Standardized thigh muscle area measured by computed axial tomography as an alternate muscle mass index for nutritional assessment of hemodialysis patients

BACKGROUND: Quantification of muscle mass, which represents the largest protein pool in the body, is important for nutritional assessment but is difficult to achieve with conventional methods in hemodialysis patients. OBJECTIVE: We measured the cross-sectional area of the thigh occupied by muscle by using computed tomography and compared this with other muscle mass indicators. DESIGN: Thigh muscle area (TMA) was examined and correlated with creatinine production and various nutritional indexes in 163 patients undergoing hemodialysis. Where appropriate, TMA was expressed relative to bone area in the thigh (TBA) to avoid the influence of body size. RESULTS: TMA was highly correlated with creatinine production as measured in the spent dialysate (r = 0.85, P < 0.001), indicating that TMA substantially reflects total-body muscle mass. TMA standardized for TBA was negatively correlated with age and positively correlated with other nutritional indicators including body weight, body mass index, serum albumin, serum transthyretin, and protein catabolic rate. Multiple regression analysis revealed that of these variables, age, serum albumin, and protein catabolic rate independently predicted TMA standardized for TBA. By using correlations with various nutritional indicators, we concluded that patients with a value <10.0 for TMA standardized for TBA were likely to be malnourished whereas those with a value >13.0 were likely to be well nourished. CONCLUSIONS: These results indicate that TMA standardized for TBA, measured by computed tomography, is a reliable indicator of muscle mass that could be used for nutritional assessment of hemodialysis patients.     

Stratégies de prise en charge nutritionnelle spécifiques : l'enfant en cancérologie

In children with cancer, malnutrition may antedate the diagnosis or be a result of aggressive chemotherapeutic regimens. The prevalence of malnutrition at diagnosis is related to the type of tumour and the extent of the disease, ranging from < 10% in patients with standard-risk acute lymphoblastic leukaemia to 50% in children with advanced neuroblastoma. The pathogenis of the energy imbalance that underlies the development of malnutrition is complex, including increased breakdown of fat and protein as well as energy-consumptive changes in carbohydrate metabolism (Cori cycle). Despite several confounding factors (different definitions of nutritional status and the wide variety of measures used for its assessment), studies have shown decreased tolerance of chemotherapy associated with altered metabolism of antineoplastic drugs, increased infection rates, altered quality of life and possibly poor clinical outcome in malnourished patients. In this article, we review guidelines for the nutritional management of a child with cancer and we purpose an algorithm for nutritional support.     

Intérêt et limites de la 3-méthylhistidine pour la mesure du catabolisme musculaire

3-methylhistidine has long been used as a marker of muscle protein breakdown. Although certain factors such as exogenous intake and gastrointestinal synthesis may limit its validity, recent publications suggest that 3-methylhistidine is still a valuable index of muscle protein catabolism. The use of the 3-methylhistidine (μmol/l)/creatinine (mmol/l) ratio can limit interindividual variations and provide useful information, even when 24 h urine collection is incomplete. Although in clinical practice the measurement of urinary urea or nitrogen is the main parameter used to quantify the hypercatabolic response to acute illness, the 3-methylhistidine/creatinine ratio is of value when 24 h urine collections are incomplete, as well as in hypercatabolic patients with severe protein-calorie malnutrition and for evaluating the quality of nutritional support. Needless to say, this parameter remains crucial for the determination of muscle protein catabolism in clinical research.     

Évaluation nutritionnelle chez le dialysé

Malnutrition is common among patients with end stage renal disease treated by hemodialysis or peritoneal dialysis. It is a major cause of morbidity and mortality. Nutritional status may be assessed by several clinical markers including dietary records, anthropometric measurements and subjective global assessment. Among biochemical parameters, albumin is the most commonly examined nutritional index and transthyretin the most useful. Protein catabolic rate reflects dietary protein intake. Body composition analysis by bioelectrical impedance analysis or better by dual energy X-ray absorptiometry offers a reasonable estimation of body compartments such as total body water, fat mass and lean body mass. Periodic assessment of nutritional status must take into account the limitations of all the criteria used.     

