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Cancer cachexia is a multifactorial syndrome characterized by the continuous loss of skeletal muscle. The pathogenic mechanism of cancer cachexia remains unknown, and the effectiveness of routine nutritional therapy is limited. The mitochondrial disorder is demonstrated to play an important role in the mechanism of tumor-induced skeletal muscle atrophy, including alterations to the mitochondrial ultrastructure, biogenesis, dynamics, mitophagy, and functions. Interventions targeting mitochondrial alterations provide a potential solution to cancer cachexia and represent a new focus in this research field.
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The inconsistency of diagnostic criteria for malnutrition has confused clinicians since the 1980s. After the implementation of disease diagnosis related group payment (DRG) in China's public hospitals, the diagnosis of malnutrition and the correct documentation of nutrition-related diagnosis on the front sheet of medical records are related to the correct classification of the disease group and the medical insurance payment. Therefore, the reliable diagnostic criteria for malnutrition, especially disease-related malnutrition, is urgently needed in clinical practice. In September 2018, The global leadership Iinitiative on malnutrition (GLIM) diagnostic criteria consensus was launched. GLIM aimed to provide the explicit and unified diagnostic criteria for malnutrition in adult hospitalized patients. However, GLIM criteria was based on the voting by nutritional experts and was merely a consensus in nature. The clinical validity of GLIM criteria needs prospective verification, i.e., to demonstrate that patients with malnutrition as per GLIM criteria could have improved clinical outcomes with reasonable nutritional interventions. In November 2020, the article titled Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS 2002 was published on the journal Nutrition. It was the first study comparing nutritional risk screening 2002 (NRS 2002) and GLIM malnutrition diagnostic criteria among Chinese patients for the indication of nutritional support therapy. The clinical effectiveness of the two tools was retrospectively verified as well. Here we discussed the key points of this retrospective study, including the critical research methods, to inform the currently ongoing prospective validation of the GLIM malnutrition diagnostic criteria (the item of reduced muscle mass not included).
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Objective:To analyze the correlation between nutritional status and frailty and sarcopenia in geriatric inpatients (GIPs) planning to receive major hepatopancreatobiliary (HPB) surgery.Methods:From December, 2020 to September, 2022, GIPs who were planning to receive major HPB surgery were recruited. Nutritional assessment was performed using nutritional risk screening 2002 (NRS-2002) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty and sarcopenia assessment were performed using Fried frailty phenotype (FFP) and Asian Working Group for Sarcopenia (AWGS) 2019 consensus on sarcopenia diagnosis and treatment. The prevalence and concurrence of malnutrition, frailty and sarcopenia were investigated, and the correlation between nutritional status and frailty and sarcopenia was analyzed.Results:A total of 144 participants at the mean age of (70.10±7.44) years were included. The prevalence of nutritional risk, malnutrition, and severe malnutrition were 73.6% ( n ?=?106), 68.1% ( n ?=?98), and 34.7% ( n ?=?50) respectively. The prevalence of frailty was 20.8% ( n ?=?30) and that of sarcopenia was 35.4% ( n ?=?51). The prevalence of severe malnutrition increased significantly in older participants and the prevalence of nutritional risk, malnutrition and severe malnutrition decreased significantly with higher BMI. The prevalence was 35.4% (51/144) for concurrent sarcopenia and malnutrition, 19.4% (28/144) for frailty and malnutrition, 14.6% (21/144) for sarcopenia and weakness, and 14.6% (21/144) for sarcopenia, malnutrition, and weakness. There was a positive correlation between nutritional risk and frailty ( r = 0.603, P < 0.001). The risk of pre-frailty and frailty in the nutritional risk group was higher than that in the non-nutritional risk group ( χ 2 = 31.830, P < 0.001). The risk of pre-frailty and frailty in the malnutrition group was higher than that in the normal nutrition group ( χ 2 = 36.727, P < 0.001). Logistic regression analysis showed that the risk of frailty in patients with severe malnutrition was 12.303 times higher than that in patients with normal nutrition status (95% CI: 2.592 to 58.409, P = 0.002). The risk of sarcopenia in the nutritional risk group was higher than that in the non-nutritional risk group ( χ 2 = 13.982, P < 0.001). The risk of sarcopenia in the malnutrition group was higher than that in the normal nutrition group ( χ 2 = 37.066, P < 0.001). Conclusions:The prevalence and concurrence rate of malnutrition, frailty, and sarcopenia are high in GIPs undergoing major HPB surgery. GIPs with malnutrition are susceptible to frailty.
