Cancer patients are at high risk of malnutrition,which can lead to adverse health outcomes such as prolonged hospitalization,increased complications,and increased mortality.Accurate and timely nutritional assessment p...Cancer patients are at high risk of malnutrition,which can lead to adverse health outcomes such as prolonged hospitalization,increased complications,and increased mortality.Accurate and timely nutritional assessment plays a critical role in effectively managing malnutrition in these patients.However,while many tools exist to assess malnutrition,there is no universally accepted standard.Although different tools have their own strengths and limitations,there is a lack of narrative reviews on nutritional assessment tools for cancer patients.To address this knowledge gap,we conducted a non-systematic literature search using PubMed,Embase,Web of Science,and the Cochrane Library from their inception until May 2023.A total of 90 studies met our selection criteria and were included in our narrative review.We evaluated the applications,strengths,and limitations of 4 commonly used nutritional assessment tools for cancer patients:the Subjective Global Assessment(SGA),Patient-Generated Subjective Global Assessment(PG-SGA),Mini Nutritional Assessment(MNA),and Global Leadership Initiative on Malnutrition(GLIM).Our findings revealed that malnutrition was associated with adverse health outcomes.Each of these 4 tools has its applications,strengths,and limitations.Our findings provide medical staff with a foundation for choosing the optimal tool to rapidly and accurately assess malnutrition in cancer patients.It is essential for medical staff to be familiar with these common tools to ensure effective nutritional management of cancer patients.展开更多
BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplan...BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplant outcomes.AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation(LT).METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022.RESULTS This study identified several independent risk factors associated with 30-d mor-tality,including blood loss,the prognostic nutritional index(PNI),the nutritional risk index(NRI),and the control nutritional status.The 30-d mortality rate was 8.6%.Blood loss,the NRI,and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications.The NRI achieved the highest prediction values for 30-d mortality[area under the curve(AUC)=0.861,P<0.001]and severe complications(AUC=0.643,P=0.011).Compared to those in the high NRI group,the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels,as well as higher alanine aminotransferase and total bilirubin levels,Model for End-stage Liver Disease scores and prothrombin time(P<0.05).Furthermore,the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding,primary graft nonfunction,and mortality.CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT.The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.展开更多
Hepatic encephalopathy(HE) is one of the worst complications of liver disease and can be greatly influenced by nutritional status. Ammonia metabolism, inflammation and muscle wasting are relevant processes in HE patho...Hepatic encephalopathy(HE) is one of the worst complications of liver disease and can be greatly influenced by nutritional status. Ammonia metabolism, inflammation and muscle wasting are relevant processes in HE pathophysiology. Malnutrition worsens the prognosis in HE, requiring early assessment of nutritional status of these patients. Body composition changes induced by liver disease and limitations superimposed by HE hamper the proper accomplishment of exams in this population, but evidence is growing that assessment of muscle mass and muscle function is mandatory due to the role of skeletal muscles in ammonia metabolism. In this review, we present the pathophysiological aspects involved in HE to support further discussion about advantages and drawbacks of some methods for evaluating the nutritional status of cirrhotic patients with HE, focusing on body composition.展开更多
Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely...Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between Subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: Subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.展开更多
AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to Ju...AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student's t test and oneway analysis of variance. Spearman's rank correlation coefficients were calculated to evaluate the association between the scores and variables. RESULTS: The prevalence of malnutrition at admissionwas 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status. CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status in case of gastric cancer patients after gastrectomy.展开更多
Malnutrition is a liver cirrhosis complication affecting more than 20%-50%of patients.Although the term can refer to either nutrient deficiency or excess,it usually relates to undernutrition in cirrhosis settings.Frai...Malnutrition is a liver cirrhosis complication affecting more than 20%-50%of patients.Although the term can refer to either nutrient deficiency or excess,it usually relates to undernutrition in cirrhosis settings.Frailty is defined as limited physical function due to muscle weakness,whereas sarcopenia is defined as muscle mass loss and an advanced malnutrition stage.The pathogenesis of malnutrition in liver cirrhosis is multifactorial,including decreased oral intake,maldigestion/malabsorption,physical inactivity,hyperammonemia,hypermetabolism,altered macronutrient metabolism and gut microbiome dysbiosis.Patients with chronic liver disease with a Body Mass Index of<18.5 kg/m2 and/or decompensated cirrhosis or Child-Pugh class C are at the highest risk of malnutrition.For patients at risk of malnutrition,a detailed nutritional assessment is required,typically including a history and physical examination,laboratory testing,global assessment tools and body composition testing.The latter can be done using anthropometry,cross-sectional imaging including computed tomography or magnetic resonance,bioelectrical impedance analysis and dual-energy X-ray absorptiometry.A multidisciplinary team should screen for and treat malnutrition in patients with cirrhosis.Malnutrition and sarcopenia are associated with an increased risk of complications and a poor prognosis in patients with liver cirrhosis;thus,it is critical to diagnose these conditions early and initiate the appropriate nutritional therapy.In this review,we describe the prevalence and pathogenesis of malnutrition in liver cirrhosis patients and discuss the best diagnostic approach to nutritional assessment for them.展开更多
