Malnutrition is a prognostic factor in Amyotrophic Lateral Sclerosis (ALS). Sometimes, this condition is underdiagnosed, and it might influence on disease progression.
To evaluate a) nutritional ...status at the beginning of specialized nutritional treatment and b) the influence of initial nutritional status on disease evolution and survival in a group of patients with amyotrophic lateral sclerosis (ALS).
An interhospital registry of patients with motor neuron disease treated at the Clinical Nutrition Clinics of six hospitals in the region of Castilla y León in Spain was created. The study was developed from January 2015 to December 2017. An anamnesis, affiliation data, past medical history, disease evolution, nutritional history and an anthropometry and bioelectrical impedance analysis were performed at baseline. The mortality rate was compared among those patients with worse nutritional status at the beginning of the follow-up against those with a better nutritional situation using two tools: The Subjective Global Assessment (SGA) and the criteria of the Global Leadership Initiative for Malnutrition (GLIM).
A total of 93 patients were analysed. The median age of the patients was 67 (57.5–75.5) years. The median Body Mass Index was 24.4 (21.7–25.9) kg/m2 and the median percentage of weight loss was 9.32 (2.7–17.6)% without differences between the onset type. According to the SGA, 27 (29%) patients were in grade A; 43 (46.3%) patients were in grade B and 23 (24.7%) were in grade C. According to the new GLIM malnutrition criteria, 45 patients (48.4%) had malnutrition. Patients with worse nutritional status had a lower survival median with both SGA (SGA A: 20.5 (10.2–35) months vs SGA B–C: 12 (5.2–23.7) months (p = 0.03)) or the new GLIM criteria according to severity (severe malnutrition: 18 (5–24) months vs. no severe malnutrition: 20 (12–33) months (p = 0.01)). In the multivariate analysis, malnutrition measured by SGA was an independent risk factor (HR: 4.6 (1.5–13.9) p = 0.007) for survival over 15 months when adjusted for age, sex and type of onset of ALS.
Patients with ALS have a severe deterioration in nutritional status when analysed using a classical malnutrition test (SGA) or a new one (GLIM criteria). Patients with a better nutritional situation according to SGA and GLIM severity classification were associated with a longer survival time.
Introduction
Obesity is a chronic disease associated with other comorbidities, including atherogenic dyslipidemia (AD). Bariatric surgery (BS) has shown to reduce cardiovascular risk (CVR) by ...achieving a significant weight reduction and improving the lipid profile. Different surgical techniques may have a different effect on the lipoprotein profile.
Purpose
To evaluate the lipid profile at 3 years after BS according to the surgical technique used and to determine which variables predict variation in the lipid profile at 3 years after BS.
Methods
Retrospective observational study of 206 patients who underwent BS between 2010 and 2019. We analyzed the variation of lipid parameters in the 3 years of follow-up according to the surgical technique, including a group analysis of patients according to whether they had dyslipidemia and whether they were treated or untreated and determined which variables predict variation in the lipid profile at 3 years after BS.
Results
There was a significant increase in high-density lipoprotein cholesterol (HDL-c) with sleeve gastrectomy (SG) and a significant decrease in total cholesterol (TC), LDL-cholesterol (LDL-c), non-HDL, and LDL/non-HDL with biliopancreatic diversion (BPD). Variables predicting lipid profile variation were surgical technique and pre-surgery lipoprotein level.
Conclusions
Malabsorptive techniques achieve a greater decrease in TC and LDL-c throughout follow-up and could also improve residual cardiovascular risk (non-HDL and LDL/non-HDL). The type of surgical technique and the presurgery lipid profile predict variation after 3 years of BS.
Graphical abstract
Background
Bariatric surgery (BS) is a very effective treatment regarding body weight loss but might affect food tolerance and energy and protein intake. The aim of this study was to compare three BS ...techniques (biliopancreactic diversion (BPD), gastric bypass (GB), and sleeve gastrectomy (SG)) and their effect on food tolerance.
Methods
Prospective study conducted between April 2016 and April 2019. Visits included were 1 before and 6, 12, and 24 months after BS. Food tolerance test (FTT), 24-h recall, and bioelectrical impedance (TANITA MC780) were performed at all visits.
