Relación entre el estado nutricional y el riesgo de presentar úlceras por presión en pacientes incluidos en el programa de atención domiciliaria

ObjectiveThe objective of the present study was to evaluate the relationship between the nutritional status and the risk of pressure ulcers (PU) in patients within home care programs (ATDOM). We also evaluated the relationship between the level of cognitive impairment, physical dependence, underlying diseases and the nutritional status.ScopePatients in home care program in Primary Health Care.Patients100 home care patients.Main variablesage, sex, caregiver, illness, BMI, haemoglobin, haematocrit, lymphocyte count, albumin, cholesterol, Barthel index, Pfeiffer, nutritional assessment (MNA) and Braden scale.ResultsFourteen percent of the ATDOM patients had malnutrition and 46% a high risk of malnutrition. The degree of dependency, and the level of cognitive impairment increased (P < 001) the risk of pressure ulcers. Furthermore, the nutritional status affected the risk of pressure ulcers (P < 001) with OR 3.73 higher in malnourished patients. Values of 3.76 ± 0.05 g/dL albumin and cholesterol of 176.43 ± 6.38 were associated with an increased risk of ulceration. There was a significant relationship between nutritional status (P < 01) and the degree of dependence. In malnourished patients albumin levels decreased to 3.46 ± 0.098, with averages of 11.41 ± 154.95 mg/dL cholesterol. Finally, a lower BMI was significantly related to malnutrition.ConclusionsThe present study demonstrates that 14 % of the ATDOM patients showed malnutrition, and 46 % a high risk of malnutrition. Malnutrition, the degree of physical dependence and severity of cognitive impairment is associated with an increased risk of ulceration, which justify the need for carrying out some personalised measurements on ATDOM patients.     

Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea

ObjectiveAlthough malnutrition is common in cancer patients in Korea, little attention is paid to its risks and consequences. This study was carried out to investigate the prevalence and risk factors of malnutrition in hospitalized cancer patients according to tumor location and stage.MethodsOf 14 972 cancer patients admitted to the National Cancer Center, screening examinations were carried out for 12 112 patients and nutritional status was assessed in 8895 patients. Information on age, sex, length of hospital stay, and tumor location and stage were collected from the electronic medical records system. The nutritional status of each subject was assessed using body mass index, serum albumin, total lymphocyte count, and diet and classified into three groups: high risk, moderate risk, and low risk of malnutrition.ResultsAbout 61% of hospitalized patients were malnourished and the prevalence of malnutrition was higher in male patients with longer hospital stays (60.2%, P = 0.0101) and readmitted patients (66.6%, P < 0.0001). Patients with liver and lung cancer (86.6% and 60.5%, respectively) and patients with advanced cancer stage (60.5%, III or IV) had a higher prevalence of malnutrition than other patients (P < 0.0001). Logistic regression analysis showed that patients with advanced cancer stage and longer hospital stay and readmitted patients were at a higher risk for malnutrition.ConclusionThe prevalence of malnutrition in hospitalized cancer patients was high and varied across tumor location and stage. Early identification of malnutrition status is required for proper nutritional intervention during hospitalization.     

Relationship between malnutrition and sarcopenia in elderly Turkish community-dwellers

ObjectivesSarcopenia is frequently seen at older ages, with primary sarcopenia being associated with mitochondrial dysfunction or age-related decreases in sex hormones while other explanations include endocrine and neurodegenerative diseases. This study was planned and conducted to determine the relationship between malnutrition and sarcopenia in elderly Turkish community-dwellers.Material and methodsIn total, 173 community-dwelling elderly individuals were recruited from the capital city of Turkey. A questionnaire form was applied via face-to-face method and the MNA-SF and Barthel Index were administered. In addition, some anthropometric measurements were taken.ResultsBody mass (P < 0.05) and body height (P < 0.05) were higher in non-sarcopenic elderly individuals. Age was lower in non-sarcopenic elderly (P < 0.05). In this study, while the prevalence of sarcopenia was 50.2% in the elderly, the prevalence of malnutrition risk was found to be 42.2%. MNA-score was found to be significantly lower in sarcopenic elderly individuals. There was a strong relationship between sarcopenia and malnutrition risk, but not with daily living activities.ConclusionThe prevalence of sarcopenia was much higher than prevalence of risk at malnutrition. In Turkey, there is no bioelectrical impedance analysis performed among such community-dwellers, so this is the first study not using BIA while screening for sarcopenia in elderly community-dwellers. This study suggests that current nutritional policies in Turkey should target elderly individuals living in communities to screen for nutritional status regularly and apply interventions quickly. In doing so, there is no need for expensive equipment.     

