was assessed between June and August 2021 in the course of a 7-year phone call follow-up from the EFFORT trial, which included medical inpatients at nutritional risk from 2014 to 2018. A validated questionnaire (Six-Item Short Form 2012 of the U.S: Household Food Security Survey Module) was used to assess food security status.
Results
Of the 433 included patients, 30 (6.9%) were food insecure. A significant association between food insecurity and age, governmental financial support and self-reported loneliness was found. When compared with the food secure group, there was a significant lower quality of life measured by the EQ-5D VAS.
Conclusion
In an older Swiss population of patients at nutritional risk, food insecurity was named as a contributing factor for malnutrition in about 7% of patients, particularly younger individuals with financial support, and self-reported loneliness. In the assessment of malnutrition, physician and dieticians should ask for food insecurity and if detect take appropriate actions.
A balanced diet has the goal of providing adequate amounts of different nutrients to promote and maintain physical and psychological health. Our aim was to study the association between different ...sociodemographic, socioeconomic and lifestyle factors and low energy or protein intake among the Swiss population. This is a cross-sectional cohort study based on the national nutritional survey "MenuCH", which is the first representative, detailed assessment of dietary habits in the adult Swiss population conducted in 2014/2015. We compared the mean protein and caloric intake based on two 24 h recall nutritional assessments with current recommendations based on resting metabolic rate calculation and DACH guidelines. A total of 1919 participants with a median age of 46 years and 53% females were included. Overall, 10.9% and 20.2% of participants had an energy and protein intake, respectively, below the dietary reference values. However, a high income (>9000 CHF per month) reduced the risk of low energy intake (OR 0.49 0.26-0.94,
= 0.032), obesity (OR 6.55 3.77-11.38,
< 0.01), and living in a household with children (OR 2.1 1.15-3.85,
= 0.016) was associated with higher risk. Regarding low protein intake, the most important risk factors were an age group of 65-75 years (OR 2.94 1.57-5.52,
= 0.001) and female gender (OR 1.73 1.15-2.6,
= 0.008). Regular meat consumption reduced the risk of low protein intake (OR of 0.23 (0.1-0.53),
= 0.001). Within this survey, several socio-economic and lifestyle factors were associated with low energy and protein intake in the healthy Swiss population. A bunderstanding of these factors may help to reduce the risk of malnutrition.
Background and aimsNutritional support improves clinical outcomes during hospitalisation as well as after discharge. Recently, a systematic review of 27 randomised, controlled trials showed that ...nutritional support was associated with lower rates of hospital readmissions and improved survival. In the present economic modelling study, we sought to determine whether in-hospital nutritional support would also return economic benefits.MethodsThe current economic model applied cost estimates to the outcome results from our recent systematic review of hospitalised patients. In the underlying meta-analysis, a total of 27 trials (n=6803 patients) were included. To calculate the economic impact of nutritional support, a Markov model was developed using transitions between relevant health states. Costs were estimated accounting for length of stay in a general hospital ward, hospital-acquired infections, readmissions and nutritional support. Six-month mortality was also considered. The estimated daily per-patient cost for in-hospital nutrition was US$6.23.ResultsOverall costs of care within the model timeframe of 6 months averaged US$63 227 per patient in the intervention group versus US$66 045 in the control group, which corresponds to per patient cost savings of US$2818. These cost savings were mainly due to reduced infection rate and shorter lengths of stay. We also calculated the costs to prevent a hospital-acquired infection and a non-elective readmission, that is, US$820 and US$733, respectively. The incremental cost per life-day gained was −US$1149 with 2.53 additional days. The sensitivity analyses for cost per quality-adjusted life day provided support for the original findings.ConclusionsFor medical inpatients who are malnourished or at nutritional risk, our findings showed that in-hospital nutritional support is a cost-effective way to reduce risk for readmissions, lower the frequency of hospital-associated infections, and improve survival rates.
Cortisol is a metabolically active stress hormone that may play a role in the pathogenesis of malnutrition. We studied the association between admission cortisol levels and nutritional parameters, ...disease severity, and response to nutritional support among medical inpatients at nutritional risk. Admission cortisol was measured in a subset of 764 patients participating in the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a multicentre, randomized-controlled trial that compared individualized nutritional support with usual nutritional care. Overall, mean cortisol levels were 570 (+ or - 293) nmol/L and significantly higher in patients with high nutritional risk (NRS greater than or equal to 5) and in patients reporting loss of appetite. Cortisol levels in the highest quartile (> 723 nmol/l) were associated with adverse outcomes including mortality at 30 days and 5 years (adjusted HR 2.31, 95%CI 1.47 to 3.62, p = 0.001 and 1.51, 95%CI 1.23 to 1.87, p < 0.001). Nutritional treatment tended to be more effective regarding mortality reduction in patients with high vs. low cortisol levels (adjusted OR of nutritional support 0.54, 95%CI 0.24 to 1.24 vs. OR 1.11, 95%CI 0.6 to 2.04, p for interaction = 0.134). This effect was most pronounced in the subgroup of patients with severe malnutrition (NRS 2002 greater than or equal to 5, p for interaction = 0.047). This secondary analysis of a randomized nutritional trial suggests that cortisol levels are linked to nutritional and clinical outcome among multimorbid medical patients at nutritional risk and may help to improve risk assessment, as well as response to nutritional treatment.
Cancer-related malnutrition is a prevalent condition associated with a loss of muscle mass and impaired functional status, leading to immunodeficiency, impaired quality of life and adverse clinical ...outcomes. Handgrip strength (HGS) is a practical measure to assess muscle strength in individual patients during clinical practice. However, HGS reference values refer to populations of healthy people, and population-specific values, such as those in the population of cancer patients, still need to be defined.
