Seven‐Point Subjective Global Assessment Is More Time Sensitive Than Conventional Subjective Global Assessment in Detecting Nutrition Changes

Background: It is important for nutrition intervention in malnourished patients to be guided by accurate evaluation and detection of small changes in the patient's nutrition status over time. However, the current Subjective Global Assessment (SGA) is not able to detect changes in a short period. The aim of the study was to determine whether the 7‐point SGA is more time sensitive to nutrition changes than the conventional SGA. Methods: In this prospective study, 67 adult inpatients assessed as malnourished using both the 7‐point SGA and conventional SGA were recruited. Each patient received nutrition intervention and was followed up after discharge. Patients were reassessed using both tools at 1, 3, and 5 months from baseline assessment. Results: It took significantly shorter time to see a 1‐point change using the 7‐point SGA compared with the conventional SGA (median: 1 month vs 3 months, P = .002). The likelihood of at least a 1‐point change is 6.74 times greater in the 7‐point SGA compared with the conventional SGA after controlling for age, sex, and medical specialties (odds ratio, 6.74; 95% confidence interval, 2.88–15.80; P < .001). Fifty‐six percent of patients who had no change in SGA score had changes detected using the 7‐point SGA. The level of agreement was 100% (κ = 1, P < .001) between the 7‐point SGA and 3‐point SGA and 83% (κ = 0.726, P < .001) between 2 blinded assessors for the 7‐point SGA. Conclusion: The 7‐point SGA is more time sensitive in its response to nutrition changes than the conventional SGA. It can be used to guide nutrition intervention for patients.     

Assessing the Effect of Preoperative Nutrition on Upper Body Function in Elderly Patients Undergoing Elective Abdominal Surgery

Background: Malnutrition among elderly surgical patients has been associated with poor postoperative outcomes and reduced functional status. Although previous studies have shown that nutrition contributes to patient outcomes, its long‐term impact on functional status requires better characterization. This study examines the effect of nutrition on postoperative upper body function over time in elderly patients undergoing elective surgery. Methods: This is a 2‐year prospective study of elderly patients (≥70 years) undergoing elective abdominal surgery. Preoperative nutrition status was determined with the Subjective Global Assessment (SGA). The primary outcome was handgrip strength (HGS) at 1, 4, 12, and 24 weeks postsurgery. Repeated measures analysis was used to determine whether SGA status affects the trajectory of postoperative HGS. Results: The cohort included 144 patients with a mean age of 77.8 ± 5.0 years and a mean body mass index of 27.7 ± 5.1 kg/m². The median (interquartile range) Charlson Comorbidity Index was 3 (2–6). Participants were categorized as well‐nourished (86%) and mildly to moderately malnourished (14%), with mean preoperative HGS of 25.8 ± 9.2 kg and 19.6 ± 7.0 kg, respectively. At 24 weeks, 64% of well‐nourished patients had recovered to baseline HGS, compared with 44% of mildly to moderately malnourished patients. Controlling for relevant covariates, SGA did not significantly affect the trajectory of postoperative HGS. Conclusion: While HGS values over the 24 weeks were consistently higher in the well‐nourished SGA group than the mildly to moderately malnourished SGA group, no difference in the trajectories of HGS was detected between the groups.     

The New European Society for Clinical Nutrition and Metabolism Definition of Malnutrition: Application for Nutrition Assessment and Prediction of Morbimortality in an Emergency Service

