Comparison of a malnutrition screening tool with subjective global assessment in hospitalised patients with cancer--sensitivity and specificity

Malnutrition is common in hospitals and it is important to implement an appropriate nutrition screening tool to identify patients at risk. The aim of the study was to assess the sensitivity and specificity of the malnutrition screening tool developed by the Malnutrition Advisory Group of the British Association of Parenteral and Enteral Nutrition against subjective global assessment in hospitalised patients with cancer. A cross-sectional study assessing the risk of malnutrition and nutritional status of sixty-five hospitalised patients with cancer, aged 56 +/- 15 years. According to subjective global assessment, 25 % of patients were well nourished and 75% were malnourished (63% were moderately or suspected of being malnourished and 12% severely malnourished). The malnutrition screening tool had a low sensitivity of 59% and a specificity of 75%. The positive predictive value was 88% and the negative predictive value 38%. There were significant linear trends between subjective global assessment classification and percentage weight loss in the previous six months (P < 0.001) and body mass index (P = 0.007). The malnutrition screening tool developed by the Malnutrition Advisory Group of the British Association of Parenteral and Enteral Nutrition is not a suitable screening tool for detecting risk of malnutrition in hospitalised patients with cancer.     

The association between nutritional status and handgrip strength in older Rwandan refugees

OBJECTIVES: To investigate the association between nutritional status and handgrip strength in older Rwandan refugees. DESIGN: Cross-sectional study. SETTING: Rwandan refugee camp located in Karagwe district in the north-west of Tanzania. The study was carried out in the post-emergency phase. The response rate was 85%. SUBJECTS: A total of 413 men and 415 women aged 50-92 y participated in the study. METHODS: Weight, height, mid-upper-arm circumference (MUAC) and triceps skinfold were obtained using standard techniques. For people with visible kyphosis, height was estimated from armspan using regression equations developed from non-kyphotic subjects within the sample. Handgrip was measured using a mechanical handgrip dynamometer. Information regarding physical activity and health status was obtained by interview and clinical screening. RESULTS: Handgrip strength (kg) was significantly higher in men than in women (30.3+/-6.7 vs 22.3+/-5.1), and significantly lower in each older age group in both sexes. Handgrip strength was positively correlated to BMI (body mass index) and AMA (arm muscle area). The relative risk of impaired handgrip strength in individuals with poor nutritional status (BMI<18.5 kg/m(2)) compared with those of adequate nutritional status was 1.75. After controlling for potential confounders (sex, age and height), BMI remained a significant contributor to the variation in handgrip strength. CONCLUSION: Poor nutritional status is associated with poor handgrip strength independent of sex, age and height, in this refugee population. This may indicate that underweight older people are likely to have more difficulties in functioning independently in the community. Research is needed to investigate if improving nutritional status can lead to better functional ability. SPONSORSHIP: Department for International Development (UK) and HelpAge International.     

Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients

BACKGROUND: Serum albumin has limitations as a nutritional marker in patients undergoing peritoneal dialysis (PD) in that it is affected by inflammation, systemic disease, overhydration, and urinary and dialysate protein loss. Handgrip strength is a simple, easily performed bedside test that has been shown to correlate with lean body mass in patients close to inception of dialysis. OBJECTIVE: We evaluated the associations of handgrip strength with other clinical factors and examined its relations with mortality and cardiovascular death in PD patients. DESIGN: We prospectively enrolled 233 chronic PD patients and assessed handgrip strength and other variables at baseline and then followed the patients for a mean (+/-SD) of 30 +/- 14 mo. RESULTS: Baseline handgrip strength was significantly associated with age, sex, height, diabetes, residual glomerular filtration rate (GFR), and hemoglobin but not with C-reactive protein (CRP). After adjustment for age, sex, and height, handgrip strength was most strongly correlated with lean body mass on the basis of creatinine kinetics (r = 0.334, P < 0.001), followed by serum albumin and subjective global assessment. Both men and women who died had lower handgrip strengths than did those who remained alive (P < 0.001). After control for age, sex, diabetes, atherosclerotic vascular disease, GFR, hemoglobin, CRP, and serum albumin, greater handgrip strength was predictive of lower all-cause [hazards ratio (HR): 0.95 (95% CI: 0.92, 0.99); P = 0.005] and cardiovascular [HR: 0.94 (0.90, 0.98); P = 0.004] mortality. CONCLUSIONS: Handgrip strength not only is a marker of body lean muscle mass but also provides important prognostic information independent of other covariates, including CRP and serum albumin. Our data suggest that handgrip strength may be used in conjunction with serum albumin as a nutrition-monitoring tool in patients undergoing PD.     