透析营养客观评分法评估血液透析患者的营养状况：75例观察

目的 应用透析营养客观评分法对维持性血液透析患者进行营养评估,了解营养不良的发生情况及严重程度,探讨引起患者营养不良的影响因素.方法 选择维持性血液透析患者75例,以透析营养客观评分作为营养不良的判断标准对患者进行营养评估,将患者分为营养正常、轻中度营养不良和重度营养不良3组.采用Logistic回归法分析引起患者营养不良的相关因素,和传统的主观综合营养评估进行比较,观察其对血液透析患者营养不良评估的价值.结果 75例患者中男女比例1.13∶1,平均年龄(54.90±12.10)岁,透析龄(85.37 ±54.17)个月.根据透析营养客观评分营养正常患者15例(20％)、轻中度营养不良者42例(56％)、重度营养不良者18例(24％).重度营养不良组与营养正常组相比,患者的体重指数[(19.81 ±2.22)比(23.90±2.44)kg/m2,P=0.030]、干体重[(50.85±7.60)比(59.94±10.89)kg,P=0.020]差异具有统计学意义,并且轻中度营养不良、重度营养不良组与营养正常组相比,患者的胆固醇[(4.60±0.84)、(3.73±0.68)mmol/L比(5.71±1.64)mmol/L,P =0.011,P=0.000]、标准蛋白质分解率[1.17、1.15g/(kg·d)比1.45 g/(kg·d),P=0.030,P=0.010]、肱三头肌皮下脂肪厚度[(1.44±0.77)、(1.00 ±0.41)cm比(1.80±0.63)cm,P=0.032,P=0.020]、上肢中臂周径[(24.85±1.48)、(21.66±1.48)cm 比(24.99 ±2.30)cm,P=0.046,P=0.037]差异具有统计学意义.多因素Logistic回归显示C反应蛋白[OR=12.482,95％ CI=0.190-130.928,P=0.035]和标准蛋白质分解率[OR =0.128,95％ CI=0.022-0.736,P=0.021]与营养不良存在相关性.结论 营养不良在维持性血液透析患者中的发生率较高,炎症和蛋白质摄入不足是引起血液透析患者营养不良的独立影响因素.     

Lower Geriatric Nutritional Risk Index (GNRI) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis

Background: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (GNRI), an indicator of nutritional status, and the incidence of bone fractures in patients undergoing hemodialysis. Methods: We included 1342 registered patients undergoing hemodialysis and performed a post hoc analysis. We divided patients into the high GNRI group (≥92), considered to have a low risk of malnutrition, and the low GNRI group (<92), considered to have a high risk of malnutrition. Fracture-free survival in the low and high GNRI groups was evaluated by the Kaplan–Meier method. Cox proportional hazards models were used to identify the risk factors for fractures requiring hospitalization. All results were stratified by sex. Results: New bone fractures developed in 108 (8.0%) patients in 5 years of follow-up. Bone fractures occurred more frequently in the low GNRI group compared with the high GNRI group (HR: 3.51, 95% CI: 1.91–6.42, p < 0.01 in males; HR: 2.47, 95% CI: 1.52–4.03, p < 0.01 in females). A low GNRI was significantly associated with an increased incidence of bone fractures, even after adjustment for covariates. However, the serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase were not associated with the incidence of bone fractures. Conclusions: A low GNRI is an independent risk factor for bone fractures in patients undergoing hemodialysis. Early intervention for the low GNRI group may be important in preventing the occurrence of fractures.     

Biodisponibilité de la glutamine et réponse du métabolisme protéique à l'apport de glutamine chez l'homme

Glutamine is synthetized in most tissue and accounts for two-thirds of the free amino acid pool in skeletal muscle. Glutamine is not only an interorgan nitrogen shuttle but a precursor of urinary ammonium, and a favorite fuel of the immune system and the gut (which uses ≠ 17 g of glutamine per day). Because they were designed at a time when glutamine was considered both unstable and non-essential, « tradtionalparenteral nutrition (PN) solutions are devoid of glutamine. Although « classicPN is able to maintain normal rates of glutamine turnover in healthy subjects or unstressed patients, classic PN solutions are unable to correct the precipitous depletion of glutamine pool that accompagnies catabolic illness. Glutamine becomes a « conditionally essentialamino acid in these situations. Replenishment of glutamine pool seems to stimulate protein synthesis, and improve nitrogen balance in catabolic patients. Supplementation of PN with glutamine-containing dipeptides or α-ketoglutarate (at doses of 15–50 g/d) is as effective as glutamine itself. The enteral route represents an attractive alternative for the supply of glutamine since : 1) glutamine is efficiently absorbed ; 2) nearly 50 % of enterally infused glutamine reaches systemic blood ; 3) glutamine residues present in a bound form in peptides seem to be bioavailable ; and 4) in addition to its protein anabolic effect, glutamine affects intestinal absorption and trophicity.     