Simplifier le dépistage de la dénutrition du sujet âgé en médecine générale : test de concordance entre un outil simple,le « Malnutrition Universal Screening Tool » (« MUST ») et le « Mini Nutritional Assessment-Short Form » (« MNA-SF »)

ObjectiveThe main goal of this study is to assess how results from two clinical tools, the Mini Nutritional Assessment-Short Form (MNA-SF) and the Malnutrition Universal Screening Tool (MUST), correlate in the framework of nutritional status evaluation of elderly under ambulatory care. Additionally, determinants of nutritional risk have been analyzed.MethodsThe evaluation of a multicentric diagnostic test has been carried out with 81 patients over 70-years-old, while consulting at their general practitioner's office, or at home. For each patient, MUST and MNA-SF scores were calculated and compared with the kappa coefficient. Subjects were classified into two groups according to the absence or presence of nutritional risk. Univariate comparative analyses were realized between MUST and MNA-SF data.ResultsRespectively, MNA-SF and MUST screened 33.3% and 18.5% of the patients at nutritional risk. Consistency between both tools was moderate: κ = 0.438 ± 0.2058. Compared with subjects at nutritional risk, patients with a good nutritional status were younger, took less drugs, their body mass index was higher (for a limit at 23), they were less lonely and tended to have a higher weight.ConclusionsMUST isn’t a satisfying screening tool of elderly malnutrition in ambulatory primary care. Thus, MNA-SF remains the gold standard.     

Estimation of protein loss from wound fluid in older patients with severe pressure ulcers

ObjectiveProtein loss from wound fluid is usually recognized as one of the factors contributing to the deterioration of the nutritional status in older patients with severe pressure ulcers. We quantified the protein loss owing to pressure ulcers and investigated associations with wound-related factors and nutritional status.MethodsThis cross-sectional study included 25 patients (≥60 y) from 10 institutions, with full-thickness pressure ulcers. Wound fluid was collected once after accumulating beneath a film dressing. The amount of protein loss per day was estimated by the volume of wound fluid per hour and the total protein concentration in the wound fluid. Wound evaluations and nutritional assessments were performed. Correlations between variables were obtained using Spearman's rank correlation.ResultsThe median age of the patients was 79 y (range 61–100), and median body mass index was 19.6 kg/m² (12.2–24.9). The median amount of protein loss was 0.2 g/d (0.04–2.1), which corresponded to 0.01 g · kg^?1 · d^?1 (<0.01–0.04) and 0.6% (0.1–13.8) of protein intake. Four wounds characterized as infected or surgically debrided lost 1.5–2.1 g of protein per day, which was substantially higher than other wounds lost. Protein loss was correlated with wound severity including area, depth, the wound severity score, and infectious markers (all Ps < 0.05), but not with body mass index or arm muscle circumference (P > 0.05).ConclusionThe amount of protein loss could be small and thus may not be related directly to nutritional status, although it increased as the wound became more severe.     

Estado nutricional y factores asociados en pacientes ancianos ambulatorios

ObjectiveTo analyze the nutritional status (NS) of patients older than 65 years and establish their relationship with sociodemographic and health variables.DesignCross-sectional observational study in patients older than 65 years.Location3 health centers.Participants255 patients: ambulatory (AP), in domiciliary care (DP) or institutionalized (IP). They completed the study 243 (response rate 95.3%).Main measurementsThe Chang method was applied to determine the NS. Sociodemographic, anthropometric variables, dependence, mood, cognitive and analytical parameters were collected. Associations were analyzed applying chi-square and analysis of variance. The prevalence ratio (PR) for malnutrition was calculated. A multivariate model was applied (binary logistic regression). Significance was considered for p<0.05.ResultsThe average age was 81.3 years (SD = 7.4) and 72.0% were women. 48.9% were AP, 26.8% DP and 24.2% IP. 29.6% (95% CI: 23.9-35.8) presented malnutrition. Greater malnutrition was established in relation to living in a residence or requiring home help (PR = 5.3), age over 85 (PR = 4.9), presenting a moderate or higher dependency for basic activities of daily living (PR = 3.9) and instrumental (PR = 3.3), need help for mobility (PR = 2.9) and present moderate/severe cognitive impairment (PR = 2.1). The determinants of malnutrition in the multivariate model were older than 85 years old and being IP or DP.ConclusionsEmphasis should be placed on evaluating NS in patients older than 85 years of age who live in a residence or require home care, since they are the groups at greatest risk of malnutrition.     

