End Stage Liver Disease ; complications ; Humans ; Malnutrition ; etiology ; therapy

Objective: To explore the value of phase angle (PA) in constructing a predictive model of nutrition evaluation for tumor patients. Methods: A retrospective analysis was performed on 1 129 patients with malignant tumors hospitalized in the Cancer Center of Changzhi People's Hospital from June 2020 to February 2021. PA values of six parts of the body were measured by the body composition analyzer, including: left arm (LA), right arm (RA), left leg (LL), right leg (RL), the trunk (TR), and the whole body (WB). Patients' body mass index (BMI) was calculated and patient-generated subjective global assessment (PG-SGA) was assessed. The differences of PA values of six parts were compared and their correlations with BMI and PG-SGA in combination with age, gender and tumor disease types were analyzed, binary classification regression on BMI and PG-SGA was performed, and the functions of the best prediction model was fitted. Decision tree, random forest, Akaike information criterion in a Stepwise Algorithm (stepAIC) and generalized likelihood ratio test were used to select appropriate variables, and the logit logistic regression model was used to fit the data. Results: Comparing the PA values of six parts in pairs, it was found that the PA values of LA and RA, LL and RL, and TR and WB were linearly correlated and the coefficient was close to 1 (P<0.001). Binary classification regression was performed for BMI and PG-SGA, respectively. In order to make the data have clinical significance, 18.5 kg/m(2) was used as the classification point for BMI, 4 and 9 were used as the classification points for PG-SGA score, and the models of A, B and C were obtained. Suitable variables including PA-LA, PA-TR and tumor disease types were used as variables to fit BMI classification; BMI, PA-LA and age were used as variables to fit the PG-SGA model with 9 as the classification point. PA-LA, PA-TR, BMI, age and tumor disease types were used as variables to fit the PG-SGA model with 4 as the classification point. In this study, the predicted values of models A, B and C obtained by R-studio were imported into SPSS 26.0 software, and the cut-off values of classification were obtained by the receiver operating characteristic (ROC) curve. The ROC analytic results showed that the best cut-off values of Model A, B and C were 0.155, 0.793 and 0.295. Model A recommended when the probability is >0.155, a patient's nutritiond tatus should be classified as BMI < 18.5 kg/m(2) group. Model B recommended that PG-SGA<9 group be classified as the probability is >0.793. Model C recommended that PG-SGA < 4 group should be classified when probability is >0.295. Conclusions: The PG-SGA classification prediction model is simple to operate, and the nutritional status of patients can be roughly divided into three groups: normal or suspected malnutrition group (PG-SGA<4), moderate malnutrition group (4≤PG-SGA<9), and severe malnutrition group (PG-SGA≥9). This model can more efficiently predict the nutritional status of cancer patients, greatly simplify the nutritional assessment process, and better guide the standardized treatment of clinical malnutrition.
Humans ; Nutrition Assessment ; Retrospective Studies ; Nutritional Status ; Malnutrition ; Neoplasms/complications*

The disease course of children with persistent or chronic diarrhea lasts from two weeks to two months or over. Diarrhea is a clinical syndrome caused by a group of multiple etiologies. This paper reviews common causes of persistent or chronic diarrhea in children, including intestinal infections, nonspecific inflammatory bowel diseases, food allergy, lactose intolerance, antibiotic-associated diarrhea, neural regulation abnormality, immunodeficiency disease, malnutrition, Celiac disease and zinc deficiency.
Child ; Chronic Disease ; Diarrhea ; etiology ; Humans ; Infection ; complications ; Inflammatory Bowel Diseases ; complications ; Lactose Intolerance ; complications ; Malnutrition ; complications ; Zinc ; deficiency