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Acute abdominal pain is one of the most frequent complaints of patients presenting to the emergency department. Timely diagnosis and correct treatment affect the prognosis of patients. Traditional diagnosis mostly depends on physical examination and radiology. In terms of treatment, some patients need exploratory laparotomy. In recent years, with the development of interventional ultrasound, new techniques such as contrast-enhanced ultrasound, ultrasound-guided biopsy, drainage have been gradually applied to the diagnosis and treatment of surgical acute abdomen, especially the surgeon-performed interventional ultrasound, which has effectively improved the diagnostic efficiency and broadened the treatment choice. In this article, we aim to review and evaluate the application and progress of interventional ultrasound in the diagnosis and treatment of surgical acute abdomen.
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Objective:To investigate the nutritional status of elderly inpatients in China, and to assess its relationship with clinical outcomes.Methods:A prospective, multicenter, parallel investigation was organized and conducted by the Chinese Medical Association's Group of Geriatric Nutrition Support.Patients aged ≥65 years from 30 major hospitals of 14 cities in China were evaluated by the Nutritional Risk Screening 2002(NRS2002)and the Mini-Nutritional Assessment-Short Form(MNA-SF), in order to understand the nutritional status and nutritional risk of elderly inpatients in China.The indicators of clinical outcomes were summarized, and the correlation between nutritional status and clinical outcomes was analyzed.Results:A total of 10 184 elderly patients who met the inclusion criteria were enrolled in this study, aged 65-112(74.81±7.01)years, with a body mass index(BMI)of 17.80-35.50(23.32±3.83)kg/m 2.Grip strength of the dominant hand was(16.95±18.42)kg, upper arm circumference was(25.68±3.70)cm, and calf circumference was(32.07±3.89)cm.BMI, grip strength, upper arm circumference and calf circumference decreased significantly with age( F=13.74, 97.47, 28.31 and 88.68, all P<0.001). NRS2002 was conducted on 10 182 patients.Of them, 10.14%(895/10 182)suffered malnutrition(BMI≤18.5 kg/m 2), and 46.42%(4 726/10 182)were at nutritional risk(NRS2002 score≥3). Nutrition deficiency and nutritional risk showed upward trends with age( F=43.41 and 177.05, both P<0.001). A total of 9 755 patients(95.79%, 9 755/10 182)completed the MNA-SF.Of them, 14.67%(1 431/9 755)had malnutrition, 35.04%(3 418/9 755)were at risk of malnutrition, and 50.29%(4 906/9 755)had normal nutritional status.The incidence of malnutrition and the risk of malnutrition significantly increased with age( F=172.79, 12.10 and 152.42, all P<0.05). Nutritional risk(NRS2002 score≥3)was related to age, BMI, mortality, infectious complications, length of hospital stay and total hospital cost(all P<0.05). Conclusions:The incidence of malnutrition and the risk of malnutrition are high in elderly inpatients in China.Nutritional risk is an influencing factor for adverse clinical outcomes.