Infection palustre et état nutritionnel : résultats d’une cohorte d’enfants âgés de 6 à 59 mois au Kivu en République démocratique du Congo

BackgroundDespite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey.MethodsA cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at ?3 and ?2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed.ResultsAfter adjustment for season, children with severe stunting (height for age Z score < ?3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/μL of blood as compared to those in with a better nutritional status (height for age Z score ≥ ?2) (OR = 0.48, 95% CI: 0.25–0.91).ConclusionSeverely stunted children are at a lower risk of high-level malaria parasitemia.     

Évolution du statut nutritionnel d’une cohorte d’enfants tunisiens au cours de l’hospitalisation : facteurs de risque de la dénutrition hospitalière

ObjectivesStudy the evolution of the nutritional status of a cohort of hospitalized children and identify the risk factors of hospital malnutrition.MethodsProspective, cross-sectional study carried out in a pediatric department over a period of six months, including all children aged ≥ 30 days, hospitalized for a period ≥ six days. Anthropometric data were assessed on admission and discharge. Food consumption was assessed using the flower tool. We identified the risk factors for hospital undernutrition (HUN) by multivariate analysis.ResultsWe included 120 patients with a mean age 46.3 months. The prevalence of acute undernutrition at admission was 21.7% and that of chronic undernutrition was 10%. The prevalence of acute undernutrition at discharge rose to 34%. Weight loss during hospitalization was noted in 68.3% of cases. The prevalence of HUN was 55% considering a decrease in BMI or P/PAT z-score ≥ 25%. The risk factors for HUN were: age ≤ 24 months (P = 0.039; OR 95% CI = 2.67 [1.05–6.82]), the presence of undernutrition on admission (P = 0.002; OR 95% CI = 2.32 [0.93–6.51]) and average food consumption < 50% during hospitalization (P < 10^?3; OR 95% CI = 6.69 [2.57–17.40]).ConclusionScreening for undernutrition on admission to hospital as well as assessment of the nutritional risk in hospitalized children is essential so that preventive or curative nutritional care can be taken.     

Waterpipe and Cigarette Smoking Among College Athletes in the United States

PurposeTobacco use using a waterpipe is an emerging trend among college students. Although cigarette smoking is low among college athletes, waterpipe tobacco smoking may appeal to this population. The purpose of this study was to compare cigarette and waterpipe tobacco smoking in terms of their associations with organized sport participation.MethodsIn the spring of 2008, we conducted an online survey of 8,745 college students at eight institutions as part of the revised National College Health Assessment. We used multivariable regression models to assess the associations between tobacco use (cigarette and waterpipe) and organized sports participation.ResultsParticipants reported participation in varsity (5.2%), club (11.9%), and intramural (24.9%) athletics. Varsity athletes and individuals who were not varsity athletes had similar rates of waterpipe tobacco smoking (27.6% vs. 29.5%, p = .41). However, other types of athletes were more likely than their counterparts to have smoked waterpipe tobacco (35.1% vs. 28.7%, p < .001 for club sports and 34.8% vs. 27.7%, p < .001 for intramural sports). In fully-adjusted multivariable models, sports participants of any type had lower odds of having smoked cigarettes, whereas participants who played intramural sports (odds ratio = 1.15, 95% confidence interval = 1.03, 1.29) or club sports (odds ratio = 1.15, 95% confidence interval = 1.001, 1.33) had significantly higher odds of having smoked waterpipe tobacco.ConclusionsCollege athletes are susceptible to waterpipe tobacco use. In fact, compared with their nonathletic counterparts, club sports participants and intramural sports participants generally had higher odds of waterpipe tobacco smoking. Allure for waterpipe tobacco smoking may exist even for individuals who are traditionally considered at low risk for tobacco use.     