Results
Sixty-six patients were included (74.2% women). FTT showed a better self-perception of the intake after surgery in BPD at 6 months (
p
= 0.013), and at 12 months (
p
= 0.006). BPD had a better tolerance of 8 food groups at 6 months (red meat
p
= 0.017, white meat
p
= 0.026, salad
p
= 0.017, bread
p
< 0.001, rice
p
= 0.047, pasta
p
= 0.014, fish
p
= 0.027) and at 12 months, but only red meat (
p
= 0.002), bread (
p
< 0.001), rice (
p
= 0.025), and pasta (
p
= 0.025) remained statistically different. Twenty-four months after surgery, only the red meat food group (
p
= 0.007) showed differences. BPD had the lowest incidence of vomiting at 6 months (
p
< 0.001), 12 months (
p
= 0.008), and 24 months (
p
= 0.002). The total score of FTT was better in BPD at 6 months 25.6 (SD 1.5),
p
< 0.001, 12 months 25.6 (SD 2.4),
p
< 0.001, and 24 months 25.7 (SD 1.3),
p
= 0.001. BPD showed the best intake in energy and proteins at 6 months 1214.8 (SD 342.4) kcal and 67.1 (SD 18.4) g and 12 months 1199.6 (SD 289.7) kcal and 73.5 (SD 24.3) g. % FML was higher in GB both at 6 and 12 months being statistically different (
p
< 0.050).
Conclusion
Biliopancreatic diversion appears to be the technique with a better food tolerance and protein and energy intake in the first year of follow-up after BS.
Graphical Abstract
(1) Background: Both sarcopenia and disease-related malnutrition (DRM) are unfortunately underdiagnosed and undertreated in our Western hospitals, which could lead to worse clinical outcomes. Our ...objectives included to determine the impact of low muscle mass (MM) and strength, and also DRM and sarcopenia, on clinical outcomes (length of stay, death, readmissions at three months, and quality of life). (2) Methodology: Prospective cohort study in medical inpatients. On admission, MM and hand grip strength (HGS) were assessed. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose DRM and EWGSOP2 for sarcopenia. Assessment was repeated after one week and at discharge. Quality of life (EuroQoL-5D), length of stay (LoS), readmissions and mortality are reported. (3) Results: Two hundred medical inpatients, median 76.0 years-old and 68% with high comorbidity. 27.5% met GLIM criteria and 33% sarcopenia on admission, increasing to 38.1% and 52.3% on discharge. Both DRM and sarcopenia were associated with worse QoL. 6.5% died and 32% readmission in 3 months. The odds ratio (OR) of mortality for DRM was 4.36 and for sarcopenia 8.16. Readmissions were significantly associated with sarcopenia (OR = 2.25) but not with DRM. A higher HGS, but not MM, was related to better QoL, less readmissions (OR = 0.947) and lower mortality (OR = 0.848) after adjusting for age, sex, and comorbidity. (4) Conclusions: In medical inpatients, mostly polymorbid, both DRM but specially sarcopenia are associated with poorer quality of life, more readmissions, and higher mortality. Low HGS proved to be a stronger predictor of worse outcomes than MM.
Background
Secondary hyperparathyroidism (SHPT) is a matter of concern after biliopancreatic diversion (BPD). The aim of this study was to investigate the relationship between SHPT, 25(OH)D, and ...calcium after BPD.
Design
A retrospective analysis in obese patients after BPD performed between 1998 and 2016.
Methods
Patients with at least 1 year of follow-up were included. SHPT was considered when PTH > 65 pg/mL in the absence of an elevated corrected calcium. 25(OH)D (ng/mL) status was defined as: deficiency < 20, insufficiency 20–29.9, and sufficiency ≥ 30.
Results
In total, 321 patients were included (76.6% women), with mean age 43.0 (10.5) years. Median follow-up was 6.0 (IQR 3.0–9.0) years. Mean body mass index was 49.8 (7.0) kg/m
2
. SHPT increased to a maximum of 81.9% in the ninth year of follow-up (95% CI: 1.5–9.1). Two years after surgery, 33.9% of patients with 25(OH)D sufficiency had SHPT (
p
= 0.001). Corrected calcium levels were lower in patients with PTH > 65 pg/mL when compared with PTH < 65 pg/mL; 1 year: 8.96 vs 9.1 mg/dL and 5 years: 8.75 vs 9.12 mg/dL (
p
< 0.01). After surgery, patients with PTH > 65 pg/mL and 25(OH)D sufficiency had lower corrected calcium levels when compared with subjects with PTH and 25(OH)D in normal range. Two years: 9.0 vs 9.2 mg/dL (
p
< 0.05) and 4 years: 8.9 vs 9.2 mg/dL (
p
< 0.01).
Conclusions
Once 25(OH)D is sufficient, the increase in PTH persists associated with a decrease in serum corrected calcium. It is important to ensure a sufficient calcium intake in these patients in order to avoid SHPT and osteomalacia in the future.