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Objective:To evaluate the perioperative safety of pancreaticoduodenectomy(PD)in elderly patients.Methods:Clinical data of 152 patients undergoing PD in Beijing Hospital between 2016 and 2019 were retrospectively analyzed.According to the age, patients were divided into the elderly group(age≥65 years)and the non-elderly group(age<65 years). The perioperative and postoperative parameters were compared between the two groups.Results:There was no significant difference in the operative time, intraoperative blood loss and intraoperative urine output between the elderly group and the non-elderly group(352.7±69.5)min vs.(359.0±94.4)min, (708.7±672.7) vs.(662.6±896.7)ml and(875.8±497.3)ml vs.(1010.6±568.2)ml, all P>0.05). The perioperative mortality, postoperative complications(Clavien-Dindo classification ≥ grade Ⅲ)and reoperation rate had no significant difference between elderly group and the non-elderly group(6.1% vs.1.2%, 21.2% vs.19.8%, 10.6% vs.8.1%, respectively, χ2=1.487, 0.048 and 0.272, all P>0.05). The incidences of operation-related complications, cardiovascular or cerebrovascular adverse events in elderly group were comparable to non-elderly group( P>0.05). The postoperative hospital stay had no significant difference between the elderly group and the non-elderly group[(28±19)d vs.(27±18)d, P>0.05]. Conclusions:PD is safe in elderly patients.Age is not a contraindication to pancreaticoduodenectomy.The comprehensive systemic evaluation, intraoperative delicate operation and enhanced perioperative management are necessary in the elderly patients undergoing PD.
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Precision medicine emphasizes formulating reasonable diagnosis, treatment and prevention strategies according to patients′ different genotypes, metabolic characteristics, lifestyle and environment. It is the frontier and development direction of modern medicine. As an important branch of precision medicine, precision nutrition has attracted extensive attention. On the one hand, metabolomics and nutriomics researches based on gene level have become hot spots in this field, but it will take some time to apply it to clinical practice; On the other hand, based on the concept of "precision", the practice of individualized nutrition diagnosis and treatment centered on phenotypic characteristics is gradually carried out in various clinical medical fields, reflecting good application value. With the research progress, precision nutrition will be better combined with clinical nutrition to benefit patients.
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In the 42 nd and 44 th workshops of CSPEN-nutritional risk-undernutrition-support-outcome-cost effectiveness ratio (NUSOC) multi-center database collaboration group, Jens Kondrup and Henrik Rasmussen described again the application of NRS 2002, the evidence-based basis of NRS 2002 development and the methodology for prospective validation of clinical effectiveness. There is no gold standard for validation. They both considered that malnutrition could be identified as a score of 3 or more for impaired nutritional status in NRS 2002. Although NRS 2002 is simple and easy to be applied, it is not comprehensive enough for malnutrition diagnosis. ASPEN and ESPEN on-line published the Global Leadership (nutritional) Initiative on Malnutrition(GLIM)diagnosis criteria in September 2018. With the gradual implementation of medicare payment based on diagnosis related groups(DRG)in China, the nutritional risk and the malnutrition diagnosis with Chinese version of ICD-10 (2016) code should be recorded in the first page of the medical records. In this terminology interpretations, the terms of nutritional risk screening(NRS 2002.01.016)and malnutrition diagnosis (GLIM-phenotypic criteria 01.028, etiologic criteria 01.029) published in Parenteral and Enteral Nutrition Terminology 2019 are discussed based on the reports given by Kondrup and Rasmussen in Beijing and Zhengzhou.
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Objective:To assess the current practice in perioperative nutritional managament of patients undergoing pancreatoduodenectomy from 64 level A tertiary hospitals in China, and investigate nutritional managament strategies.Methods:The cross-sectional survey was conducted. From March 31 st to April 13 th, electronic questionnaires of perioperative nutritional management of patients undergoing pancreatoduodenectomy were sent to the members of Youth Club of Chinese Pancreatic Surgery Association and some pancreatic surgeons from other level A tertiary hospitals in China. The questionnaires were issued by online Wechat platform. Observation indicators: (1) general data; (2) preoperative nutritional management; (3) intraoperative nutritional management; (4) postoperative nutritional management; (5) comparison of nutritional management among medical centers with different surgical amount. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Results:(1) General data: a total of 96 questionnaires from 64 level A tertiary hospitals in 35 cities of 22 provinces were retrieved. There were 94 males and 2 females, aged (42±7) years, with a range from 29 to 59 years. (2) Preoperative nutritional management. ① Preoperative nutritional evaluation and screening: 62.5%(60/96) of surgeons evaluated preoperative nutritional status for patients. For preoperative screening, 41.7%(40/96) of surgeons performed nutritional screening in every patient, and 54.2%(52/96) performed nutritional screening when considering nutritional support. For screening tools, Nutritional Risk Screening 2002 was used in 66.7%(64/96) of surgeons. For selection of non-tool evaluation parameters, 97.9%(94/96) chose two or more indicators for comprehensive evaluation, 92.7%(89/96) chose Albumin as the evaluation parameter. ② Preoperative nutritional support: there were 13.5%(13/96) of surgeons conducting nutritional support regularly. For preoperative nutritional support methods, nutritional support based on diet was conducted by 94.8%(91/96) of surgeons. For timing of perioperative nutritional support, 43.8%(42/96) of surgeons determined the time according to the surgical time. Based on the theory of enhanced recovery after surgery, 24.0%(23/96)of surgeons routinely gave liquid diet or carbohydrate load at the preoperative 2 hours. (3) Intraoperative nutritional management. ① Intraoperative jejunostomy management: 8.3%(8/96) of surgeons performed routine jejunostomy. ② Intraoperative nutrition line management: the nasojejunal tube was placed intraoperatively by 30.2%(29/96), and the nasogastric tube was placed intraoperatively by 78.1%(75/96). Of the above surgeons, 38.7%(29/75) determined the time to nasogastric tube removal based on gastric volume, and 32.0%(24/75) removed the nasogastric tube after flatus in patients. (4) Postoperative nutritional management. ① Postoperative nutritional support methods: 84.4%(81/96) of surgeons gave nutritional support, in which 56.8%(46/81) mainly gave the parenteral nutrition and transition to diet. Total parenteral nutrition at the postoperative first day or complementary parenteral nutrition was the first choice in 78.1%(75/96) of surgeons, oral feeding at postoperative 7 days was the first choice in 86.5%(83/96) of surgeons. ② Postoperative nutritional management for complications: 63.5%(61/96) of surgeons chose enteral nutritional support through percutaneous endoscopic gastrojejunostomy, nasogastric tube or nasojejunal tube for grade B or C pancreatic fistula, 72.9%(70/96) chose enteral nutritional support through percutaneous endoscopic gastrojejunostomy or nasojejunal tube for delayed gastric emptying. (5) Comparison of nutritional management among medical centers with different surgical amount: of the 96 surgeons, surgeons in medical centers with surgical amount >100 cases a year had the nasogastric tube placement rate of 66.7%(32/48), and surgeons in medical centers with surgical amount ≤100 cases a year had the nasogastric tube placement rate of 89.6%(43/48), showing a significant difference between the two groups ( χ2=7.375, P<0.05). Conclusions:There is no uniform standards for indications, routes, or timing of perioperative nutritional management of patients undergoing pancreatoduodenectomy among surgeons from level A tertiary hospitals in China. In patients undergoing pancreatoduodenectomy, the theories and practice of perioperative nutritional management and enhanced recovery after surgery are diverse, which urgently require prospective study with nutritional management strategy as intervention and expert consensus on perioperative nutritional managament in pancreatic surgery accorded with clinical practice in China.
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Objective@#To investigate the prevalence of malnutrition in elderly cancer inpatients based on global leadership initiative on malnutrition(GLIM)diagnostic criteria.@*Methods@#Clinical data of 1 472 inpatients with cancer aged 65 years and over from a multicenter study in 2012 were retrospectively analyzed.Nutritional assessment was performed based on GLIM diagnostic criteria and the prevalence of malnutrition in a different stratifieddiagnosis was recorded.@*Results@#Of 1472 consecutive patients, 924 cases(62.8%)were diagnosed as nutritional risk.The malnutrition rate was 51.8%(762 cases)based on GLIM diagnostic criteria, with 29.6%(436 cases)of moderate malnutrition and 22.3%(326 cases)of severe malnutrition.The prevalences of nutritional risk, total malnutrition and severe malnutrition were increased along with aging(P=0.000). There were 906 cases not receiving surgery treatment.Among the 906 cases, the prevalence of nutritional risk and malnutrition were 61.9%(561/906 cases)and 53.3%(483 /906 cases), the moderate malnutrition rate was 53.3%(483/906 cases)and the severe malnutrition rate was 22.1%(200/906 cases)respectively.There were 566 cases undergoing surgery treatment.And among 566 cases, the prevalence of nutritional risk and malnutrition were 64.1%(236 cases)and 49.5%(280 cases), the moderate malnutrition rate was 26.9%(152 cases)and the severe malnutrition rate was 22.6%(128 cases). The prevalence of nutritional risk was high in patients with gastrointestinal cancer who underwent surgery, and the prevalence of malnutrition in patients with gastrointestinal cancer or lung cancer was higher in the non-surgical group than in the surgical group.@*Conclusions@#The prevalence of malnutrition is high in elderly cancer inpatients, which is increased along with aging.GLIM diagnostic criteria has clinical operability, and its availability needs more studies in the future.