Background : Recently, the European Society for Clinical Nutrition and Metabolism (ESPEN) provided novel consensus criteria for malnutrition diagnosis. This study aimed to evaluate the applicability of this instrument in combination with different nutrition screening tools (1) to identify malnutrition and (2) to predict morbidity and mortality in hospitalized patients. Materials and Methods : Observational prospective study in 750 adults admitted to the emergency service of a tertiary public hospital. Subjective Global Assessment (SGA—reference method) and the new ESPEN criteria were used to assess nutrition status of patients, who were initially screened for nutrition risk using 4 different tools. Outcome measures included length of hospital stay, occurrence of infection, and incidence of death during hospitalization, analyzed by logistic regression. Results : There was a lack of agreement between the SGA and ESPEN definition of malnutrition, regardless of the nutrition screening tool applied previously (κ = ?0.050 to 0.09). However, when Malnutrition Screening Tool and Nutritional Risk Screening–2002 (NRS‐2002) were used as the screening tool, malnourished patients according to ESPEN criteria showed higher probability of infection (relative risk [RR], 1.54; 95% confidence interval [CI], 1.02–2.31 and RR, 2.06; 95% CI, 1.37–3.10, respectively), and when the NRS‐2002 was used, the risk for death was 2.7 times higher (hazard ratio, 2.69; 95% CI, 1.07–6.81) in malnourished patients than in well‐nourished patients. Conclusion : Although the new ESPEN criteria had a poor diagnostic value, it seems to be a prognostic tool among hospitalized patients, especially when used in combination with the NRS‐2002.     

Effect of Critical Illness on Triglyceride Absorption

Background: Adequate nutrition support for critically ill patients optimizes outcome, and enteral feeding is the preferred route of nutrition. Small intestinal glucose absorption is frequently impaired in critical illness. Despite lipid being a major constituent of liquid nutrient administered, there is little information about lipid absorption during critical illness. Objectives: To determine small intestinal lipid, as well as glucose, absorption in critical illness compared with health. Materials and Methods: Twenty‐nine mechanically ventilated critically ill patients and 16 healthy volunteers were studied. Liquid nutrient (60 mL, 1 kcal/mL), containing 200 µL ¹³C‐triolein and 3 g 3‐O‐methyl‐glucose (3‐OMG), was infused directly into the duodenum at a rate of 2 kcal/min. Exhaled ¹³CO₂ and serum 3‐OMG concentrations were measured at timed intervals over 360 minutes. Lipid absorption was measured as the cumulative percentage dose (cPDR) of ¹³CO₂ recovered at 360 minutes. Glucose absorption was measured as the area under the 3‐OMG concentration curve. Data are median (range) and analyzed using the Mann‐Whitney U and Pearson correlation tests. Results: Lipid absorption was markedly less in the critically ill (cPDR¹³CO₂: patients, 22.6% [0%–100%] vs healthy participants, 40.7% [5.3%–84.7%]; P = .018). While glucose absorption was less at 60 minutes in the critically ill (3‐OMG₆₀: 13.2 [3.5–29.5] vs 21.1 [9.3–31.9] mmol/L·min; P = .003), this was not apparent at 360 minutes (3‐OMG₃₆₀: 92.7 [54.5–147.9] vs 107.9 [64.0–168.7] mmol/L·min; P = .126). There was no relationship between lipid and glucose absorption. Conclusion: Small intestinal absorption of lipid is diminished during critical illness.     

Can We Rely on Predicted Basal Metabolic Rate in Patients With Intestinal Failure on Home Parenteral Nutrition?

Background and Aims: Intestinal failure (IF) is a serious and common complication of short bowel syndrome with patients depending on parenteral nutrition (PN) support. Effective nutrition management requires an accurate estimation of the patient's basal metabolic rate (BMR) to avoid underfeeding or overfeeding. However, indirect calorimetry, considered the gold standard for BMR assessment, is a time‐ and resource‐consuming procedure. Consequently, several equations for prediction of BMR have been developed in different settings, but their accuracy in patients with IF are yet to be investigated. We evaluated the accuracy of predicted BMR in clinically stable patients with IF dependent on home parenteral nutrition (HPN). Methods: In total, 103 patients with IF were included. We used indirect calorimetry for assessment of BMR and calculated predicted BMR using different equations based on anthropometric and/or bioelectrical impedance parameters. The accuracy of predicted BMR was evaluated using Bland‐Altman analysis with measured BMR as the gold standard. Results: The average measured BMR was 1272 ± 245 kcal/d. The most accurate estimations of BMR were obtained using the Harris‐Benedict equation (mean bias, 14 kcal/d [P = .28]; limits of agreement [LoA], ?238 to 266 kcal/d) and the Johnstone equation (mean bias, ?16 kcal/d [P = .24]; LoA, ?285 to 253 kcal/d). For both equations, 67% of patients had a predicted BMR from 90%–110% All other equations demonstrated a statistically and clinically significant difference between measured and predicted BMR. Conclusions: The Harris‐Benedict and Johnstone equations reliably predict BMR in two‐thirds of clinically stable patients with IF on HPN.     