The effect of dietary supplements on the nPCR in stable hemodialysis patients.

OBJECTIVE: To investigate whether (1) dietary supplements raise the normalized protein catabolic rate (nPCR) and/or further improve the nutritional status of stable hemodialysis patients who have both a low nPCR and a low dietary protein intake, <1.2 g/kg body weight/day; and if (2) protein intake measured by nPCR reflects protein intake measured by estimated food diaries in stable patients. DESIGN: Prospective experimental study with a single intervention group. SETTING: Hospital outpatient hemodialysis unit. SUBJECTS: Seventeen stable chronic hemodialysis patients (10 men, 7 women) were studied over 8 months. INTERVENTION: Subjects with both a low nPCR and dietary protein intake <1.2 g/kg body weight/day received dietary supplements for the first 2 months. Measurements to assess protein intake and nutritional status were taken at baseline and repeated at the end of 2 months, and at 6 months postintervention. MAIN OUTCOME MEASURE: nPCR, dietary protein intake using 7-day estimated food diaries, serum urea, serum albumin, serum creatinine, serum bicarbonate, dialysis adequacy (Kt/V), and body mass index (BMI). RESULTS: Dietary supplements significantly increased both the nPCR and the total protein intake at 2 months (1.21 +/- 0.26, 1.10 +/- 0.12, respectively) compared with baseline (0.95 +/- 0.18, 0.75 +/- 0.19, respectively) and 8 months (0.99 +/- 0.12, 0.78 +/- 0.21, respectively), P <.0001, respectively. There was no change in the nutritional status of the subjects. There was a significant difference between the nPCR and the dietary protein intake at baseline, P <.004; at 2 months, P <.047; and at 8 months, P <.001. CONCLUSION: Dietary supplements can significantly increase the nPCR and dietary protein intake in stable hemodialysis patients with a low nPCR and dietary protein intake. Because a low nPCR is associated with a high morbidity and mortality rate, it may be prudent to supplement such patients. The use of the nPCR to quantify dietary protein intake in stable hemodialysis patients should be used with caution.     

Nutrition périopératoire chez la personne âgée. Cas particulier de la fracture de l’extrémité supérieure du col du fémur

Emergency surgery is associated with an increase in the risk of malnutrition in the elderly. Thirty to fifty percent of elderly persons admitted to in surgery are malnourished. In patients for which nutritional status is threatened by both the aging process and comorbidities, the surgical intervention represents an additional stress that will induce or worsen malnutrition. Nutritional care must no be delayed. First choice is the oral route, including protein and energy rich nutritional supplements, and must be a part of multidimensional perioperative care It is recommended to reach 30 to 40 kcal tot/kg/day and 1.2 to 1.5 g of proteins/kg/day. It is recommended to prescribe, during the stay in rehabilitation wards after surgery, oral nutritional supplements. This oral supplementation has been shown to be efficacious in malnourished elderly patients: there is weight gain, a lower risk for complications and a lower mortality rate. However, compliance may be reduced in elderly patients with low appetite, especially in case of dementia, or early medical complications. In order to prevent other falls and fractures, it is recommended to look for vitamin D deficiency and to prescribe vitamin D 800–1200 UI/day.     