Identifying factors associated with treatment delay in leptospirosis: A retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015

BackgroundLeptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases.Patients and methodsWe carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014–2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics.ResultsOf the 117 patients included, 107 were men, with an average age of 44.9 ± 15 years. The median therapeutic delay was 4 days (interquartile: 2–5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08–7.3], P = 0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43–14.93]; P = 0.01) instead of emergency unit. No socio-economic or geographic characteristics were found to be linked to a longer therapeutic delay.ConclusionAlthough delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care.     

Combined effect of Controlling Nutritional Status and Acute Kidney Injury on severe COVID-19 short-term outcomes

Introduction/ObjectivesAcute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis.Materials and methodsThis is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between April 25th and June 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression.ResultsAmong the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank < 0.0001). Their relative risks are respectively (HR = 3.25 CI 95% [1.99–5.3] and HR = 2.42 CI 95% [1.5–3.9], p < 0.0001). In multivariate analysis, the highest risk was observed for the AKI-CONUT-high combination (HR = 3.0, 95% CI [1.5–6.1], p = 0.002).ConclusionA possible synergistic interaction between AKI and CONUT score for COVID-19 short-term mortality has been highlighted. Monitoring of renal function associated with assessment of nutritional status should be performed routinely and systematically from the early stages of admission.     

Promoting the awareness of hospital malnutrition in children: ePINUT 10th anniversary in 2020

ObjectiveThe year 2020 marks the 10th consecutive year of the ePINUT study which is used for promoting awareness of hospital malnutrition in paediatric wards. The present article describes the methods and the studied population.Materials and methodsePINUT is a cross-sectional study gathering data each year over 2 weeks in March. Any child up to 18 years old, hospitalized except in neonatal and intensive care units could be included in this study. Length of hospitalization, weight variations and height were measured. An online calculator was made available for nutritional indices (http://www.epinut.fr/), in accordance with the French Paediatric Society guidelines. A geographic grouping was done based on university inter-regions.ResultsA total of 13,332 entries in France were included from 2010 to 2019. On a geographic level, 6 of the 7 regions contributed yearly to 10 to 15% of these entries, while the western region accounted for 25% of the entries (P < 0.001). Ninety-two cities participated, with 36% participating 5 to 9 years, 39% participating 2 to 4 years, and 26% participating once. The median age was 4 years old, 10.2% of children had a Weight-for-Height z-score smaller than ?2 at admittance. These children stayed longer in the hospital (8.3 ± 11.3 vs. 6.4 ± 9.3 days, P = 0.02) and had a greater percent weight change during hospitalization (2.8 ± 4.7 vs. 0.4 ± 3.8%, P < 0.0001).ConclusionSuch a long-term promotion of awareness about hospital malnutrition is unique. The future aim is to empower young patients and their parents and to get them involved in reducing hospital malnutrition in children.     

Obesity is associated with a reduced odds for blunt intra-abdominal injuries in children

ObjectivesChildren with obesity may possess unique injury characteristics that may affect their emergency care. To better understand this relationship, we investigated the association of obesity in pediatric trauma patients and intra-abdominal injuries (IAIs) and routinely utilized emergency department (ED) diagnostic procedures (computed tomography (CT) scans and ultrasound (US) examinations).MethodsThis secondary data analysis utilized Pediatric Emergency Care Applied Research Network (PECARN) data from 2007 to 2010. Since height data were not available, children (2–17 years) with obesity were defined using weight-for-age percentiles. Non-parametric testing determined potential confounders. Adjusted odds ratios (aOR) were calculated using binary logistic regression for weight status and IAIs and diagnostic procedures.ResultsThere were 3846 patients with actual weight recorded: 3301 (85.8%) children without obesity and 545 (14.2%) with obesity. Children with obesity had decreased odds for IAI after adjusting for race, mechanical force injury (MFI) type, vomiting, and abdominal wall trauma (adjusted odds ratio (aOR) = 0.58 (95% CI 0.35–0.97); p-value = 0.04). Patients with obesity had reduced odds for a CT examination. No association was found between obesity status and US utilization. African-American patients had decreased odds for IAIs, CT scans and US examinations after adjustment which could be related to MFI type.ConclusionsObesity appears to reduce the odds for pediatric IAIs and CT scans, but not for US examinations. Selection bias is possible due to injury severity and missing or excluded weight data. Further research is needed in other pediatric populations with obesity and blunt injuries.     