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Objective@#To examine the effect of standardized lymphectomy and sampling of resected lymph nodes (LN) on TNM staging of resectable pancreatic head cancer.@*Methods@#Consecutive patients with resectable pancreatic head cancer who received standard pancreatoduodenctomy at Department of General Surgery in Beijing Hospital from December 2017 to November 2018 were recruited as study group. After operation, the surgeon sampled lymph nodes from the fresh specimen following the Japanese Gastric Cancer Guidelines.Thirty-three cases were recruited in the study group and the mean age was (59.8±15.2) years.Pathologic reports from December 2015 to November 2016 were taken as control group, containing 29 cases with age of (57.0±13.0) years. Number of lymph nodes, standard-reaching ratio and positive nodes ratio were compared between two groups. According to the seventh edition and eighth edition of TNM staging, the changes of N staging and TNM staging were analysed. The quantitative data conforming to normal distribution were tested by independent sample t test, the quantitative data not conforming to normal distribution were tested by rank sum test, and the enumeration data were analysed by χ2 test.@*Results@#The basal data of the two groups were comparable (all P>0.05) . The number of lymph nodes sampled in the study group was 23.27±8.87, significantly more than in control group (12.86±5.90, t=0.653, P=0.000) .Ratio of cases with more than 15 nodes was 81.8% (27/33) in the study group and 34.5% (10/29) in the control group with statistical significance (χ2=14.373, P=0.000) . In the study group, the positive lymph node ratios of No. 17a+17b, 14a+14b, 8a+8p LN were 36.4% (12/33) , 30.3% (10/33) and 9.1% (3/33) respectively. The positive lymph node ratio in No.14a+14b LN was higher than in No.8 LN (χ2=4.694, P=0.030) . According to the change in N staging system in the AJCC eighth edition, 2 cases (6.1%, 2/33) changed from ⅠB to ⅡA, 7 cases (21.2%, 7/33) from ⅡA to ⅠB and 5 cases (15.2%, 5/33) changed from ⅡB to Ⅲ (25.0%, 5/20) .@*Conclusions@#No.14 LN should be treated as the first station rather than second station because of the anatomic character and higher metastatic ratio. Standardised lymphectomy and sampling may increase the number of LN resected and improve the TNM staging of resectable pancreatic head cancer.
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It is well known that parenteral and enteral nutrition support is helpful to improve clinical outcomes in patients with malnutrition or nutritional risk, and surgical nutrition has been used in China for 40 years. However, there is still insufficient awareness of malnutrition among clinical workers. There were different opinions from many experts after the publications of the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus of malnutrition assessment 2015 and ESPEN guidelines on definitions and terminology of clinical nutrition 2017. Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition has also been published in 2018. Though it is lack of clinical validation, it is a big step forward. In order to achieve better prevention and treatment of malnutrition in clinical work, this present paper analyzes and compares the core contents of malnutrition assessment (diagnosis) in recent years, proposes current practical strategy for Chinese clinical workers, emphasizes that GLIM criteria cannot replace the three steps named "screening-assessment-intervention" .