Consommation alimentaire et durée d’hémodialyse chez l’insuffisant rénal chronique : corrélation aux paramètres nutritionnels

The aim of this study was to describe food consumption of CRF patients after different hemodialysis duration and to correlate them with some nutritional parameters. Fifty-eight patients divided into three groups: GI: <1 year, GII: 1 to 5 years, GIII: 5 to 13 years of hemodialysis were compared with 22 controls. Reduction of total energy intake by 47% and 30% and protein intake by 49% and 38% was noted in GIII vs GI and GII, respectively. Patients had a dialysis dose (Kt/V) of 0.83±0.35 and a low body mass index. Seventy-seven per cent of patients had hypoalbuminemia (<37g/L). Decreased food consumption involves protein-energy malnutrition and represents a mortality risk.     

Abnormal dark adaptation in adult patients with protein-energy malnutrition: Correction by protein-energy repletion

Markedly abnormal dark adaptation was observed in three patients with treated pancreatic insufficiency and one patient with histologically inactive alcoholic cirrhosis despite normal serum vitamin A (>40 μg/dl) and zinc levels (>70 μg/dl). Intrinsic retinal disease was excluded by extensive ophthalmological examinations in each case. Abnormal dark adaptation was associated with protein-energy malnutrition in all patients. In two patients, dietary protein repletion without supplemental vitamin A or zinc led to a rise in serum albumin and serum vitamin A transport proteins, and correction of the dark adaptation abnormality. No change was observed in total serum vitamin A and serum zinc levels after protein repletion for six weeks. These observations may indicate impaired peripheral utilization of retinol in chronically ill patients with protein-energy malnutrition.     

Phase Angle as a Comprehensive Tool for Nutritional Monitoring and Management in Patients with Crohn’s Disease

Background and Aims: Crohn’s disease (CD) is usually accompanied by malnutrition. CD-related malnutrition can increase morbidity, disability, mortality, and hospitalization costs. The purpose of this study was to find a reliable indicator for evaluating CD patients’ nutritional status. Methods: All data were retrospectively collected from Xiangya Hospital, Central South University between May 2021 and February 2022. All patients were evaluated for nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Body composition, resistance, and reactance were recorded by a body analyser, and the phase angle (PhA) was calculated simultaneously. The Mann–Whitney U test, chi-square test, Fisher’s exact test, and univariate and multivariate logistic regression analyses were used. A receiver operating characteristic (ROC) curve was built to evaluate the predictive value of differential variables for diagnosing malnutrition based on the GLIM criteria. Results: A total of 169 CD patients were enrolled, of which 74 (58.3%) males and 32 (76.2%) females were diagnosed with malnutrition; 34 (45.9%) males and 22 (68.8%) females were severely malnourished. Univariate analysis identified that as nutritional status deteriorated, body mass index, PhA, and levels of haemoglobin and albumin decreased, while platelet count, erythrocyte sedimentation rate, and levels of C-reactive protein and fibrinogen increased (p < 0.05). Logistic regression analysis revealed that the PhA was significantly independently associated with malnutrition (p < 0.05). The ROC curve analysis indicated that the optimal PhA cut-off levels of 6.11° and 5.55° could be used to predict malnutrition according to the GLIM criteria in males and females, respectively, with a PhA < 5.53° and < 5.12° indicating severe malnutrition in males and females, respectively. Conclusion: The PhA is a sensitive, noninvasive, portable, inexpensive tool that can be used to monitor and manage the nutritional status of CD patients.     

Biochemical assessment of nutritional status in patients with chronic obstructive pulmonary disease and acute respiratory failure on admission to an intensive care unit