河北省成人握力体重指数与代谢综合征的相关性研究

目的 分析成人握力体重指数与代谢综合征(metabolic syndrome,MS)之间是否存在相关性。方法 2017年7—8月在河北省7个区(县)进行横断面研究,收集MS和握力的相关指标和数据,将握力体重指数分为4个水平(Q₁～Q₄),采用趋势性检验和多因素logistic回归模型,分析MS及其组分与握力体重指数之间是否存在关联。结果 本研究共纳入6 373名符合标准的成年人,其MS患病率为20.02%。患有MS的居民总体握力体重指数为40.31(32.26,51.81)kg/kg,低于未患MS的居民45.76(37.72,55.70)kg/kg,差异有统计学意义(P<0.05)。进行趋势性检验后可以得知,无论男女,其MS及其组分的患病率与握力体重指数水平的变化趋势相反(P均<0.001)。多因素logistic回归分析过程中,调整年龄、民族、吸烟及饮酒的频率、现住址、受教育程度后,握力体重指数最高组比最低组患MS、超重/肥胖、高血压、血脂紊乱、高血糖的风险低(男性居民OR值分别为:0.25、0.09、0.59、0.46、0.50; 女性居民OR值分别为:0.14、0.06、0.47、0.39、0.42; P均<0.001)。结论 MS患病情况与握力体重指数有关联,二者呈现负相关的关系,且无性别差异。     

主观综合性营养评价法在住院病人营养状况及预后评价中的作用

主观综合性营养评价法(SGA)虽在临床应用广泛,但对其用途及评价结果的临床意义,各家报道差异甚大.有些研究将其视为筛选营养风险的工具;有些将其视为预测病人预后的工具,甚至将其视为评价其他营养评价方法或指标的参照值.不同营养状况评价指标所反映出的营养状况改变的侧重点不同.故临床应针对不同病人采用不同的评价方法或指标,以客观和有所侧重地评价病人的营养状况,为实施营养干预提供依据.     

The correlation between anergy, malnutrition and clinical outcome in an elderly hospital population

The nutritional state of 482 out of 501 newly admitted elderly patients was assessed by anthropometry, serum protein analyses and the delayed hypersensitivity skin test (DH) on admission and after 8 and 26 weeks. The mean age of the women was 81.3 +/- 7.7 and of the men 77.9 +/- 9.3. Protein-energy malnutrition (PEM) was initially defined as three or more subnormal criteria, one in each of the three categories of measurement. The data was then reanalysed excluding anergy and using the two other criteria only. The prevalence of PEM on the first assessment was 28.5% and was 10% higher when anergy was excluded as a criterion. PEM was more common in women and increased with age. The anergic patients had lower mean values in serum protein and anthropometry than those with normal reactivity. Anergic patients had a higher mortality rate and more pressure sores than the reactive group. Nutritional supplementation was associated with an increase in skin reactivity.     

Comparison of forearm muscle dynamometry with nutritional prognostic index, as a preoperative indicator in cancer patients

We studied 95 patients with cancer of the gastrointestinal tract in various sites. The aim of the study was to compare the forearm dynamometry vs the prognostic nutritional index which was reported by Busby et al, 1890. We used these methods as preoperative prognostic indicators for postoperative mortality and morbidity. The forearm muscle dynamometry has greater positive predictive value (58.33 vs 32.4%), higher sensitivity (77.78 vs 66.6%), and specificity (86.11 vs 65.28%) than the prognostic nutritional index. The forearm muscle dynamometry predicted the patients mortality with a high rate of sensitivity (100%). The results suggest that dynamometry is a useful, rapid, and inexpensive test. It is more accurate than the nutritional index, and can identify cancer patients at a high risk of developing major postoperative complications, and predict the postoperative morbidity and mortality.     

The relationship between delayed hypersensitivity response, nutritional status and clinical outcome in surgical patients referred for nutritional support

Delayed hypersensitivity responses to recall antigens were measured in 125 surgical patients referred for nutritional assessment and support. On initial testing 57 patients were skin test positive and 68 were anergic each of these patient groups being closely matched in terms of surgical conditions. There was a mortality of 4 in the skin test positive group and 26 in the anergic group. The anergic patients were significantly older and in biochemical and anthropometric terms were in poorer nutritional status than the skin test positive group. Of 33 anergic patients who were repeat tested, 15 remained anergic and 18 converted to a positive response. Conversion from anergy to a positive response was not associated with changes in the measured indices of nutritional status and did not improve clinical outcome. The value of repeat skin testing is therefore in doubt.     