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Objective To investigate the prevalence of malnutrition in elderly cancer inpatients based on global leadership initiative on malnutrition(GLIM)diagnostic criteria.Methods Clinical data of 1 472 inpatients with cancer aged 65 years and over from a multicenter study in 2012 were retrospectively analyzed.Nutritional assessment was performed based on GLIM diagnostic criteria and the prevalence of malnutrition in a different stratifieddiagnosis was recorded.Results Of 1472 consecutive patients,924 cases(62.8％)were diagnosed as nutritional risk.The malnutrition rate was 51.8 ％ (762 cases)based on GLIM diagnostic criteria,with 29.6 ％ (436 cases)of moderate malnutrition and 22.3％ (326 cases)of severe malnutrition.The prevalences of nutritional risk,total malnutrition and severe malnutrition were increased along with aging (P=0.000).There were 906 cases not receiving surgery treatment.Among the 906 cases,the prevalence of nutritional risk and malnutrition were 61.9％ (561/906 cases)and 53.3 ％ (483/906 cases),the moderate malnutrition rate was 53.3 ％ (483/906 cases)and the severe malnutrition rate was 22.1％ (200/906 cases)respectively.There were 566 cases undergoing surgery treatment.And among 566 cases,the prevalence of nutritional risk and malnutrition were 64.1％ (236 cases) and 49.5％ (280 cases),the moderate malnutrition rate was 26.9％(152 cases)and the severe malnutrition rate was 22.6％ (128 cases).The prevalence of nutritional risk was high in patients with gastrointestinal cancer who underwent surgery,and the prevalence of malnutrition in patients with gastrointestinal cancer or lung cancer was higher in the nonsurgical group than in the surgical group.Conclusions The prevalence of malnutrition is high in elderly cancer inpatients,which is increased along with aging.GLIM diagnostic criteria has clinical operability,and its availability needs more studies in the future.
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Objective To evaluate the value of contrast-enhanced ultrasonography(CEUS)in neoadjuvant chemotherapy(NAC) for triple negative breast cancer(TNBC)in the elderly.Methods A total of 16 elderly patients with TNBC admitted to hospital from October 2017 to June 2018 were selected,and they underwent ultrasound examination before treatment.Changes in lesion size and time intensity curve (TIC)parameters were compared against postoperative microscopic diagnoses,which were used as the gold standard,to evaluate the effect of NAC in elderly TNBC patients.Results Compared with pre-treatment imaging data,the sum of the diameters of target lesions was reduced by 38.0％ after NAC treatment[(7.29±1.62)cm vs.(4.52± 1.21)cm,t =2.313,P＜0.05],and TIC parameters showed that the peak intensity(PI)and the time to peak(TTP)and the slope of the ascending part of the curve,or Grad,were statistically different between pre and post-NAC treatment measurements[(-65.14± 3.75)dB vs.(57.67± 1.93)dB,(11.57±7.34)s vs.(5.35±0.83)s,(1.21±0.27) vs.(2.29± 0.45),t =3.512,2.271 and 2.727,P =0.003,0.049 and 0.026,respectively].When compared with microscopic examination results,CEUS TIC analysis for evaluating the efficacy of NAC showed an accuracy of 87.5％ (14/16),a sensitivity of 92.9％ (13/14),a specificity of 50.0％ (1/2),a positive predictive value of 81.3％ (13/16) and an inter-method kappa value of 0.429(x2=0.500,P=0.230).Using CEUS to evaluate the efficacy of NAC achieved an accuracy rate of 81.3％(13/16).Conclusions CEUS can effectively evaluate the efficacy of NAC in elderly patients with TNBC,and guide the clinician to develop an accurate,individualized treatment program benefiting the patients.
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Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.