Although chronic obstructive pulmonary disease (COPD) is associated with weight loss and malnutrition, there is a paucity of relevant data on COPD patients with acute respiratory failure (ARF). We studied 30 consecutive patients on the day of admission to our intensive care unit for ARF. In addition to a clinical work-up, the following biochemical parameters were determined: markers of nutritional status (albumin - ALB, transferrin - TRF, transthyretin - TTR, retinol binding protein - RBP, fibronectin), inflammation (C-reactive protein - CRP, alpha(1) glycoprotein acid - alpha(1)GPA) and catabolism (plasma phenylalanine - PHE, urinary 3-methylhistidine - 3-MH). Values were expressed as mean +/- SD and compared to those of 10 healthy subjects matched for age. COPD-ARF patients had a poor protein status (ALB = 30 +/- 5 vs 42 +/- 3 g.l(-1); TTR = 118 +/- 75 vs 251 +/- 43 mg.l(-1); RBP = 23 +/- 12 vs 46 +/- 8 mg.l(-1); p < 0.001), were hypercatabolic (3-MH Cr = 31 +/- 12 vs 22 +/- 7 mumol.mmol Cr (-1); PHE = 62 +/- 27 vs 46 +/- 10 mumol.l(-1); p < 0.001) and inflamed (CRP = 68 +/- 50 vs 12 +/- 5 mg.l(-1); alpha(1)GPA = 1.2 +/- 0.4 vs 0.5 +/- 0.1 g.l(-1); p < 0.001). Severity of the disease correlated with short half-life proteins and protein catabolism markers but not with inflammation markers. Considering ALB, TTR, RBP, the 3- MH Cr ratio and PHE values, the 30 COPD patients fell into 3 groups: chronic malnutrition (n = 7), acute malnutrition (n = 2), and acute + chronic malnutrition (n = 18). 3 patients had normal nutritional status. We conclude that an assessment of nutritional status at admission to intensive care units could contribute towards a rapid formulation of specific nutritional therapy.     

Should a single centre for the assay of biochemical markers of nutritional status be mandatory in multicentric trials?

Clinical trials to identify patients at risk and to assess new therapeutic agents in the nutritional field are often single-site. The principal advantage of mounting a multicentric trial is that patient accrual is much quicker. Albumin, transthyretin, and C-reactive protein are frequently used biochemical markers of nutritional and inflammation status. However, the different techniques, reagents, and calibrators used to measure these markers introduce wide variations in values among laboratories. This study was carried out as part of a prospective multicentric study in chronic respiratory disease patients to evaluate variability and comparability of results among laboratories for these biochemical markers, and to determine whether centralization is necessary. Thirty enrolled laboratories provided their own range of reference values for those proteins a nd were then requested to process two control samples C1 and C2 blind. The results showed a broad dispersion of values for albumin and transthyretin. In 7% of laboratories, results of albumin for C2 (mean, all techniques: 39.1+/-3 g/l) were <35 g/l, the threshold value indicating a potential risk of malnutrition. When only laboratories using immunonephelemetry were considered, the results were satisfactory (CV<10% for all proteins). Given the possible incorrect classification of patients at risk, measurement should be made per site only if all participants use an immunonephelometric method. Otherwise, a centralizing assay of these biological markers should be considered.     

Malnutrition: Percentage and Association with Prognosis in Patients Hospitalized for Coronavirus Disease 2019

Previous studies have found a correlation between malnutrition and prognosis in respiratory infections. Our objectives were to determine (i) the percentage of malnutrition, and (ii) its prognosis in patients admitted for coronavirus disease 2019 (COVID-19). In this monocentric retrospective study, we consecutively included all adult patients presenting with acute COVID-19 between 9 April and 29 May 2020. Malnutrition was diagnosed on low body mass index (BMI) and weight loss ≥ 5% in the previous month and/or ≥ 10% in the previous six months. The Nutritional Risk Index (NRI) defined nutritional risk. Severe COVID-19 was defined as a need for nasal oxygen ≥ 6 L/min. We enrolled 108 patients (64 men, 62 ± 16 years, BMI 28.8 ± 6.2 kg/m²), including 34 (31.5%) with severe COVID-19. Malnutrition was found in 42 (38.9%) patients, and moderate or severe nutritional risk in 83 (84.7%) patients. Malnutrition was not associated with COVID-19 severity. Nutritional risk was associated with severe COVID-19 (p < 0.01; p < 0.01 after adjustment for C reactive protein), as were lower plasma proteins, albumin, prealbumin, and zinc levels (p < 0.01). The main cause of malnutrition was inflammation. The high percentage of malnutrition and the association between nutritional risk and COVID-19 prognosis supports international guidelines advising regular screening and nutritional support when necessary.     