Ganglioside Intake Increases Plasma Ganglioside Content in Human Participants

Background: Preclinical studies reveal associations between intestinal ganglioside content and inflammatory bowel disease (IBD). Since a low level of ganglioside is associated with higher production of proinflammatory signals in the intestine, it is important to determine safety and bioavailability of dietary ganglioside for application as a potential therapeutic agent. Materials and Methods: Healthy volunteers (HVs; n = 18) completed an 8‐week supplementation study to demonstrate safety and bioavailabity of ganglioside consumption. HVs were randomized to consume a milk fat fraction containing 43 mg/d ganglioside or placebo, and patients with IBD (n = 5) consumed ganglioside supplement in a small pilot study. Plasma gangliosides were characterized using reverse‐phase liquid chromatography–QQQ mass spectrometry. Intestinal permeability was assessed by oral lactulose/mannitol, and quality of life was assessed by quality of life in the IBD questionnaire. Results: There were no adverse events associated with dietary ganglioside intake. Ganglioside consumption increased (P < .05) plasma content of total GD3 by 35% over 8 weeks. HVs consuming ganglioside exhibited a 19% decrease in intestinal permeability (P = .04). Consumption of ganglioside was associated with a 39% increase (P < .01) in emotional health and a 36% improvement (P < .02) in systemic symptoms in patients with IBD. Conclusion: Impaired intestinal integrity characteristic of IBD results in increased permeability to bacterial antigens and decreased nutrient absorption. Intestinal integrity may be improved by dietary treatment with specific species of ganglioside. Ganglioside is a safe, bioavailable dietary compound that can be consumed to potentially improve quality of life in patients with IBD and treat other disorders involving altered ganglioside metabolism. This study was registered at clinicaltrials.gov as NCT02139709.     

No Clinical or Biochemical Evidence for Essential Fatty Acid Deficiency in Home Patients Who Depend on Long‐Term Mixed Olive Oil– and Soybean Oil–Based Parenteral Nutrition

Background: Home parenteral nutrition (HPN) patients depend on lipid emulsions as part of their parenteral nutrition regimen to provide essential fatty acids (EFAs). Mixed‐oil sources are used in modern lipid emulsions to decrease the amount of proinflammatory EFAs, mainly linoleic acid, which is present in large amounts in soybean oil. It is unknown whether patients who fully depend on such mixed lipids have adequate EFA supply. We therefore evaluated whether HPN patients who depend on mixed olive oil– and soybean oil–based HPN show clinical or biochemical evidence of EFA deficiency. Materials and Methods: Fatty acid status was assessed in plasma phosphatidylcholine (PC) and peripheral blood mononuclear cells from 30 patients receiving mixed olive oil– and soybean oil–based HPN (>3 months, ≥5 times per week) and 30 healthy controls. Innate immune cell functions were evaluated by assessing expression of surface membrane molecules, and reactive oxygen species, and cytokine production. Results: None of the patients or controls showed clinical evidence (skin rash) or biochemical evidence (increased Holman index [>0.2]) for EFA deficiency. The Holman index in plasma PC (median [25th–75th percentile]) was significantly higher in patients (0.019 [0.015–0.028]) compared with controls (0.015 [0.011–0.017]). No differences were found in innate immune cell functions between groups, except for a 3.6‐fold higher tumor necrosis factor–α production in patients. Conclusion: We found no clinical or biochemical evidence that HPN patients who fully and long‐term depend on mixed olive oil– and soybean oil–based lipids have an increased risk for EFA deficiency.     