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Objective To investigate the application value of mini-nutritional assessment short-form(MNA-SF) in screening and evaluating nutritional status in elderly hospitalized patients with malignant tumor.Methods 1472 elderly hospitalized patients(≥65 years old)with malignant tumor were enrolled and prospectively studied for evaluating the nutritional status by nutritional risk screening 2002 (NRS 2002)assessment.Indicators of clinical outcomes were summarized.The consistencies of MNA-SF with body mass index(BMI),grip and results of NRS 2002 assessment,and the relationship between the different nutritional status and clinical outcomes were analyzed.Results The patients meeting the inclusion/exclusion criteria were aged(72.1±5.9)years,with BMI of(22.3 ±3.7)kg/m2 and grip of(21.7± 19.0)kg.Among 16.7％ of the malnourished patients with malignant tumors,pancreatic cancer (30.9 ％),bile duct cancer (24.1％) and esophageal cancer (21.2 ％) occupied the top three incidence of malnutrition,with the lowest (5.4％)incidence in breast cancer.Among 59.2％ of patients being malnourished (16.7％)or at risk(42.5％)of malnutrition,the highest incidence was in bile duct cancer(82.8％),and lowest one was in breast cancer(28.6 ％).MNA-SF-discriminated malnutrition(0～ 7 points)showed a great agreement with malnutrition evaluation by BMI(＜18.5),but had a poor agreement with grip in screening malnutrition.MNA-SF-discriminated nutrition problem(malnourishment plus at risk of malnutrition)showed a great agreement with NRS 2002-discovered nutrition problem (score≥3).Under-nourished patients had a higher infection complication(9.29％ vs.5.14％,P =0.006)and longer hospital stays(15.4 d vs.12.8 d,P＜0.01)as compared with patients with normal nutrition status.Conclusions The prevalence and risk factors for malnutrition are higher in elderly patients with malignant tumor.Poor nutritional status is correlated with poor clinical outcomes.MNA-SF can be used as a tool for evaluating the nutritional status of elderly patients with malignant tumor.
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In 2017,the Ministry of Human Resources and Social Security issued the "National Basic Medical Insurance,Work-related Injury Insurance,and Maternity Insurance Drag List (2017 Edition) ",which is a major innovation in the 2009 edition of the directory.In particular,in the aspect of parenteral and enteral nutrition,the directory provides clearer indications of medication based on "nutritional risk".In this article,based on the research advances in recent years,we briefly analyzed the contents of parenteral and enteral nutrition in the 2017 edition.
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Objective To investigate the nutritional status,body composition,and energy metabolism of hepatocarcinoma patients undergoing surgical treatment and explore the relationships of the nutritional status with body composition and energy metabolism.Methods Totally 112 hospitalized hepatocarcinoma patients undergoing surgical treatment met the inclusion and exclusion criteria were enrolled as the intervention group,and another 100 patients with cholelithiasis during the the same period were enrolled as the control group.Their general clinical data including body mass index(BMI),arm circumference,grip,albumin,prealbumin,energy expenditure,and body composition were collected.The nutritional status was assessed by the scored patient-generated subjective global assessment(PG-SGA).The relationships of the nutritional status with body composition and between energy metabolism were analyzed.All the data were analysed by SPSS 16.0 software package.Results The arm circumference [(23.9±3.6)cm vs.(25.3±4.5)cm,t=2.57,P=0.014],hand grip[(31.7±6.0)kg vs.(39.2±7.6)kg,t=8.19,P<0.001],serum albumin[(32.5±4.7)g/L vs.(36.5±7.2)g/L,t=4.92,P=0.007] and prealbumin[(0.172±0.052)g/L vs.(0.263±0.077)g/L,t=10.3,P=0.004] of the intervention group were significantly lower than the control group.The total malnutrition rate of the intervention group was 37.5％(42 cases at levels B and C),and that of the control group was 14.4％(14 cases at levels B and C)(X2=19.73,P<0.001).The extracellular water significantly increased in the intervention group compared with that of the control group[(15.35±2.21)L vs.(13.51±2.73)L,t=5.54,P<0.001];however,the somatic cell mass [(27.54±4.42)kg vs.(29.03±4.38)kg,t=2.53,P=0.012],fat mass[(13.44±4.23)kg vs.(17.36±5.21)kg,t=6.18,P<0.001],and muscle mass[(43.11±6.27)kg vs.(48.17±7.13)kg,t=5.63,P<0.001] had significantly decreased compared with the control group.The measured value of rest energy expenditure(mREE)[(6 581.62±1 201.70)kJ/d vs.(6 290.73±1 071.68)kJ/d,t=1.98,P=0.042] of the intervention group was significantly higher than the control group(P=0.042),and the respiratory quotient(RQ)was also significantly higher(0.87±0.10 vs.0.85±0.06,t=2.72,P=0.027).The extracellular fluid(PG-SGA A vs.B P=0.035;A vs.C P<0.001;B vs.C P=0.042)were significantly increased,and the number of somatic cells(A vs.B P=0.015;A vs.C P=0.001;B vs.C P=0.022),fat(A vs.B P=0.026;A vs.C P=0.003;B vs.C P=0.022)and muscle mass(A vs.B P=0.029;A vs.C P=0.011;B vs.C P=0.036)were decreased with the deterioration of nutritional status,resting energy expenditure(A vs.B P=0.023;A vs.C P=0.002;B vs.C P=0.032),and RQ(A vs.C P=0.004;B vs.C P=0.012)were also increased with the deterioration of nutritional status,and there was significant difference among three groups.Conclusions The incidence of malnutrition is high in hepatocarcinoma patients undergoing surgical treatment.The patients can have lower lean body mass,more water retention,and higher energy metabolism,which may worsen along with the deterioration of nutritional status.