Significance of albumin and C-reactive protein variations in 300 end stage renal disease patients in Tehran University of Medical Sciences Hospitals during year 2010

Protein- energy malnutrition, wasting and inflammation are frequent complication among patients with end-stage renal disease (ESRD). Malnutrition is associated with cardiac co-morbidity, inflammation and poor survival in ESRD patients. Serum albumin is a well-known marker of nutrition in ESRD patients. Serum albumin is still the most commonly used nutritional marker in ESRD patients. C-reactive protein (CRP), the major acute phase response (APR) protein is elevated in these patients. High CRP levels are linked to the degree of atherosclerosis in coronary, peripheral, and extracranial brain arteries. The aim of the present study was to investigate nutritional factor (albumin) and CRP levels in ESRD patients. In this cross- sectional study a total of 300 patients who had ESRD and had been on hemodialysis treatment for at least 6 months were selected. The laboratory tests consisted of measurement of CRP and albumin using high sensitive ELISA kits. The study patients included 157 males (52.3%) and 143 females (47.7%) with average age of 41.5 ± 14.3 years. Mean CRP level was 7.96 mg/ dl (±1.52), mean serum albumin was 4.07 g/dl (±0.19).Of 300 patients, 21 died (7%). These were patients with serum albumin <4 g/dl and CRP>9.5 mg/dl. This study showed that low albumin and high CRP levels are the main predictors for death. There was a significant difference between CRP and albumin levels in ESRD patients (P<0.0001). Measuring CRP as a marker of inflammation can be helpful in managing these patients.     

A cross-sectional study comparing the nutritional status of peritoneal dialysis and hemodialysis patients in Korea.

OBJECTIVE: This study was performed to compare the nutritional status of peritoneal dialysis (PD) and hemodialysis (HD) patients in Korea and to validate the nutritional assessment method. DESIGN: For nutritional assessment, we used five nutrition-related indicators, including percentage unplanned weight loss, percentage ideal body weight (IBW), serum albumin, appetite and intake, and any gastrointestinal symptoms affecting intake. A 1-month food frequency interview was conducted by clinical dietitians using food models to estimate energy and protein intake. The validity of the nutritional assessment method was tested by objective measures. PATIENTS/SETTING: A cross-sectional study was conducted in our center for 51 PD patients and 169 HD patients who met the study criteria. In the study, HD patients typically underwent dialysis three times per week, and most PD patients performed four 2-L dialysis exchanges every day. RESULTS: Our data showed a higher incidence of malnutrition in PD patients than in HD patients (33% v 18%) and in diabetics than in nondiabetics. Age, height, and dietary energy intake of the two groups were comparable. In PD patients, however, duration of dialysis treatment (23.9 +/- 19.1 months v 41.8 +/- 31.7 months, P < 0.001) and serum albumin (35.2 +/- 5.0 g/L v 39. 7 +/- 3.4 g/L, P < 0.0001) were significantly lower, whereas percentage IBW (108.1% +/- 12.4% v 96.2% +/- 11.6%, P < 0.0001) and dietary protein intake (1.12 +/- 0.34 g/kg IBW v 0.98 +/- 0.31 g/kg IBW, P < 0.05) were significantly higher than in HD patients. In malnourished PD and HD patients, percentage IBW, serum albumin, dietary energy, and protein intake were significantly lower than in well-nourished counterparts. CONCLUSION: A higher incidence of malnutrition was observed in PD patients than in HD patients. Nutritional profile of PD patients was different from that of HD patients. Higher body weight and lower serum albumin in PD patients did not seem to be related to dietary energy and protein intake. The five nutritional indicators can be used as a simple inexpensive and reliable method for the early detection of malnutrition in dialysis patients.     

Obstruction in patients with colorectal cancer increases morbidity and mortality in association with altered nutritional status