Introduction: oncohematological diseases are associated with a high prevalence of malnutrition during hospitalization. Our aim was to analyze the appearance and repercussions of malnutrition in ...well-nourished hematological inpatients at admission. Method: a prospective one-year study conducted in hematology inpatients. The Malnutrition Screening Tool (MST) was used at admission and repeated weekly. Patients with a negative screening at admission who developed malnutrition during hospitalization constituted our study sample. A nutritional evaluation and intervention was performed. We also analyzed the effect of newly diagnosed malnutrition on patients' outcomes in comparison with the outcomes of patients that remained well-nourished during hospitalization. Results: twenty-one percent of hematological inpatients who were well nourished at admission developed malnutrition during hospitalization. Of the patients, 62.4% needed a nutritional intervention (100% oral supplements, 21.4% diet changes, 5.2% parenteral nutrition). After intervention, an increase in real intake was achieved (623 kcal and 27.3 g of protein/day). Weight loss was slowed and visceral protein was stabilized. Length of stay was 8.5 days longer for our sample than for well-nourished patients. Conclusions: newly diagnosed malnutrition appeared in one in five hematological well-nourished inpatients, leading to a longer length of stay. Nutritional intervention improved intake and nutritional status. Nutritional surveillance should be mandatory.
Malnutrition in oncology and hematology-oncology patients is important due to its prevalence and associated mortality and morbidity. The aims of the study were to assess the prevalence of ...malnutrition in oncology and hematology patients and determine if intake or malnutrition influences hospitalization outcomes.
A cohort study was performed in all patients admitted to the oncology and hematology wards in a 30-day period. Nutritional assessment was performed within 24-hours of admission and repeated after 7 days of hospitalization, including Subjective Global Assessment, anthropometry, dietary assessment (24-hour recall) and estimation of caloric and protein needs. Medical records were reviewed 30 days after discharge.
Seventy-three patients were evaluated on admission and 29 on day 7 of hospitalization. The prevalence of malnutrition was 47.7%. On admission, patients consumed 71.6 (SD 22.0)% of the prescribed dietary calories and 68.2 (SD 23.5)% of prescribed proteins. The death rate was 2.8% among patients who ate ≥75% and 17.9% among those who ate <75% (p = 0.040). No significant differences were observed between the intake of calories (p = 0.124) and protein (p = 0.126) on admission and on day 7 of hospitalization. Nutritional status was related to readmission rate, being 35.1% for malnourished vs. 8% for well-nourished (p = 0.014). Nutritional status and food intake were not related to the rest of the studied outcomes (length of stay and mechanical, metabolic or infectious complications).
Intake did not decrease during hospitalization. There was an upward trend between reduced intake and mortality. Malnutrition was related to hospital readmission.
Nutritional profile of multiple sclerosis Redondo Robles, Laura; Pintor de la Maza, Begoña; Tejada García, Javier ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
2019-Apr-10, Letnik:
36, Številka:
2
Journal Article
Odprti dostop
Background: multiple sclerosis (MS) is an inflammatory, neurodegenerative disease of the central nervous system. Weight loss and malnutrition are prevalent in advanced stages of MS. Objective: the ...aim of this study was to define the nutritional profile in moderate-advanced MS (especially by documenting malnutrition) and its evolution. Methods: a case-control study was designed; cross-sectional observational study was complemented by a 12-month prospective longitudinal observational study of MS patients. Nutritional status was evaluated by collecting clinical, anthropometric, dietary and analytical data. Results: one hundred and twenty-four patients with MS and 62 controls were recruited; 8% of the patients were malnourished or at risk of malnutrition. Only MS patients with advanced disability needed nutritional support. During the follow-up, five patients died and four of them received nutritional support. Conclusions: malnutrition was unusual in our sample of patients with moderate-advanced MS. The need for nutritional support is related to dysphagia in patients with advanced neurological disability. The nutritional status of patients with moderate-advanced MS is defined by a tendency to overweight and by the decrease in basal energy expenditure and handgrip strength test in relation to the loss of muscle mass. The deficient intake of polyunsaturated fatty acids, fiber and vitamin D is exacerbated in the evolution of the disease.
Background
Biliopancreatic diversion (BPD) has been shown to be one of the most effective techniques for losing weight, although the relationship between body composition and diet after the procedure ...is not well known. Our aim was to assess dietary changes and their effects on body composition.