医师科研绩效指标体系评估与专家主观评估的比较

目的为了探讨对医师科研绩效指标体系评估的有效方法,客观评估医师的科研绩效。方法应用特尔菲法建立的医师科研绩效指标体系和专家主观评估法,分别对医师的科研绩效进行评估打分,并进行比较分析。结果两种评估结果基本一致,绩效指标体系评估法优于主观评估法。结论医师科研绩效指标体系评估是一“满意”的评估,也是一动态系统,需不断完善和发展。     

Indications and limitations of the use of subjective global assessment in clinical practice: an update

PURPOSE OF REVIEW: Subjective global assessment is a clinical tool for assessing nutritional status that merges alterations in body composition and physiological function. Although it was first described almost two decades ago, many studies using this method have been published during the past few years. This review describes recent findings from such studies. RECENT FINDINGS: Subjective global assessment has proved to be a good nutritional assessment and prognostic indicator in several clinical situations. Agreement between subjective global assessment and newer screening methods is not always acceptable, and it has not been validated with respect to clinical outcome. Some modifications have been suggested that may increase the sensitivity of subjective global assessment as a screening tool. A scored version of subjective global assessment for cancer patients is now being validated for use in other patient groups. This could increase its utility in nutritional intervention studies if it can be demonstrated that subtle changes in nutritional status are reflected by numerical scores in patient-generated subjective global assessment. SUMMARY: Subjective global assessment represents a good option for assessing nutritional status in various clinical situations. As a screening tool, it better identifies established malnutrition than nutritional risk but its sensitivity is suboptimal. The scored version of subjective global assessment may have advantages and extend the usefulness of this tool even further.     

Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support

The objective of this study is to examine the prevalence of malnutrition and evaluate the nutrition status and clinical outcome in hospitalized patients aged 65 years and older receiving enteral‐parenteral nutrition. This retrospective study was carried out at Ba?kent University Hospital, Adana, Turkey. A total of 119 patients older than 65 years were recruited. Patients were classified into 3 groups: protein‐energy malnutrition (PEM), moderate PEM, and well nourished according to subjective global assessment (SGA) at admission. All patients were fed by enteral or parenteral route. Acute physiological and chronic health evaluation (APACHE‐2) and simplified acute physiology (SAPS 2) scores were recorded in patients followed in the intensive care unit (ICU). Nutrition status was assessed with biochemical (serum albumin, serum prealbumin) parameters. These results were compared with mortality rate and length of hospital stay (LOS). The subjects' mean (±SD) age was 73.1 ± 5.4 years. Using SGA, 5.9% (n = 7) of the patients were classified as severely PEM, 27.7% (n = 33) were classified as moderately PEM, and 66.4% (n = 79) were classified as well nourished. Some 73.1% (n = 87) of the patients were followed in the ICU. Among all patients, 42.9% (n = 51) were fed by a combined enteral‐parenteral route, 31.1% (n = 37) by an enteral route, 18.5% (n = 22) by a parenteral route, and 7.6% (n = 9) by an oral route. The average length of stay for the patients was 18.9 ± 13.7 days. The mortality rate was 44.5% (n = 53). The mortality rate was 43% (n = 34) in well‐nourished patients (n = 79), 48.5% (n = 16) in moderately PEM patients (n = 33), and 42.9% (n = 3) in severely PEM patients (n = 7) (P = .86). The authors observed no difference between well‐nourished and malnourished patients with regard to the serum protein values on admission, LOS, and mortality rate. In this study, malnutrition as defined by SGA did not influence the mortality rate of critically ill geriatric patients receiving enteral or parenteral nutrition. Furthermore, no factor was found to be a good predictor of survival.     

Specialized oral nutritional supplement (ONS) improves handgrip strength in hospitalized,malnourished older patients with cardiovascular and pulmonary disease: A randomized clinical trial

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Nutritional screening and mortality in newly institutionalised elderly: a comparison between the geriatric nutritional risk index and the mini nutritional assessment

Background & aims

Several tools are available for nutritional screening. We evaluated the risk of mortality associated with the Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) in newly institutionalised elderly.

Methods

A prospective observational study involving 358 elderly newly admitted to a long-term care setting. Hazard ratios (HR) for mortality among GNRI categories and MNA classes were estimated by multivariable Cox’s model.

Results

At baseline, 32.4% and 37.4% of the patients were classified as being malnourished (MNA <17) and at severe nutritional risk (GNRI <92), respectively, whereas 57.5% and 35.2%, respectively, were classified as being at risk for malnutrition (MNA 17–23.5) and having low nutritional risk (GNRI 92–98). During a median follow-up of 6.5 years [25th–75th percentile, 5.9–8.6], 297 elderly died. Risk for all-cause mortality was significantly associated with nutritional risk by the GNRI tool (GNRI<92 HR = 1.99 [95%CI, 1.38–2.88]; GNRI 92–98 HR = 1.51 [95%CI, 1.04–2.18]) but not with nutritional status by the MNA. A significant association was also found with cardiovascular mortality (GNRI <92 HR = 1.79 [95%CI, 1.23–2.61]).

Conclusions

Nutritional risk by GNRI but not nutritional status by MNA was associated with higher mortality risk. Present data suggest that in the nutritional screening of newly institutionalised elderly the use of the GNRI should be preferred to that of the MNA.