Intestinal obstruction aggravates the prognosis of colorectal cancer (CRC) patients. The aim of this study was to carry out a comparative analysis of nutritional status and inflammatory response in CRC patients with or without intestinal obstruction. The study was carried out on 43 patients with CRC. Twenty-three of these patients had intestinal obstruction. Anthropometric measurements, serum protein content, acute phase reactants, and diagnostic and risk nutritional indices were analyzed. The presence of intestinal obstruction reduced albumin (31 +/- 5.2 vs. 36 +/- 4.2 g/l; P = 0.0025) and prealbumin (0.13 +/- 0.047 vs. 0.21 +/- 0.042 g/l; P = 0.0001) and increased C-reactive protein (49 +/- 43.8 vs. 14 +/- 16.7 mg/l; P = 0.006) and alpha1-antitrypsin (189 +/- 34.7 vs. 148 +/- 35.4 mg/dl; P = 0.0011). Intestinal obstruction was related to malnutrition (86% vs. 33%; P = 0.019) and Mullen's prognostic nutritional index (48 +/- 21.7 vs. 31 +/- 17.9; P = 0.038) in CRC patients. Mullen's nutritional risk index was inversely correlated to total cholesterol (r = -0.51; P = 0.0002) and albumin (r = -0.81; P = 0.0001). No correlation was found between Duke's tumor stages and acute phase response, inflammatory parameters, and malnutrition. In conclusion, intestinal obstruction occurred more frequently in CRC patients with malnutrition. The increased morbidity and mortality of CRC patients was also associated with acute phase response, inflammation, and low serum cholesterol and triglyceride concentration.     

Recombinant human growth hormone in patients with acute renal failure.

OBJECTIVE: The objective of this study is to determine the impact of recombinant human growth hormone (rhGH) on metabolic and nutritional parameters in malnourished patients with acute renal failure. DESIGN: The design is an open-labeled pilot trial examining the effects of rhGH administration in a small group of highly catabolic, malnourished patients with acute renal failure. Each patient served as his or her own control. SETTING: An intensive care unit in a tertiary care medical institution. PATIENTS: Five patients with established acute renal failure in a critical care unit. Entry criteria included clinical evidence of malnutrition: a serum albumin level of <3.2 g/dL, a prealbumin level of < or = 20 mg/dL, and an insulin-like growth factor IGF 1 level <200 ng/mL. The study consisted of 3 periods: phase I, 3 day baseline; phase II, 6 day treatment; and phase III, 3 day washout. During the entire study, blood and urine samples were obtained daily to calculate normalized protein catabolic rate, total nitrogen appearance rate (TNA), and nitrogen balance. Additional data were collected to measure metabolic and inflammatory parameters. INTERVENTION: The intervention consisted of administering 100 microg/kg/d of rhGH for 6 days. RESULTS: There were significant changes in TNA, normalized protein catabolic rate, and nitrogen balance during the 3 study phases. TNA decreased from 43.3 +/- 24.4 g/d in phase I, to 25.2 +/- 16.5 g/d during phase II (P <.001). There was a further decrease in TNA to 16.2 +/- 8.3 g/d during phase III (P <.001 v phase I). Nitrogen balance improved from - 31.8 +/- 21.4 g/d during phase I, to - 12.9 +/- 10.3 g/d during phase II (P <.001), and further improved to - 4.1 +/- 4.0 g/d in phase III (P <.001 v phase I). Significant changes were also noted in levels of blood urea nitrogen, phosphorous, serum growth hormone, IGF-1, and serum leptin levels after growth hormone administration. A statistically significant increase in serum albumin was noted in phase III (3.1 g/dL) versus phase I (2.7 +/- 0.7 g/dL). CONCLUSIONS: Administration of rhGH to critically ill patients with acute renal failure resulted in improvements in negative nitrogen balance and a significant decrease in total nitrogen appearance rate. These changes corresponded to increases in serum growth hormone, IGF-1, IGF-1 binding protein 3, and leptin levels after growth hormone administration.     

L’évaluation nutritionnelle chez le sujet âgé en 2008

Malnutrition is frequent in elderly patients and results from multifactorial mechanisms, including age-related metabolic alterations, reduction of food intake and intercurrent diseases, especially inflammatory processes, that compromise nutritional status. Nutritional evaluation must be systematically and repeatedly performed and based primarily on clinical parameters such as weight, body mass index, weight loss, anthropometric measurements and dietetic history eventually combined in scores such as the mini-nutritional assessment (MNA). Fat-free mass evaluated by bioimpedance analysis has a prognostic value. Hypoalbuminemia is indicative of bad prognosis and may be combined with weight loss in the geriatric nutritional risk index (GNRI) to assess the nutritional risk. The determination of plasma transthyretin (prealbumin) is especially useful to assess acute malnutrition state and the response to nutritional support. Routine determination of the above criteria may be facilitated by the spreading of simple integrated tools and a better education of health professionals to the screening and active treatment of malnutrition in the elderly.