Objective To compare the value and consistency among the Patient Generated-Subjective Global Assessment(PG-SGA)and the Prognostic Nutrition Index(PNI)for assessing nutritional status in gastrointestinal tumor patients...Objective To compare the value and consistency among the Patient Generated-Subjective Global Assessment(PG-SGA)and the Prognostic Nutrition Index(PNI)for assessing nutritional status in gastrointestinal tumor patients.Methods 251 patients from gastric cancer surgical ward from January 2019 to January 2020 were recruited through convenience sampling in this respective study.Nutritional screening and assessment were conducted for 251 gastrointestinal tumor patients using the nutritional risk screening 2002(NRS 2002)PG-SGA,and the PNI.PNI was calculated using the serum albumin level and the total lymphocyte count obtained from the patients’routine laboratory examination when they were admitted to the hospital.The receiver operating characteristic(ROC)of the PG SGA and the PNI were plotted with the NRS 2002 used as the gold standard,and the diagnostic value of the PG-SGA and PNI was reflected by the area under the curve(AUC),sensitivity,specificity and Youden index.We then determined the optimal cut-off for the PNI and tested the consistency of the PG-SGA and PNI.Results The optimal cut-off point for the PNI was calculated to be 50.78.The AUC of the PG-SGA was 0.908(95%CI 0.871-0.944).The sensitivity was 89.9%,specificity was 76.2%and the Youden index was 0.661.The AUC of the PNI was 0.594(95%CI 0.516-0.572).The sensitivity was 73.8%,specificity was 44.3%and the Youden index was 0.181.In the consistency test,the kappa value was 0.838(P<0.001).Conclusion The PNI is of limited value for assessing malnutrition,although it did have good consistency with the PG-SGA.The combination of the PNI and PG-SGA can be used for diagnosing assessing malnutrition in clinical practice.展开更多
Undernutrition is frequently underestimated in the elderly, because clinical manifestations are non-specific. For the francophone Club geriatrics and nutrition, poly medication is one of the warning signs to be the po...Undernutrition is frequently underestimated in the elderly, because clinical manifestations are non-specific. For the francophone Club geriatrics and nutrition, poly medication is one of the warning signs to be the possibility of malnutrition in an elderly person. To do this, it is particularly interesting to verify what the profiles of hypertensive patients who are at risk of malnutrition are. This component remains very little explored and studies are lacking. The authors conducted a descriptive cross-sectional study whose objective is to evaluate the prevalence of undernutrition in hypertensive patients with or without associated cardiovascular risk factors, in a population of consultants of liberal medical offices, determine the profiles of hypertensive patients who are at risk of undernutrition and describe their eating habits and their anthropometric parameters as well as the link between the number of supported antihypertensives and risk of undernutrition. 1144 patients with an average age of 65 years old have been collected during the period of recruitment. The data collection was done using a questionnaire: the MNA. Sensitive and specific, it is validated method which has international sacle. The percentage of the risk of malnutrition was estimated at 36.7%. Thus the number of associated cardiovascular risk factors becomes larger, and the risk of malnutrition is increased. The risk of malnutrition was three times higher in patients who take more than three medications per day compared with those who consumed less (75.8% vs. 24.2%). As a monotherapy, an increased risk of malnutrition is associated with diuretics. For these older hypertensives, the risk of malnutrition was linked to the type of used dual. The percentage of hypertension risk of malnutrition treated with free dual was significantly higher compared to hypertensive treated dual handset. Some associations have proved to be more favorable than others in terms of nutritional risk. Finally, a third of hypertension patients who were treated with quadruple therapy were at risk of malnutrition. This work was also designed to present an argument to a doctor to detect the risk of undernutrition in elderly hypertensives. The use of the MNA is a simple, effective and quick way for pressure balance rhymes with nutritional balance.展开更多
Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia.The presence of malnutrition causes a severe impact on patients with liver cirrhosis.The etiology of cirrhosis di...Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia.The presence of malnutrition causes a severe impact on patients with liver cirrhosis.The etiology of cirrhosis differs in the South Asian region compared to the West,with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time.Comorbid malnutrition worsens outcomes for cirrhosis patients.Urgent attention to address malnutrition is needed to improve patient outcomes.The etiology and pathophysiology of malnutrition in liver diseases is multifactorial,as reduction in liver function affects both macronutrients and micronutrients.A need for nutritional status assessment for liver disease patients exists in all parts of the world.There are many widely studied tools in use to perform a thorough nutritional assessment,of which some tools are low cost and do not require extensive training.These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan.Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world,but the knowledge and practice of nutritional counseling in Pakistan is poor,both amongst patients and physicians.Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed.Simultaneously,treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.展开更多
BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommende...BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.展开更多
Malnutrition encompassing both macro-and micro-nutrient deficiency,remains one of the most frequent complications of alcohol-related liver disease(ArLD).Protein-energy malnutrition can cause significant complications ...Malnutrition encompassing both macro-and micro-nutrient deficiency,remains one of the most frequent complications of alcohol-related liver disease(ArLD).Protein-energy malnutrition can cause significant complications including sarcopenia,frailty and immunodepression in cirrhotic patients.Malnutrition reduces patient’s survival and negatively affects the quality of life of individuals with ArLD.Moreover,nutritional deficit increases the likelihood of hepatic decompensation in cirrhosis.Prompt recognition of at-risk individuals,early diagnosis and treatment of malnutrition remains a key component of ArLD management.In this review,we describe the pathophysiology of malnutrition in ArLD,review the screening tools available for nutritional assessment and discuss nutritional management strategies relevant to the different stages of ArLD,ranging from acute alcoholic hepatitis through to decompensated end stage liver disease.展开更多
Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in C...Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.展开更多
Background Malnutrition is common in patients with cancer,and this adversely affects the survival and quality of life of patients.Chinese Society for Nutritional Oncology issued a multi-center,large-scale,long-term fo...Background Malnutrition is common in patients with cancer,and this adversely affects the survival and quality of life of patients.Chinese Society for Nutritional Oncology issued a multi-center,large-scale,long-term follow-up prospective study,the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC study)since 2013.This is an extension to the previous 2013-2020 study protocol.This study still sought to:①address the prognostic impact of nutritional factors and quality of life on cancer patient survival;②describe the overall and cancer-specific incidence and/or distribution of malnutrition and different measurements of patient quality of life.Methods and study design This is an observational,multi-centered,hospital-based prospective cohort study.Data collection will be performed at baseline(within 48 hours after patient admission),during the hospital stay and 30 days after hospital admission.Follow-up will be conducted for 1-20 years after enrollment.The primary outcome will be the all-cause mortality/overall survival,and secondary outcomes will be the length of hospital stay and costs of hospitalization.Study factors will include demographic characteristics,tumor characteristics,information about chronic diseases,hematological measurements(e.g.,red blood cell count,total lymphocyte counts,hemoglobin,albumin,prealbumin,creatinine,C-reactive protein,IL-6),anthropometric measurements(e.g.,height,weight,arm circumference,arm muscle circumference,triceps skinfold thickness,and waist circumference),body composition parameters,PG-SGA scores,quality of life(as indicated by the QLQ-C30 questionnaire),muscle mass(as indicated by the calf circumference),muscle strength(as indicated by the handgrip strength),muscle function(as indicated by the six-meter walking speed test)and physical status assessments(as indicated by the Karnofsky Performance Status scores).This clinical study protocol was approved by local Ethics Committees of all the participating hospitals.Written informed consent is required for each subject included.Discussion This multi-center,large-scale,long-term follow up prospective study will help improve the diagnosis of malnutrition in cancer patients and identify the risk factors associated with adverse clinical outcomes.The anticipated results of this study will highlight the need for a truly scientific appraisal of nutrition therapy in Chinese oncology populations,and finally help treat the potentially reversible elements of malnutrition in cancer patients to improve their clinical outcomes in the future.展开更多
Following an esophagectomy, nurses’ patient nutrition observations are important for physical recovery and quality of life. The study proposed to identify the factors associated with physical recovery among esophagea...Following an esophagectomy, nurses’ patient nutrition observations are important for physical recovery and quality of life. The study proposed to identify the factors associated with physical recovery among esophageal cancer patients after surgery based on nurses’ observations and nutritional evaluations. Data were collected from the nursing records of 21 esophagectomy patients. The data included patients’ rate of weight loss, body mass index (BMI), energy intake, and postoperative complications. Patients were divided into two groups according to their weight loss rate: <8% and ≥8%. Patient outcomes were compared between the two groups. There was no difference in average BMI before or after surgery between the two groups. There was no difference in albumin levels during hospitalization;however, after esophagectomy, energy intake at discharge was insufficient in both groups. The ≥8% weight loss may be facilitated, or at least confounded, by the presence of recurrent nerve paralysis and aspiration pneumonia. Thus, the nursing records typically identified the need to check for recurrent laryngeal nerve palsy and aspiration pneumonia in conjunction with nutritional assessment to enhance patients’ physical recovery. When weight loss was significant, nurses provided oral intake support with the NST, and patients maintained oral intake levels similar to the group with weight loss under 8%. In order to better support physical recovery among malnourished, post esophagectomy patients, nurses need to monitor for signs of recurrent nerve palsy and aspiration pneumonia in addition to nutritional intake.展开更多
The high incidence of malnutrition in patients with colorectal cancer directly affects their clinical outcomes,and is associated with increased postoperative complications,prolonged hospital stays,and decreased tolera...The high incidence of malnutrition in patients with colorectal cancer directly affects their clinical outcomes,and is associated with increased postoperative complications,prolonged hospital stays,and decreased tolerance of chemotherapy and radiotherapy.Therefore,the nutritional management of patients with colorectal cancer is important.The perioperative nutritional management of patients includes preoperative education,nutritional screening and evaluation,preoperative intestinal preparation,and postoperative nutritional management.This article summarizes the current status of perioperative nutritional therapy and bowel preparation for patients with colorectal cancer.展开更多
Objective To characterize the nutritional variables of patients referred to an outpatient oncology nutrition service.Methods The electronic medical records of patients diagnosed with malignant neoplasms were analyzed ...Objective To characterize the nutritional variables of patients referred to an outpatient oncology nutrition service.Methods The electronic medical records of patients diagnosed with malignant neoplasms were analyzed for several parameters:weight loss,body mass index(BMI),hand-grip strength(HGS),fat-free mass index(FFMI)and serum C-reactive protein(CRP).Statistical methods included Pearson’s correlation(significance was set at P≤0.05).Results There was a high prevalence of malnutrition(44%,n=28)and sarcopenia(61%,n=23)and a relatively low prevalence of cachexia(13%,n=6).Moderate positive correlations were observed between the tumor site and CRP level,correlation r=0.328(P=0.026);the tumor site and BMI(r=0,P=0.001);FFMI and BMI(r=0.606,P=4.334056e-005)and CRP and weight loss(r=0.355,P=0.024).There were negative correlations between the tumor staging and BMI (r=-0.409,P=0.001)and weight loss and FFMI(r=-0.467,P=3,228325e-004).Conclusion These preliminary findings may help institutions implement nutritional approaches,such as the adoption of a line-ofcare focused on nutrition in the department of oncology.展开更多
The coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field.Patients with COVID-19 usually have respiratory symptoms.Ho...The coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field.Patients with COVID-19 usually have respiratory symptoms.However,liver dysfunction is not an uncommon presentation.Additionally,the degree of liver dysfunction is associated with the severity and prognosis of COVID-19.Prevention,diagnosis,and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19,especially in those with liver dysfunction.Recently,a large number of studies have reported that nutrition therapy measures,including natural dietary supplements,vitamins,minerals and trace elements,and probiotics,might have potential hepatoprotective effects against COVID-19-related liver dysfunction via their antioxidant,antiviral,anti-inflammatory,and positive immunomodulatory effects.This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction,nutritional and metabolic characteristics,nutritional status assessment,and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.展开更多
Tumor cachexia is widely seen in patients with various stages of cancer,manifested by inadequate intake or abnormal hypermetabolism resultingin negative nitrogen and energy balance. Early intervention of nutritionalth...Tumor cachexia is widely seen in patients with various stages of cancer,manifested by inadequate intake or abnormal hypermetabolism resultingin negative nitrogen and energy balance. Early intervention of nutritionaltherapy and penetrate it into other anti-cancer treatment processes cansignificantly benefit cancer patients who receiving palliative treatment.Nutritional therapy for cancer is a process of planning, implementing, evaluatingand nutritional intervention to treat cancer and its complications orphysical condition, to improve the prognosis of cancer patients, includingnutritional diagnosis (screening/evaluation), nutritional intervention, efficacyevaluation (including follow-up) three stages. In practice, we shouldchoose appropriate nutritional risk assessment tools and interventionmethods according to the actual situation of patients, avoid over-treatment,reduce complications, and maximize patients'interests as far as possible.Nutritional support therapy for cancer involves ethics, morality and thewishes of patients and their families, and needs further exploration andimprovement. The best nutritional support strategy often requires the jointparticipation of many disciplines, including clinicians, nurses, nutritionistsand psychosocial workers. Nutritional support group and multidisciplinarycollaboration group on cancer are gradually becoming a trend. With theaccumulation of experience in cancer nutrition therapy, the developmentand application of drugs and nutritional preparations, and the deepening ofmulti-disciplinary collaboration, more cancer patients will benefit in clinicalwork.展开更多
Background Patients with advanced cancer often present with malnutrition.Globally,minority populations frequently suffer from higher rates of malnutrition than the majority group.It was unknown whether the nutritional...Background Patients with advanced cancer often present with malnutrition.Globally,minority populations frequently suffer from higher rates of malnutrition than the majority group.It was unknown whether the nutritional status of cancer patients is different between ethicality groups(i.e.Uyghur and Han)in China.Methods A total of 251 Uyghur cancer patients were enrolled from the Xinjiang Kashgar First People's Hospital in the INSCOC Program.The Han patients were 1∶1 matched to Uyghur patients by age,gender and type of cancer from 72 hospitals around China in INSCOC Program.The nutritional risk and nutritional status were assessed using the Nutrition Risk Screening 2002(NRS 2002)and Patient-Generated Subjective Global Assessment(PG-SGA),respectively.Then,the functional status of cancer patients was determined based on the Karnofsky Performance Status(KPS).Results The incidence of an abnormal NRS-2002(≥3),PG-SGA(≥4),and KPS(≤70)was significantly different(86.1%vs 59.0%,70.5%vs 27.5%,and 18.7%vs 4.0%,respectively P<0.05).The abnormal rate of laboratory indicators in Uyghur cancer patients was significantly higher than that in Han cancer patients,including total protein,albumin,serum total bilirubin,direct bilirubin,HDL-C,white blood cell,lymphocyte,red blood cell,and platelet(all P<0.05).The abnormal rates of TSF,HGS and CC were significantly higher than that of Han nationality patients(17.5%vs 9.7%,39.6%vs 19.6%,29.1%vs 15.2%,P<0.001).The nutritional support rate of Uyghur patients was lower than that of Han patients(0%vs 16.3%).After adjusting for potential risk factors,malnutrition was associated with gender(female,OR=0.35,95%CI=0.13-0.92,P=0.034),age(>60 years,OR=5.32,95%CI=1.46-19.41,P=0.011),cancer type(gastroesophageal tumor,OR=33.62,95%CI=3.42-330.67,P=0.003),and treatment methods(received radical tumor resection,OR=5.78,95%CI=1.45-23.08,P=0.008;received radiotherapy or chemotherapy:OR=7.69,95%CI=2.27-26.04,P<0.001).Conclusions The nutritional status of Uyghur cancer patients is worse than that of Han patients and the Uyghur patients with poor nutritional status lack the necessary nutritional support.展开更多
Recombinant plant-derived pharmaceuticals have been investigated for the last two decades and some products will soon be brought to market. Since veterinary pharmaceuticals seem to be the front-runners of plant-derive...Recombinant plant-derived pharmaceuticals have been investigated for the last two decades and some products will soon be brought to market. Since veterinary pharmaceuticals seem to be the front-runners of plant-derived vaccines, we selected one model subunit vaccine, the structural capsid protein VP60 against rabbit haemorrhagic disease, and ana-lyzed the expression of three different sequences representing the vp60 open reading frame in potato plants. The gen-eration of antigenic VP60 molecules in the leaf and tuber tissue of potato was tremendously enhanced by replacing virus-derived sequences with plant-optimized codons. In order to identify potentially undesirable alterations in the composition of these genetically modified food components, we studied their nutrient composition and nutritional value in comparison to two parental conventional breeding varieties (Albatros and Desiree). The largest differences in nutrient composition were found between the two conventional breeds and between conventional Desiree and its near-isogenic genetically modified potato plant, indicating that genetic modification as well as conventional breeding can influence nutrient composition. Nevertheless, most parameters of nutritional value seemed to be more affected by conventional breeding than by genetic modification.展开更多
基金financially supported by the Guangxi Medical University 2023 Innovation and Entrepreneurship Training Program Project(No.202310598015).