Within a secondary analysis of a previous randomized controlled nutritional trial focusing on hospitalized cancer patients at risk for malnutrition, we investigated sex-specific HGS values stratified by age and tumor entity. Additionally, we examined the association between HGS and 180-day all-cause mortality.
We included data from 628 cancer patients, which were collected from eight hospitals in Switzerland. Depending on the age of patients, HGS varied among female patients from 7 kg to 26 kg and among male patients from 20.5 kg to 44 kg. An incremental decrease in handgrip strength by 10 kg resulted in a 50% increase in 180-day all-cause mortality (odds ratio 1.52 (95%CI 1.19 to 1.94),
= 0.001).
Our data provide evidence of the prognostic implications of HGS measurement in cancer patients and validate the prognostic value of handgrip strength in regard to long-term mortality. In addition, our results provide expected HGS values in the population of hospitalized malnourished cancer patients, which may allow better interpretation of values in individual patients.
Disease-related malnutrition in adult patients who have been admitted to hospital is a syndrome associated with substantially increased morbidity, disability, short-term and long-term mortality, ...impaired recovery from illness, and cost of care. There is uncertainty regarding optimal diagnostic criteria, definitions for malnutrition, and how to identify patients who would benefit from nutritional intervention. Malnutrition has become the focus of research aimed at translating current knowledge of its pathophysiology into improved diagnosis and treatment. Researchers are particularly interested in developing nutritional interventions that reverse the negative effects of disease-related malnutrition in the hospital setting. High-quality randomised trials have provided evidence that nutritional therapy can reduce morbidity and other complications associated with malnutrition in some patients. Screening of patients for risk of malnutrition at hospital admission, followed by nutritional assessment and individualised nutritional interventions for malnourished patients, should become part of routine clinical care and multimodal treatment in hospitals worldwide.
Malnutrition is prevalent in hospitalized cancer patients and has been associated with poor therapy response and unfavorable clinical outcome. While recent studies have shown a survival benefit ...through nutritional support in a hospitalized malnourished medical population including cancer patients, we aimed to investigate the association of nutritional support with in-hospital mortality and other clinical outcomes in a nationwide inpatient cancer population. In this population-based cohort study, using a large Swiss administrative claims database from April 2013 to December 2018, we created two cohorts of malnourished cancer patients on medical wards. We generated two pairwise cohorts of malnourished patients who received nutritional support by 1:1 propensity-score matching to patients not receiving nutritional support. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were 30-days all-cause hospital readmission and discharge to a post-acute care facility. To account for disease activity, we stratified patients either admitted for cancer as main diagnosis or admitted with cancer as comorbidity. Among 1,851,498 hospitalizations on medical ward, we identified a total of 32,038 malnourished cancer patients. After matching, 11,906 (37%) cases were included in the "cancer main diagnosis cohort" and 5,954 (18.6%) in the "cancer comorbidity cohort." Patients prescribed a nutritional support showed a lower in-hospital mortality in both cohorts as compared to their respective matched controls not receiving nutritional support cancer main diagnosis cohort: 15.4 vs. 19.4 %, OR 0.76 (95% CI 0.69-0.83); cancer comorbidity cohort: 7.4 vs. 10.2%, OR 0.71 (95% CI 0.59-0.85). While we found no difference in 30-days readmission rates, discharge to a post-acute care facility was less frequent in the nutritional support group of both cohorts. In this large cohort study, nutritional support in hospitalized patients with either cancer as main diagnosis or comorbidity was associated with a lower risk of in-hospital mortality and discharge to a post-acute care facility.
Historically, admission serum albumin concentrations have been considered useful biochemical markers for nutrition assessment. However, there is a lack of randomised trial data investigating whether ...low albumin concentrations are helpful for identifying patients benefitting from nutritional support.
This study was a secondary analysis of the EFFORT trial, a Swiss-wide multicentre, randomised controlled trial comparing individualised nutritional support with usual care nutrition in medical inpatients from April 1, 2014, to February 1, 2018. 1389 of 2028 patients at nutritional risk with available albumin concentrations on admission were included. The primary endpoint was all-cause mortality within 30 and 180 days. Patients were stratified into groups of low or normal albumin based on the albumin cut-off of 30 g/L. ClinicalTrials.gov number, NCT02517476.
1389 patients (mean age, 73.1 (SD 3.5) years; 747 (53.8%) men) were included and 676 (48.7%) had low serum albumin concentrations at admission (<30 g/L). Mortality at 180 days was significantly increased in the low albumin group compared with patients with normal albumin concentrations (219/676 (32.4%) vs. 162/713 (22.7%), fully adjusted HR 1.4, 95%CI 1.11 to 1.77, p = 0.005. Effects of nutritional support on 30-day mortality were similar for patients with low compared to patients with normal albumin concentrations (HR 0.68, 95%CI 0.44 to 1.05 vs. HR 0.70, 95%CI 0.41 to 1.20), with no evidence for a subgroup effect (p for interaction=0.97).
Based on this secondary analysis of a randomised trial, low admission serum albumin concentrations in hospitalised, non-critically ill, medical patients at nutritional risk had prognostic implications and indicated higher mortality risk but were not helpful in selecting patients for nutritional interventions.
The Swiss National Science Foundation (SNSF) (PP00P3_150531) and the Research Council of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) provided funding for the EFFORT trial
PDF