Malnutrition at Hospital Admission—Contributors and Effect on Length of Stay

Background: In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS. Materials and Methods: This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization. Results: One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%–48%) were malnourished, and based on BMI, 32% (95% CI, 29%–35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1–117) days. After controlling for demographic, socioeconomic, and disease‐related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62–0.86). Other nutrition‐related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor. Conclusion: Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age‐related social factors are contributors.     

Phase Angle and Impedance Ratio: Reference Cut‐Points From the United States National Health and Nutrition Examination Survey 1999–2004 From Bioimpedance Spectroscopy Data

Background: Raw bioimpedance parameters (eg, 50‐kHz phase angle [PA] and 200‐kHz/5‐kHz impedance ratio [IR]) have been investigated as predictors of nutrition status and/or clinical outcomes. However, their validity as prognostic measures depends on the availability of appropriate reference data. Using a large and ethnically diverse data set, we aimed to determine if ethnicity influences these measures and provide expanded bioimpedance reference data for the U.S. population. Methods: The National Health and Nutrition Examination Survey (NHANES) is an ongoing compilation of studies conducted by the U.S. Centers for Disease Control and Prevention designed to monitor nutrition status of the U.S. population. The NHANES data sets analyzed were from the years 1999–2000, 2001–2002, and 2003–2004. Results: Multivariate analysis showed that PA and IR differed by body mass index (BMI), age, sex, and ethnicity (n = 6237; R² = 41.2%, P < .0001). Suggested reference cut‐points for PA stratified by age decade, ethnicity, and sex are provided. Conclusion: Ethnicity is an important variable that should be accounted for when determining population reference values for PA and IR. We have provided sex‐, ethnicity‐, and age decade–specific reference values from PA for use by future studies in U.S. populations. Interdevice differences are likely to be important contributors to variability across published population‐specific reference data and, where possible, should be evaluated in future research. Ultimately, further validation with physiologically relevant reference measures (eg, dual‐energy x‐ray absorptiometry) is necessary to determine if PA/IR are appropriate bedside tools for the assessment of nutrition status in a clinical population.     

Nutrition status and risk factors associated with length of hospital stay for surgical patients

Objective: To diagnose the nutrition status of hospitalized patients and identify the risk factors associated with hospital length of stay (LOS). Methods: The subjective approach and the body mass index (BMI) were used to classify the nutrition status, and other indicators (anthropometry, biochemistry, and energy intake) were analyzed regarding their association with length of hospital stay of 350 patients. The chi‐square test was used to compare proportions, and the Mann‐Whitney or Kruskal‐Wallis test was used to compare continuous measures. Linear association was verified using Spearman's rank correlation coefficient. Cox's regression model was used to investigate factors associated with LOS. Results: Disease was the factor that influenced LOS the most in the studied population. Longer LOS prevailed in males (P < .0001), patients aged ≥60 years (P = .0008), patients with neoplasms (P < .0001), patients who lost weight during their hospital stay (P < .0001), and malnourished patients (P = .0034). There was a negative and significant, but weak, correlation between LOS and nutrition indicators (calf circumference, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, arm fat area, lymphocyte count, and hemoglobin). Among adults, well‐nourished patients were 3 times more likely to be discharged sooner (P = .0002, RR = 3.3 [1.7–6.2]) than those who had some degree of malnutrition. Well‐nourished patients with digestive tract diseases (DTD) were also discharged sooner than malnourished patients with the same condition (P = .02, RR = 2.5 [1.1–5.8]). In patients with neoplasms, arm circumference was an independent risk factor to assess LOS (P = .009, RR = 1.1 [1.0–1.1]). Conclusions: LOS was associated with disease and nutrition status. Among the more common diseases, nutrition status according to the subjective approach determined the LOS for patients with DTD and nutrition status according to arm circumference determined the LOS for patients with neoplasms.     