文摘Cancer patients are at high risk of malnutrition,which can lead to adverse health outcomes such as prolonged hospitalization,increased complications,and increased mortality.Accurate and timely nutritional assessment plays a critical role in effectively managing malnutrition in these patients.However,while many tools exist to assess malnutrition,there is no universally accepted standard.Although different tools have their own strengths and limitations,there is a lack of narrative reviews on nutritional assessment tools for cancer patients.To address this knowledge gap,we conducted a non-systematic literature search using PubMed,Embase,Web of Science,and the Cochrane Library from their inception until May 2023.A total of 90 studies met our selection criteria and were included in our narrative review.We evaluated the applications,strengths,and limitations of 4 commonly used nutritional assessment tools for cancer patients:the Subjective Global Assessment(SGA),Patient-Generated Subjective Global Assessment(PG-SGA),Mini Nutritional Assessment(MNA),and Global Leadership Initiative on Malnutrition(GLIM).Our findings revealed that malnutrition was associated with adverse health outcomes.Each of these 4 tools has its applications,strengths,and limitations.Our findings provide medical staff with a foundation for choosing the optimal tool to rapidly and accurately assess malnutrition in cancer patients.It is essential for medical staff to be familiar with these common tools to ensure effective nutritional management of cancer patients.
基金Supported by The Self-Funded Research Project of the Health Commission of Guangxi Zhuang Autonomous Region,No.Z-A20230045.
文摘BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplant outcomes.AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation(LT).METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022.RESULTS This study identified several independent risk factors associated with 30-d mor-tality,including blood loss,the prognostic nutritional index(PNI),the nutritional risk index(NRI),and the control nutritional status.The 30-d mortality rate was 8.6%.Blood loss,the NRI,and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications.The NRI achieved the highest prediction values for 30-d mortality[area under the curve(AUC)=0.861,P<0.001]and severe complications(AUC=0.643,P=0.011).Compared to those in the high NRI group,the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels,as well as higher alanine aminotransferase and total bilirubin levels,Model for End-stage Liver Disease scores and prothrombin time(P<0.05).Furthermore,the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding,primary graft nonfunction,and mortality.CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT.The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.
基金Supported by Sao Paulo Research Foundation(FAPESP),CAPES and PROPe/UNESP,Nos.2013/15121-8 and 2013/11761-2
文摘Hepatic encephalopathy(HE) is one of the worst complications of liver disease and can be greatly influenced by nutritional status. Ammonia metabolism, inflammation and muscle wasting are relevant processes in HE pathophysiology. Malnutrition worsens the prognosis in HE, requiring early assessment of nutritional status of these patients. Body composition changes induced by liver disease and limitations superimposed by HE hamper the proper accomplishment of exams in this population, but evidence is growing that assessment of muscle mass and muscle function is mandatory due to the role of skeletal muscles in ammonia metabolism. In this review, we present the pathophysiological aspects involved in HE to support further discussion about advantages and drawbacks of some methods for evaluating the nutritional status of cirrhotic patients with HE, focusing on body composition.
文摘Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between Subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: Subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.
基金Supported by The Bisa Research Grant of Keimyung University in 2006
文摘AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student's t test and oneway analysis of variance. Spearman's rank correlation coefficients were calculated to evaluate the association between the scores and variables. RESULTS: The prevalence of malnutrition at admissionwas 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status. CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status in case of gastric cancer patients after gastrectomy.
文摘Malnutrition is a liver cirrhosis complication affecting more than 20%-50%of patients.Although the term can refer to either nutrient deficiency or excess,it usually relates to undernutrition in cirrhosis settings.Frailty is defined as limited physical function due to muscle weakness,whereas sarcopenia is defined as muscle mass loss and an advanced malnutrition stage.The pathogenesis of malnutrition in liver cirrhosis is multifactorial,including decreased oral intake,maldigestion/malabsorption,physical inactivity,hyperammonemia,hypermetabolism,altered macronutrient metabolism and gut microbiome dysbiosis.Patients with chronic liver disease with a Body Mass Index of<18.5 kg/m2 and/or decompensated cirrhosis or Child-Pugh class C are at the highest risk of malnutrition.For patients at risk of malnutrition,a detailed nutritional assessment is required,typically including a history and physical examination,laboratory testing,global assessment tools and body composition testing.The latter can be done using anthropometry,cross-sectional imaging including computed tomography or magnetic resonance,bioelectrical impedance analysis and dual-energy X-ray absorptiometry.A multidisciplinary team should screen for and treat malnutrition in patients with cirrhosis.Malnutrition and sarcopenia are associated with an increased risk of complications and a poor prognosis in patients with liver cirrhosis;thus,it is critical to diagnose these conditions early and initiate the appropriate nutritional therapy.In this review,we describe the prevalence and pathogenesis of malnutrition in liver cirrhosis patients and discuss the best diagnostic approach to nutritional assessment for them.