A 50-year-old man with a 15-year history of elevated blood glucose and an approximately 2-year history of diarrhea was admitted to the Peking Union Medical College Hospital. The initial diagnosis was type 2 diabetes. After repeated pancreatitis and pancreatoduodenectomy, severe pancreatic endocrine and exocrine dysfunction including alternating high and low blood glucose and fat diarrhea occurred. Tests for type 1 diabetes-related antibodies were all negative, C-peptide levels were substantially reduced, fat-soluble vitamin levels were reduced, and there was no obvious insulin resistance. Therefore, a diagnosis of pancreatic diabetes was clear. The patient was given small doses of insulin and supplementary pancreatin and micronutrients. Diarrhea was relieved and blood glucose was controlled. The purpose of this article is to raise clinicians' awareness of the possibility of pancreatic diabetes after pancreatitis or pancreatic surgery. Timely intervention and monitoring may reduce the occurrence of complications.
Male ; Humans ; Middle Aged ; Blood Glucose ; Diabetes Mellitus, Type 2/complications* ; Pancreaticoduodenectomy/adverse effects* ; Pancreatitis, Chronic/complications* ; Malnutrition/complications*

PURPOSE: The authors evaluate the prevalence of malnutrition and its effect on the postoperative morbidity of patients after surgery for colorectal cancer. METHODS: Three hundred fifty-two patients were enrolled prospectively. Nutritional risk screening 2002 (NRS 2002) score was calculated through interview with patient on admission. Clinical characteristics, tumor status and surgical procedure were recorded. RESULTS: The prevalence of patients at nutritional risk was 28.1 per cent according to the NRS 2002. The rate of postoperative complication was 27%. There was a significant difference in postoperative complication rates between patients at nutritional risk and those not at risk (37.4% vs. 22.9%, P = 0.006). Nutritional risk was identified as an independent predictor of postoperative complications (odds ratio, 3.05; P = 0.045). Nutritional risk increased the rate of anastomotic leakage (P = 0.027) and wound infection (P = 0.01). CONCLUSION: NRS may be a prognostic factor for postoperative complication after surgery for colorectal cancer. A large scaled prospective study is needed to confirm whether supplementing nutritional deficits reduces postoperative complication rates.
Anastomotic Leak ; Colorectal Neoplasms* ; Humans ; Malnutrition ; Mass Screening ; Postoperative Complications ; Prevalence ; Wound Infection

OBJECTIVETo investigate the nutritional risk in children with severe pneumonia using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the association between nutritional risk and adverse clinical outcomes.

METHODSAccording to the STAMP score, 216 children with severe pneumonia were classified into high nutritional risk group (HR group; n=98), moderate nutritional risk group (MR group; n=65), and low nutritional risk group (LR group; n=53). Fasting blood samples were collected to measure the levels of insulin-like growth factor-1 (IGF-1), adiponectin, leptin, non-esterified fatty acid (NEFA), albumin, transferrin, prealbumin, and retinol binding protein (RBP). The adverse clinical outcomes were recorded.

RESULTSCompared with the MR and LR groups, the HR group had significantly lower serum levels of IGF-1, leptin, adiponectin, prealbumin, and RBP, as well as a significantly higher serum level of NEFA (P<0.05). Compared with the MR and LR groups, the HR group had a significantly higher proportion of children admitted to the intensive care unit and a significantly longer duration of mechanical ventilation (P<0.05). The HR group had a significantly longer mean hospital stay and a significantly higher incidence rate of complications compared with the LR and MR groups (P<0.05).

CONCLUSIONSNutritional risk screening has an important value in evaluating the clinical outcome of children with severe pneumonia, and children at a higher nutritional risk tend to have more adverse clinical outcomes.

Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Malnutrition ; etiology ; Pneumonia ; complications ; Risk

Bariatric surgery has increasingly been applied for patients with severe obesity. By dramatically reducing body weight and producing favorable effects on disorders in endocrine metabolism, bariatric surgery has shown to be able to lower the overall mortality. However, this intervention involves a profound change in digestive physiology and may cause nutrition and endocrinal metabolism-related severe complications, which mainly result from the deficiency or unbalance of macronutrients and micronutrients. Therefore, it is necessary to establish a fixed management procedure which includes routine perioperative nutritional consultation, regular monitoring, and early preventive nutritional support, so as to prevent metabolic complications and achieve better outcomes.
Bariatric Surgery ; adverse effects ; Humans ; Malnutrition ; etiology ; therapy ; Nutritional Support ; Obesity, Morbid ; surgery ; Postoperative Complications ; therapy