Provision of Amniotic Fluid During Parenteral Nutrition Increases Weight Gain With Limited Effects on Gut Structure,Function, Immunity,and Microbiology in Newborn Preterm Pigs

Background: Small enteral boluses with human milk may reduce the risk of subsequent feeding intolerance and necrotizing enterocolitis in preterm infants receiving parenteral nutrition (PN). We hypothesized that feeding amniotic fluid, the natural enteral diet of the mammalian fetus, will have similar effects and improve growth and gastrointestinal (GI) maturation in preterm neonates receiving PN, prior to the transition to milk feeding. Materials and Methods: Twenty‐seven pigs, delivered by cesarean section at ~90% of gestation, were provided with PN and also fed boluses with amniotic fluid (AF; n = 13, 24–72 mL/kg/d) or no oral supplements (nil per os [NPO]; n = 14) until day 5 when blood, tissue, and fecal samples were collected for analyses. Results: Body weight gain was 2.7‐fold higher in AF vs NPO pigs. AF pigs showed slower gastric emptying, reduced meal‐induced release of gastric inhibitory peptide and glucagon‐like peptide 2, changed gut microbiota, and reduced intestinal permeability. There were no effects on GI weight, percentage mucosa, villus height, plasma citrulline, hexose absorptive capacity, and digestive enzymes. Intestinal interleukin (IL)–1β levels and expression of IL1B and IL8 were increased in AF pigs, while blood biochemistry and amino acid levels were minimally affected. Conclusion: Enteral boluses of AF were well tolerated in the first 5 days of life in preterm pigs receiving PN. Enteral provision of AF before the initiation of milk feeding may stimulate body growth and improve hydration in preterm infants receiving PN. Furthermore, it may improve GI motility and integrity, although most markers of GI maturation remain unchanged.     

Utility of Aminotransferase/Platelet Ratio Index to Predict Liver Fibrosis in Intestinal Failure–Associated Liver Disease in Pediatric Patients

Background: Intestinal failure–associated liver disease (IFALD) is a frequent indication for intestinal transplantation. Liver biopsy (LBX) is the gold standard test for its diagnosis. Identifying noninvasive markers of fibrosis progression would be of considerable clinical use. Aspartate aminotransferase/platelet ratio index (APRI) has a good correlation in adult patients with chronic liver disease; few studies have been performed in children with IFALD. Aim: To evaluate APRI in a cohort of children with IFALD. Materials and Methods: Retrospective analysis of a prospective database of patients <18 years with severe intestinal failure and at least 1 LBX, registered in our unit from March 2006 to December 2014. Results: Forty‐nine LBX were done on 36 patients: 20 were male, and 31 had short gut. Fibrosis was found in 71% of LBX. Biopsies were grouped according to the fibrosis stage (METAVIR [M]): (1) group 1 (G1) LBX with M 0, 1, 2 (n = 33) and (2) group 2 (G2) LBX with M 3, 4 (n = 16). The median APRI score was 0.92 (interquartile range [IQR] 0.63–1.50) for G1 and 2.50 (IQR 1.81–5.82) for G2 (P = .001) The c statistic of the receiving operating characteristic curve was 0.79 (95% CI 0.64–0.94; P < .001). The analyses allowed identifying a cutoff value for APRI of 1.6 as the point with the best sensitivity (81%) and specificity (76%) to predict advanced fibrosis. Conclusions: APRI in this cohort of patients shows that a score >1.6 correlates with advanced fibrosis.     

The Relationship Between Nutritional Status and the Glasgow Prognostic Score in Patients with Cancer of the Esophagus and Stomach

A relationship between weight loss and inflammation has been described in patients with cancer. In the present study, the relationship between subjective global assessment (SGA) and the severity of inflammation, as defined by Glasgow prognostic score (GPS), as well as the relationship of both of these measures with the presence of complications and survival time, was assessed. In addition, we compared the diagnosis given by SGA with parameters of nutritional assessment, such as body mass index, triceps skinfold, midarm circumference (MAC), midarm muscle circumference (MAMC), phase angle (PA), adductor pollicis muscle thickness (APMT), and handgrip strength (HGS). According to the SGA, the nutritional status was associated with the GPS (P < 0.05), and both the SGA and GPS were associated with the presence of complications. However, the GPS [area under the curve (AUC): 0.77, P < 0.05, confidence interval (CI) = 0.580, 0.956] seems to be more accurate in identifying complications than the SGA (AUC: 0.679, P < 0.05, CI = 0.426, 0.931). Only GPS was associated with survival time. Comparing the different nutritional assessment methods with the SGA suggested that the MAC, MAMC, APMT, PA, and HGS parameters may be helpful in differentiating between nourished and malnourished patients, if new cutoffs are adopted.     