文摘Objective To compare the value and consistency among the Patient Generated-Subjective Global Assessment(PG-SGA)and the Prognostic Nutrition Index(PNI)for assessing nutritional status in gastrointestinal tumor patients.Methods 251 patients from gastric cancer surgical ward from January 2019 to January 2020 were recruited through convenience sampling in this respective study.Nutritional screening and assessment were conducted for 251 gastrointestinal tumor patients using the nutritional risk screening 2002(NRS 2002)PG-SGA,and the PNI.PNI was calculated using the serum albumin level and the total lymphocyte count obtained from the patients’routine laboratory examination when they were admitted to the hospital.The receiver operating characteristic(ROC)of the PG SGA and the PNI were plotted with the NRS 2002 used as the gold standard,and the diagnostic value of the PG-SGA and PNI was reflected by the area under the curve(AUC),sensitivity,specificity and Youden index.We then determined the optimal cut-off for the PNI and tested the consistency of the PG-SGA and PNI.Results The optimal cut-off point for the PNI was calculated to be 50.78.The AUC of the PG-SGA was 0.908(95%CI 0.871-0.944).The sensitivity was 89.9%,specificity was 76.2%and the Youden index was 0.661.The AUC of the PNI was 0.594(95%CI 0.516-0.572).The sensitivity was 73.8%,specificity was 44.3%and the Youden index was 0.181.In the consistency test,the kappa value was 0.838(P<0.001).Conclusion The PNI is of limited value for assessing malnutrition,although it did have good consistency with the PG-SGA.The combination of the PNI and PG-SGA can be used for diagnosing assessing malnutrition in clinical practice.
文摘Undernutrition is frequently underestimated in the elderly, because clinical manifestations are non-specific. For the francophone Club geriatrics and nutrition, poly medication is one of the warning signs to be the possibility of malnutrition in an elderly person. To do this, it is particularly interesting to verify what the profiles of hypertensive patients who are at risk of malnutrition are. This component remains very little explored and studies are lacking. The authors conducted a descriptive cross-sectional study whose objective is to evaluate the prevalence of undernutrition in hypertensive patients with or without associated cardiovascular risk factors, in a population of consultants of liberal medical offices, determine the profiles of hypertensive patients who are at risk of undernutrition and describe their eating habits and their anthropometric parameters as well as the link between the number of supported antihypertensives and risk of undernutrition. 1144 patients with an average age of 65 years old have been collected during the period of recruitment. The data collection was done using a questionnaire: the MNA. Sensitive and specific, it is validated method which has international sacle. The percentage of the risk of malnutrition was estimated at 36.7%. Thus the number of associated cardiovascular risk factors becomes larger, and the risk of malnutrition is increased. The risk of malnutrition was three times higher in patients who take more than three medications per day compared with those who consumed less (75.8% vs. 24.2%). As a monotherapy, an increased risk of malnutrition is associated with diuretics. For these older hypertensives, the risk of malnutrition was linked to the type of used dual. The percentage of hypertension risk of malnutrition treated with free dual was significantly higher compared to hypertensive treated dual handset. Some associations have proved to be more favorable than others in terms of nutritional risk. Finally, a third of hypertension patients who were treated with quadruple therapy were at risk of malnutrition. This work was also designed to present an argument to a doctor to detect the risk of undernutrition in elderly hypertensives. The use of the MNA is a simple, effective and quick way for pressure balance rhymes with nutritional balance.
文摘Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia.The presence of malnutrition causes a severe impact on patients with liver cirrhosis.The etiology of cirrhosis differs in the South Asian region compared to the West,with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time.Comorbid malnutrition worsens outcomes for cirrhosis patients.Urgent attention to address malnutrition is needed to improve patient outcomes.The etiology and pathophysiology of malnutrition in liver diseases is multifactorial,as reduction in liver function affects both macronutrients and micronutrients.A need for nutritional status assessment for liver disease patients exists in all parts of the world.There are many widely studied tools in use to perform a thorough nutritional assessment,of which some tools are low cost and do not require extensive training.These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan.Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world,but the knowledge and practice of nutritional counseling in Pakistan is poor,both amongst patients and physicians.Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed.Simultaneously,treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.
基金Nation Natural Science Foundation of China(General Program),No.81870444Natural Science Foundation of Tianjin,No.17JCQNJC12800.
文摘BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.
文摘Malnutrition encompassing both macro-and micro-nutrient deficiency,remains one of the most frequent complications of alcohol-related liver disease(ArLD).Protein-energy malnutrition can cause significant complications including sarcopenia,frailty and immunodepression in cirrhotic patients.Malnutrition reduces patient’s survival and negatively affects the quality of life of individuals with ArLD.Moreover,nutritional deficit increases the likelihood of hepatic decompensation in cirrhosis.Prompt recognition of at-risk individuals,early diagnosis and treatment of malnutrition remains a key component of ArLD management.In this review,we describe the pathophysiology of malnutrition in ArLD,review the screening tools available for nutritional assessment and discuss nutritional management strategies relevant to the different stages of ArLD,ranging from acute alcoholic hepatitis through to decompensated end stage liver disease.
基金This work was supported by the National Key Research to Han Ping Shi and Development Program(No.2017YFC1309200)National Natural Science Foundation of China(No.81673167 to Hong Xia Xu).
文摘Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.
基金the Talent Innovation Capacity Development Program of Army Medical Center of PLA(2019CXJSC003,to Hong Xia Xu)Beijing Municipal Science and Technology Commission(SCW2018-06 to Han Ping Shi)the National Key Research and Development Program(No.2017YFC1309200 to Han Ping Shi).