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Nutritional support therapy includes three main components:nutritional screening,nutritional assessment,and nutritional intervention.It is important to emphasize that nutritional screening and nutritional assessment are two different concepts and definitions,which are often confusing for many physicians,nurses,and dietitians.In this review,we present an overview on the main concepts about nutritional screening and nutritional assessment,highlight their features and complementarity,and discuss the future perspectives in the clinical practice.
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Objective@#To explore the anatomical characteristics of the mesopancreas, to define the range of the total mesopancreas excision and to evaluate the feasibility, safety and effectiveness in the treatment of pancreatic cancer.@*Methods@#A regional anatomical and pathological study was performed on 14 cadavers with large slices and paraffin sections. The clinical and pathological data of 58 consecutive patients underwent total mesopancreas excision for pancreatic head carcinoma from January 2013 to December 2015 were prospectively collected and analysed. The perioperative morbidity, mortality and clinical outcomes of patients underwent total mesopancreas excision were compared with the patients underwent conventional pancreaticoduodenectomy from January 2010 to December 2012.@*Results@#The mesopancreas located in the retropancreatic area, extending from the head, neck, and uncinated process of pancreas to the aorto-caval groove, in which there were loose areolar tissue, adipose tissue, nerve plexus, lymphatic and capillaries. Although no fibrous sheath or fascia like mesocolorectum was found around the structures, a relatively fixed extent could be defined according to its embryologic and anatomic characters. In clinical practice, total mesopancreas excision was classified into two levels according to the extent of resection in this series: level Ⅰ was a"standard total mesopancreas excision" or"total mesopancreas excision in a narrow sense" , which was similar to the extent of standard resection from consensus statement of ISGPS. Level Ⅱ was defined as any procedure extending the range of level Ⅰ, called the"extended total mesopancreas excision" or"total mesopancreas excision in a broad sense". In TMpE group, the intraoperative blood loss( (461.4±184.5)ml vs. (532.2±319.8)ml, P=0.301), operation time( (368.6±92.5)minutes vs. (397.1±112.7)minutes, P=0.559), total complication rate (39.7% vs. 51.2%, P=0.250), fistula mortality (25.9% vs. 30.2%, P=0.628) were all reduced. There were significantly higher R0 rate (91.4% vs.76.7%, P=0.041) and more harvested lymph nodes (16.2 vs. 11.4, P=0.000) and lower total and local recurrence: rate (half-year local recurrence rate: 7.8% vs. 23.7%, P=0.036; one-year local recurrence rate: 18.2% vs. 39.5%, P=0.018) and longer disease-free survival (16.9 months vs. 13.4 months, P=0.044) and overall survival(22.5 months vs. 19.9 months, P>0.05) were also found in the study group.@*Conclusions@#Mesopancreas is different from mesorectum since it has no fascial envelop, which should be regarded as a surgical concept, rather than an anatomical structure. Total mesopancreas excision is safe and feasible for pancreatic head cancer and probably helps to increase the R0 resection rate and improve the clinical outcomes.