慢性放射性肠损伤病人的围手术期营养支持

目的:探讨慢性放射性肠损伤(CRII)病人围手术期营养支持情况。方法:采用主观全面评价(SGA)系统回顾性总结206例CRII病人围手术期营养支持情况,并对CRII病人的营养状况进行评估。结果:206例CRII病人接受手术229例次,86.16%的病人入院时有营养不良。经围手术期营养支持和手术治疗后,病人的营养状况得到了明显改善,但营养不良发生率仍然较高。结论:CRII病人的营养不良发生率甚高,围手术期营养支持时间较长,围手术期营养支持和手术能明显改善病人的营养状况。     

Nutrition Delivery Affects Outcomes in Pediatric Acute Respiratory Distress Syndrome

Background: Malnutrition is prevalent in critically ill children. We aim to describe nutrition received by children with acute respiratory distress syndrome (ARDS) and to determine whether provision of adequate nutrition is associated with improved clinical outcomes. Materials and Methods: We studied characteristics and outcomes of 2 groups of patients: (1) those who received adequate calories (defined as ≥80% of predicted resting energy expenditure) and (2) those who received adequate protein (defined as ≥1.5g/kg/d of protein). Outcomes of interest were mortality, ventilator‐free days (VFDs), intensive care unit (ICU)–free days, multiorgan dysfunction, and need for extracorporeal membrane oxygenation. Categorical variables were analyzed using the Fisher exact test, and continuous variables were analyzed using the Mann‐Whitney U test. Univariate and multivariate logistic regression models were used to identify associated risk factors related to these outcomes of interest. Results: In total, 107 patients with ARDS were identified. There was a reduction in ICU mortality in patients who received adequate calories (34.6% vs 60.5%, P = .025) and adequate protein (14.3% vs 60.2%, P = .002) compared with those that did not. Patients with adequate protein intake also had more VFDs (median [interquartile range], 12 [3.0–19.0] vs 0 [0.0–14.8] days; P = .005). After adjusting for severity of illness, adequate protein remained significantly associated with decreased mortality (adjusted odds ratio [95% confidence interval], 0.09 [0.01–0.94]; P = .044). Conclusion: Our study demonstrated that adequate nutrition delivery in children with ARDS was associated with improved clinical outcomes. Protein delivery may have potentially more impact than overall caloric delivery.     

Malnutrition Identified by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Consensus Criteria and Other Bedside Tools Is Highly Prevalent in a Sample of Individuals Undergoing Treatment for Head and Neck Cancer

Background: Using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (Academy/ASPEN) Consensus malnutrition definition, we estimated malnutrition prevalence in a sample of individuals with head and neck cancer (HNC) and compared it with the Patient‐Generated Subjective Global Assessment (PG‐SGA). We also investigated the utility of the 50‐kHz phase angle (PA) and 200‐kHz/5‐kHz impedance ratio (IR) to identify malnutrition. Materials and Methods: Nineteen individuals (18 males, 1 female) scheduled to undergo chemoradiotherapy were seen at 5 time points during and up to 3 months after treatment completion. Multiple‐frequency bioelectrical impedance analysis, PG‐SGA, nutrition‐focused physical examination, anthropometry, dietary intake, and handgrip strength data were collected. Results: Using the Consensus, 67% were found to be malnourished before treatment initiation; these criteria diagnosed malnutrition with overall good sensitivity (94%) and moderate specificity (43%) compared with PG‐SGA. Over all pooled observations, “malnourished” (by Consensus but not PG‐SGA category) had a lower mean PA (5.2 vs 5.9; P = .03) and higher IR (0.82 vs 0.79; P = .03) than “well‐nourished” categorizations, although the clinical relevance of these findings is unclear. PA and IR were correlated with higher PG‐SGA score (r = ?0.35, r = 0.36; P < .01) and handgrip strength (r = 0.48, r = ?0.47; P < .01). Conclusion: The Academy/ASPEN Consensus and the PG‐SGA were in good agreement. It is unclear whether PA and IR can be used as surrogate markers of nutrition status or muscle loss.     