文摘Background Malnutrition is common in patients with cancer,and this adversely affects the survival and quality of life of patients.Chinese Society for Nutritional Oncology issued a multi-center,large-scale,long-term follow-up prospective study,the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC study)since 2013.This is an extension to the previous 2013-2020 study protocol.This study still sought to:①address the prognostic impact of nutritional factors and quality of life on cancer patient survival;②describe the overall and cancer-specific incidence and/or distribution of malnutrition and different measurements of patient quality of life.Methods and study design This is an observational,multi-centered,hospital-based prospective cohort study.Data collection will be performed at baseline(within 48 hours after patient admission),during the hospital stay and 30 days after hospital admission.Follow-up will be conducted for 1-20 years after enrollment.The primary outcome will be the all-cause mortality/overall survival,and secondary outcomes will be the length of hospital stay and costs of hospitalization.Study factors will include demographic characteristics,tumor characteristics,information about chronic diseases,hematological measurements(e.g.,red blood cell count,total lymphocyte counts,hemoglobin,albumin,prealbumin,creatinine,C-reactive protein,IL-6),anthropometric measurements(e.g.,height,weight,arm circumference,arm muscle circumference,triceps skinfold thickness,and waist circumference),body composition parameters,PG-SGA scores,quality of life(as indicated by the QLQ-C30 questionnaire),muscle mass(as indicated by the calf circumference),muscle strength(as indicated by the handgrip strength),muscle function(as indicated by the six-meter walking speed test)and physical status assessments(as indicated by the Karnofsky Performance Status scores).This clinical study protocol was approved by local Ethics Committees of all the participating hospitals.Written informed consent is required for each subject included.Discussion This multi-center,large-scale,long-term follow up prospective study will help improve the diagnosis of malnutrition in cancer patients and identify the risk factors associated with adverse clinical outcomes.The anticipated results of this study will highlight the need for a truly scientific appraisal of nutrition therapy in Chinese oncology populations,and finally help treat the potentially reversible elements of malnutrition in cancer patients to improve their clinical outcomes in the future.
文摘Following an esophagectomy, nurses’ patient nutrition observations are important for physical recovery and quality of life. The study proposed to identify the factors associated with physical recovery among esophageal cancer patients after surgery based on nurses’ observations and nutritional evaluations. Data were collected from the nursing records of 21 esophagectomy patients. The data included patients’ rate of weight loss, body mass index (BMI), energy intake, and postoperative complications. Patients were divided into two groups according to their weight loss rate: <8% and ≥8%. Patient outcomes were compared between the two groups. There was no difference in average BMI before or after surgery between the two groups. There was no difference in albumin levels during hospitalization;however, after esophagectomy, energy intake at discharge was insufficient in both groups. The ≥8% weight loss may be facilitated, or at least confounded, by the presence of recurrent nerve paralysis and aspiration pneumonia. Thus, the nursing records typically identified the need to check for recurrent laryngeal nerve palsy and aspiration pneumonia in conjunction with nutritional assessment to enhance patients’ physical recovery. When weight loss was significant, nurses provided oral intake support with the NST, and patients maintained oral intake levels similar to the group with weight loss under 8%. In order to better support physical recovery among malnourished, post esophagectomy patients, nurses need to monitor for signs of recurrent nerve palsy and aspiration pneumonia in addition to nutritional intake.
文摘The high incidence of malnutrition in patients with colorectal cancer directly affects their clinical outcomes,and is associated with increased postoperative complications,prolonged hospital stays,and decreased tolerance of chemotherapy and radiotherapy.Therefore,the nutritional management of patients with colorectal cancer is important.The perioperative nutritional management of patients includes preoperative education,nutritional screening and evaluation,preoperative intestinal preparation,and postoperative nutritional management.This article summarizes the current status of perioperative nutritional therapy and bowel preparation for patients with colorectal cancer.
基金The study protocol was submitted to the institution’s research ethics committee for approval,and was approved under identification CAAE 21998619.1.0000.5440.
文摘Objective To characterize the nutritional variables of patients referred to an outpatient oncology nutrition service.Methods The electronic medical records of patients diagnosed with malignant neoplasms were analyzed for several parameters:weight loss,body mass index(BMI),hand-grip strength(HGS),fat-free mass index(FFMI)and serum C-reactive protein(CRP).Statistical methods included Pearson’s correlation(significance was set at P≤0.05).Results There was a high prevalence of malnutrition(44%,n=28)and sarcopenia(61%,n=23)and a relatively low prevalence of cachexia(13%,n=6).Moderate positive correlations were observed between the tumor site and CRP level,correlation r=0.328(P=0.026);the tumor site and BMI(r=0,P=0.001);FFMI and BMI(r=0.606,P=4.334056e-005)and CRP and weight loss(r=0.355,P=0.024).There were negative correlations between the tumor staging and BMI (r=-0.409,P=0.001)and weight loss and FFMI(r=-0.467,P=3,228325e-004).Conclusion These preliminary findings may help institutions implement nutritional approaches,such as the adoption of a line-ofcare focused on nutrition in the department of oncology.