Humans ; Aged ; Patient Readmission ; Pulmonary Disease, Chronic Obstructive ; Malnutrition/complications* ; Risk Factors ; Retrospective Studies

Malnutrition has multiple impacts on surgical success, postoperative complications, duration of hospital stay, and costs, particularly for cancer patients. There are various nutrition risk screening tools available for clinical use. Herein, we aim to determine the most appropriate nutritional risk screening system for esophageal cancer (EC) patients in China.SUBJECTS/METHODS: In total, 138 EC patients were enrolled in this study and evaluated by experienced nurses using three different nutritional screening tools, the Nutrition Risk Screening 2002 tool (NRS2002), the Patient-generated Subjective Globe Assessment (PG-SGA), and the Nutrition Risk Index (NRI).We compared sensitivity, specificity, positive and negative likelihood ratios, and Youden index generated by each of the three screening tools. Finally, cut-off points for all three tools were re-defined to optimize and validate the best nutritional risk screening tool for assessing EC patients.RESULTS: Our data suggested that all three screening tools were 100% sensitive for EC patients, while the specificities were 44.4%, 2.96%, and 59.26% for NRS 2002, PG-SGA, and NRI, respectively. NRI had a higher positive likelihood ratio as well as a higher area under the receiver operating characteristic curve compared to those of NRS 2002 and PG-SGA; although, all three tools had null negative likelihood ratios. After adjusting the cut-off points, the specificity and accuracy for all tools were significantly improved, however, the NRI remained the most appropriate nutritional risk screening system for EC patients.CONCLUSIONS: The NRI is the most suitable (highest sensitivity and accuracy) nutritional risk screening tool for EC patients. The performance of the NRI can be significantly improved if the cut-off point is modified according to the results obtained using MedCalc software.]]>
China ; Esophageal Neoplasms ; Humans ; Length of Stay ; Malnutrition ; Mass Screening ; Postoperative Complications ; ROC Curve ; Sensitivity and Specificity

OBJECTIVETo investigate the potential benefits of postoperative nutrition in malnourished patients with gastrointestinal cancer.

METHODSA total of 646 malnourished patients with gastrointestinal cancer defined by the subjective global assessment (SGA) were randomly divided into parenteral nutrition group (n=215), enteral nutrition group (n=215) and conventional group (n=216). Two nutritional regimens were designed to be isocaloric 125.5 kJ(30 kcal).kg(-1).d(-1) and isonitrogenous 0.25 g.kg(-1).d(-1) for 7 postoperative days. Conventional group did not receive artificial nutrition before and after surgery. Postoperative complications, mortality and postoperative length of hospital stay were compared.

RESULTSAll baseline and surgical characteristics were comparable among 3 groups. Overall postoperative mortality was 1.5%, and no difference was observed among 3 groups. Postoperative complications occurred in 61(28.4%) patients in enteral nutrition group, 72(33.5%) in parenteral nutrition group, and 97 (44.9%) in conventional group (P=0.000 vs enteral nutrition group; P=0.001 vs parenteral nutrition group). Postoperative length of hospital stay was (9.8+/-3.4) d in enteral nutrition group, (11.2+/-5.0) d in parenteral nutrition group, and (14.5+/-7.1) d in conventional group (P=0.001 vs enteral nutrition group; P=0.003 vs parenteral nutrition group).

CONCLUSIONSPostoperative artificial nutrition support is beneficial to the malnourished patients with gastrointestinal cancer, which improves postoperative outcome. Early enteral nutrition significantly reduces the infectious complication rate and length of postoperative hospital stay as compared with parenteral nutrition.

Aged ; Female ; Gastrointestinal Neoplasms ; complications ; surgery ; therapy ; Humans ; Male ; Malnutrition ; complications ; therapy ; Middle Aged ; Nutritional Support ; Postoperative Period ; Prospective Studies