Combining 2 Commonly Adopted Nutrition Instruments in the Critical Care Setting Is Superior to Administering Either One Alone

Background: This study aimed to determine the agreement between the modified Nutrition Risk in Critically ill Score (mNUTRIC) and the Subjective Global Assessment (SGA) and compare their ability in discriminating and quantifying mortality risk independently and in combination. Methods: Between August 2015 and October 2016, all patients in a Singaporean hospital received the SGA within 48 hours of intensive care unit admission. Nutrition status was dichotomized into presence or absence of malnutrition. The mNUTRIC of patients was retrospectively calculated at the end of the study, and high mNUTRIC was defined as scores ≥5. Results: There were 439 patients and 67.9% had high mNUTRIC, whereas only 28% were malnourished. Hospital mortality was 29.6%, and none was lost to follow‐up. Although both tools had poor agreement (κ statistics: 0.13, P < .001), they had similar discriminative value for hospital mortality (C‐statistics [95% confidence interval (CI)], 0.66 [0.62–0.70] for high mNUTRIC and 0.61 [0.56–0.66] for malnutrition, P = .12). However, a high mNUTRIC was associated with higher adjusted odds for hospital mortality compared with malnutrition (adjusted odds ratio [95% CI], 5.32 [2.15–13.17], P < .001, and 4.27 [1.03–17.71], P = .046, respectively). Combination of both tools showed malnutrition and high mNUTRIC were associated with the highest adjusted odds for hospital mortality (14.43 [5.38–38.78], P < .001). Conclusion: The mNUTRIC and SGA had poor agreement. Although they individually provided a fair discriminative value for hospital mortality, the combination of these approaches is a better discriminator to quantify mortality risk.     

Parenteral nutrition for patients with advanced ovarian malignancy

Background: Parenteral nutrition (PN) in patients with disseminated ovarian cancer remains controversial. The role of PN in providing nutrition and improving quality of life is unclear. The present study aimed to determine the pattern of prescribing in a large teaching hospital, and to identify subgroups where the use of PN was justified. Methods: Sixty‐five patients with advanced ovarian carcinoma received PN between January 2002 and May 2008. A retrospective case note review was undertaken to retrieve data on PN prescribing and outcomes in terms of duration of PN provision, complications, and survival. Results: Three subgroups were identified. Group I consisted of 18 (28%) patients who received PN for a median [interquartile range (IQR)] of 5 (2–11) days. The majority of these 18 patients (n = 13, 72%) had disease‐related terminal bowel obstruction. Out of 18 of these patients, 17 (95%) had poor performance status. The median (IQR) survival was 12 (6–28) days. Group II consisted of 40 (61%) patients who were re‐established on enteral nutrition. The median (IQR) duration of PN administration was 10 (6–17) days. The most common indication of PN was protracted ileus (n = 25, 63%). Out of 40 of these patients, 35 (88%) patients had good performance status. The median (IQR) survival was 264 (96–564) days. The third group of patients required home PN (n = 7, 11%). Four (58%) patients had short bowel syndrome and three (42%) had terminal intestinal obstruction. All of the patients had good performance status. The median (IQR) duration of PN administration and survival was 241 (90–305) days. Conclusions: Administration of PN appears to be justified in those patients with a good performance status (i.e. patients capable of self‐care), which constituted three‐quarters of this cohort. In the remaining patients with poor performance status, and particularly those with terminal intestinal obstruction, PN administration was difficult to justify. PN should not be denied based purely on the pathology, although cautious judgment is required to select those who are most likely to benefit.