基金Supported by Major Construction Program of Military Key Disciplines during the 13^(th)Five-Year Plan Period,No.2020SZ21-15。
文摘The coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field.Patients with COVID-19 usually have respiratory symptoms.However,liver dysfunction is not an uncommon presentation.Additionally,the degree of liver dysfunction is associated with the severity and prognosis of COVID-19.Prevention,diagnosis,and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19,especially in those with liver dysfunction.Recently,a large number of studies have reported that nutrition therapy measures,including natural dietary supplements,vitamins,minerals and trace elements,and probiotics,might have potential hepatoprotective effects against COVID-19-related liver dysfunction via their antioxidant,antiviral,anti-inflammatory,and positive immunomodulatory effects.This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction,nutritional and metabolic characteristics,nutritional status assessment,and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.
文摘Tumor cachexia is widely seen in patients with various stages of cancer,manifested by inadequate intake or abnormal hypermetabolism resultingin negative nitrogen and energy balance. Early intervention of nutritionaltherapy and penetrate it into other anti-cancer treatment processes cansignificantly benefit cancer patients who receiving palliative treatment.Nutritional therapy for cancer is a process of planning, implementing, evaluatingand nutritional intervention to treat cancer and its complications orphysical condition, to improve the prognosis of cancer patients, includingnutritional diagnosis (screening/evaluation), nutritional intervention, efficacyevaluation (including follow-up) three stages. In practice, we shouldchoose appropriate nutritional risk assessment tools and interventionmethods according to the actual situation of patients, avoid over-treatment,reduce complications, and maximize patients'interests as far as possible.Nutritional support therapy for cancer involves ethics, morality and thewishes of patients and their families, and needs further exploration andimprovement. The best nutritional support strategy often requires the jointparticipation of many disciplines, including clinicians, nurses, nutritionistsand psychosocial workers. Nutritional support group and multidisciplinarycollaboration group on cancer are gradually becoming a trend. With theaccumulation of experience in cancer nutrition therapy, the developmentand application of drugs and nutritional preparations, and the deepening ofmulti-disciplinary collaboration, more cancer patients will benefit in clinicalwork.
基金supported by Henan University Science and Technology Innovation Talents Support Program(19HASTIT005)the National Key Research and Development Program(No.2017YFC1309200)the Medical Science and Technology Key Projects of Henan Province and Zhengzhou(192102310088,19A32000820).
文摘Background Patients with advanced cancer often present with malnutrition.Globally,minority populations frequently suffer from higher rates of malnutrition than the majority group.It was unknown whether the nutritional status of cancer patients is different between ethicality groups(i.e.Uyghur and Han)in China.Methods A total of 251 Uyghur cancer patients were enrolled from the Xinjiang Kashgar First People's Hospital in the INSCOC Program.The Han patients were 1∶1 matched to Uyghur patients by age,gender and type of cancer from 72 hospitals around China in INSCOC Program.The nutritional risk and nutritional status were assessed using the Nutrition Risk Screening 2002(NRS 2002)and Patient-Generated Subjective Global Assessment(PG-SGA),respectively.Then,the functional status of cancer patients was determined based on the Karnofsky Performance Status(KPS).Results The incidence of an abnormal NRS-2002(≥3),PG-SGA(≥4),and KPS(≤70)was significantly different(86.1%vs 59.0%,70.5%vs 27.5%,and 18.7%vs 4.0%,respectively P<0.05).The abnormal rate of laboratory indicators in Uyghur cancer patients was significantly higher than that in Han cancer patients,including total protein,albumin,serum total bilirubin,direct bilirubin,HDL-C,white blood cell,lymphocyte,red blood cell,and platelet(all P<0.05).The abnormal rates of TSF,HGS and CC were significantly higher than that of Han nationality patients(17.5%vs 9.7%,39.6%vs 19.6%,29.1%vs 15.2%,P<0.001).The nutritional support rate of Uyghur patients was lower than that of Han patients(0%vs 16.3%).After adjusting for potential risk factors,malnutrition was associated with gender(female,OR=0.35,95%CI=0.13-0.92,P=0.034),age(>60 years,OR=5.32,95%CI=1.46-19.41,P=0.011),cancer type(gastroesophageal tumor,OR=33.62,95%CI=3.42-330.67,P=0.003),and treatment methods(received radical tumor resection,OR=5.78,95%CI=1.45-23.08,P=0.008;received radiotherapy or chemotherapy:OR=7.69,95%CI=2.27-26.04,P<0.001).Conclusions The nutritional status of Uyghur cancer patients is worse than that of Han patients and the Uyghur patients with poor nutritional status lack the necessary nutritional support.
基金This work was supported by Federal Ministry for Education and Research(BMBF),project Nr.0312744.
文摘Recombinant plant-derived pharmaceuticals have been investigated for the last two decades and some products will soon be brought to market. Since veterinary pharmaceuticals seem to be the front-runners of plant-derived vaccines, we selected one model subunit vaccine, the structural capsid protein VP60 against rabbit haemorrhagic disease, and ana-lyzed the expression of three different sequences representing the vp60 open reading frame in potato plants. The gen-eration of antigenic VP60 molecules in the leaf and tuber tissue of potato was tremendously enhanced by replacing virus-derived sequences with plant-optimized codons. In order to identify potentially undesirable alterations in the composition of these genetically modified food components, we studied their nutrient composition and nutritional value in comparison to two parental conventional breeding varieties (Albatros and Desiree). The largest differences in nutrient composition were found between the two conventional breeds and between conventional Desiree and its near-isogenic genetically modified potato plant, indicating that genetic modification as well as conventional breeding can influence nutrient composition. Nevertheless, most parameters of nutritional value seemed to be more affected by conventional breeding than by genetic modification.