The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study

ObjectivesTo test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.Study designRetrospective cohort study, Mexico, nationally representative sample of women 12–39 years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, or out of facility). We included individual and household-level confounders and calculated relative and absolute multivariable estimates of association.ResultsOur analytic sample included 7022 women (population, N = 9,881,470). Twenty percent of the population was 12–19 years old at last birth, 55% aged 20–29 and 25% 30–39 years old. Overall, 43% of women reported no postpartum contraceptive method. Age was not significantly associated with receipt of a method, controlling for covariates. Women delivering in public facilities had lower odds of receipt of a method (Odds Ratio = 0.52; 95% Confidence Interval (CI) = 0.40–0.68) compared with employment-based insurance facilities. We estimated 76% (95% CI = 74–78%) of adolescents (12–19 years) who deliver in employment-based insurance facilities leave with a method compared with 59% (95% CI = 56–62%) who deliver in public facilities.ConclusionBoth adolescents and women ages 20–39 receive postpartum contraception, but nearly half of all women receive no method. Place of delivery is correlated with receipt of postpartum contraception, with lower rates in the public sector. Lessons learned from Mexico are relevant to other countries seeking to improve adolescent health through reducing unintended pregnancy.ImplicationsAdolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method.     

Enrichissement alimentaire après fracture ostéoporotique au cours d’une réhabilitation en soins de suite et réadaptation orthogériatrique : intérêt nutritionnel et/ou fonctionnel ?

Materials and methodsThe study was retrospective, controlled, randomized, and was conducted from June 15, 2015 to July 31, 2016 in the orthogeriatric rehabilitation care unit of the Charles-Foix Hospital (Assistance publique–Hôpitaux de Paris). The population named group A benefiting from dietary enrichment in addition to traditional high protein hospital food was compared with a group B benefiting only from the high protein traditional hospital food. The comparison concerned the variation in weight, body mass index, albuminemia, length of stay, walking perimeter, autonomy and destination after hospitalization.ResultsIn total, 144 patients (mean age 86 years; females 84%) were included, with 79 people in group A and 65 in group B. All patients lost weight: −2.08 kg in group A and −0.30 kg in group B (P = 0.02). All patients improved albuminemia level with +3.84 g/L in group A and +2.73 g/L in group B, without significant difference. The recovery of walking and autonomy, and destination after hospitalization were comparable in both groups. The length of hospital stay in group A was shorter than in group B, with respectively 43 ± 23 days and 52 ± 33 days (P = 0.04).ConclusionDietary enrichment in elderly patients after fracture in orthogeriatric rehabilitation care unit allowed a decrease of the length of hospital stay, but does not improve nutritional and functional status.     

Racial Differences in Perinatal Depression among HIV-infected Women

BackgroundPerinatal depression may further complicate the health of women with human immunodeficiency virus (HIV) infection. Diagnosis and subsequent treatment of depressive symptoms may significantly improve the health of mother and newborn.ObjectiveWe sought to examine the association between race and perinatal depression among a sample of low-income women with HIV infection.MethodsThis retrospective cohort study used data from a multi-state Medicaid administrative claims database to study HIV-infected perinatal women between 2003 and 2007. Multivariate regression analysis was used to study the objective.ResultsThe overall prevalence of perinatal depression in the sample (n = 650) was 27.8%. Black women had significantly lower odds of experiencing perinatal depression (odds ratio 0.328; 95% confidence interval 0.225-0.479) compared with non-black women. Non-black women showed significantly higher comorbidity severity scores than black women (0.356 vs. 0.220, P = .035).ConclusionsThis study found that non-black women may be more vulnerable to perinatal depression. Improved health care provider vigilance for depressive symptoms among low-income, HIV-infected women of all races during the perinatal period is warranted.