Methodology
This longitudinal study included all patients eligible for BPD who had undergone body composition analysis. Two assessments were performed: 6 weeks before and 1 year after surgery. Nutritional education was given after surgery by a registered dietitian, and dual energy X-ray absorptiometry was performed and a 3-day food record was collected for further analysis at both of the visits.
Results
Forty-six patients were included. The percentage of excess of weight loss was 61.03 % (SD 14.01 %), which was statistically different by gender (
p
= 0.045). The percentage of subjects reporting a low daily protein consumption of less than 60 g and 1.2 g/kg of ideal body weight (IBW)/day was 15.2 % before surgery and 19.6 % at 12 months (
p
= 0.006). The weight loss was mainly of fat mass (FM). There were differences of body composition by gender before and after surgery. A simple correlation analysis showed a significant association between daily energy intake and FM (g) only before surgery (
p
= 0.030), and also between daily protein intake (expressed as total g) and lean body mass (LBM) 12 months after surgery (
p
= 0.018), but no association was found with achieved protein goal.
Conclusion
BPD enhanced by nutritional education seems to improve its results by achieving an adequate weight loss, preserving LBM, decreasing FM, and guaranteeing an appropriate protein intake.
Obesity is a challenge for bioelectrical impedance analysis (BIA) estimations of skeletal muscle and fat mass (FM), and none of the equations used for appendicular lean mass (ALM) have been developed ...for people with obesity. By using different equations and proposing a new equation, this study aimed to assess the estimation of FM and ALM using BIA compared with dual-energy x-ray absorptiometry (DXA) as a reference method in a cohort of people with severe obesity.
This cross-sectional study compared a multifrequency BIA (TANITA MC-780A) versus DXA for body composition assessment in adult patients with severe obesity (body mass index BMI of >35 kg/m2). Comparisons between measured (DXA) and predicted (BIA) data for FM and ALM were performed using the original proprietary equations of the device and the equations proposed by Kyle, Sergi, and Yamada. Bland-Altman plots were drawn to evaluate the agreement between DXA and BIA, calculating bias and limits of agreement (LOA). Reliability was analyzed using intraclass correlation coefficient (ICC). Stepwise multiple regression analysis was used to derive a new equation to predict ALM in patients with obesity and was validated in a subsample of our cohort.
In this study, 115 patients (72.4% women) with severe obesity (mean BMI of 46.1 5.2 kg/m2) were included (mean age 43.5 8.6 y). FMDXA was 61.4 (10.1) kg, FMBIA was 57.9 (10.3) kg, and ICC was 0.925 (P < 0.001). Bias was –3.4 (4.4) kg (–5.2%), and LOA was –14.0, +7.3 kg. Using the proprietary equations, ALMDXA was 21.8 (4.7) kg and ALMBIA was 29.0 (6.8) kg with an ICC 0.868, bias +7.3 (4.0) kg (+34.1%) and LOA –0.5, +15.1. When applying other equations for ALM, the ICC for Sergi, et al. was 0.880, the ICC for Kyle, et al. was 0.891, and the best ICC estimation for Yamada, et al. was 0.914 (P < 0.001). Bias was +2.8 (2.8), +4.1 (2.9), and +2.7 (2.8) kg, respectively. The best-fitting regression equation to predict ALMDXA in our population derived from a development cohort (n = 77) was: ALM = 13.861 + (0.259 x H2/Z) – (0.085 x age) – (3.983 x sex 0 = men; 1 = women). When applied to our validation cohort (n = 38), the ICC was 0.864, and the bias was the lowest compared with the rest of the equations +0.3 (+0.5) kg (+2.7%) LOA –5.4, +6.0 kg.
BIA using multifrequency BIA in people with obesity is reliable enough for the estimation of FM, with good correlation and low bias to DXA. Regarding the estimation of ALM, BIA showed a good correlation with DXA, although it overestimated ALM, especially when proprietary equations were used. The use of equations developed using the same device improved the prediction, and our new equation showed a low bias for ALM.
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•The reliability of bioelectrical impedance analysis for body composition in people with obesity is controversial.•Compared with dual-energy x-ray absorptiometry in 115 people with severe obesity, multifrequency bioelectrical impedance analysis is reliable enough for the estimation of fat mass, with good correlation (intraclass correlation coefficient 0.925) and low bias (–5.2%).•Regarding the estimation of appendicular lean mass, bioelectrical impedance analysis showed a good correlation with dual-energy x-ray absorptiometry, although it overestimated appendicular lean mass when proprietary equations were used.•Equations developed using the same device improved prediction, and a new equation showed a low bias for appendicular lean mass (+2.7%).
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