Factors associated with anxiety and depression in rheumatoid arthritis patients: a cross-sectional study

Abstract Background: The management of anxiety and depression symptoms in rheumatoid arthritis (RA) patients is vital. Previous study findings on this topic are conflicting, and the topic remains to be thoroughly investigated. This study aimed to clarify the association of RA disease activity with anxiety and depression symptoms after controlling for physical disability, pain, and medication. Methods: We conducted a cross-sectional study of RA patients from the XXX Rheumatoid Arthritis Management Alliance cohort. We assessed patients using the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety and Depression Scale (HADS). Anxiety and depression symptoms were defined by a HADS score ≥ 8. We analyzed the data using multivariable logistic regression analyses. Results: Of 517 participants, 17.6% had anxiety symptoms and 27.7% had depression symptoms. The multivariable logistic regression analysis demonstrated that DAS28 was not independently associated with anxiety symptoms (odds ratio [OR] [95% confidence interval; CI] 0.93 [0.48-1.78]; p = 0.82) and depression symptoms (OR [95% CI] 1.45 [0.81-2.61]; p = 0.22). However, DAS28 patient global assessment (PtGA) severity was associated with anxiety symptoms (OR [95% CI] 1.15 [1.02-1.29]; p = 0.03) and depression symptoms (OR [95% CI] 1.21 [1.09-1.35]; p < 0.01). Additionally, HAQ-DI scores ≤ 0.5 were associated with anxiety symptoms (OR [95% CI] 3.51 [1.85-6.64]; p < 0.01) and depression symptoms (OR [95% CI] 2.65 [1.56-4.50]; p < 0.01). Patients using steroids were more likely to have depression than those not using steroids (OR [95% CI] 1.66 [1.03-2.67]; p = 0.04). Conclusions: No association was found between RA disease activity and anxiety and depression symptoms in the multivariable logistic regression analysis. Patients with high PtGA scores or HAQ-DI scores ≤ 0.5 were more likely to experience anxiety and depression symptoms, irrespective of disease activity remission status. Rather than focusing solely on controlling disease activity, treatment should focus on improving or preserving physical function and the patient's overall sense of well-being.

Índice PROFUND y valoración global subjetiva. Valor pronóstico en pacientes pluripatológicos internados / PROFUND index and global subjective assessment. Prognostic value in hospitalized pluripathological patients

Resumen El índice PROFUND es una de las puntuaciones pronósticas sugeridas en pacientes pluripatológicos (PP). A pesar del valor pronóstico de la desnutrición y su prevalencia en esta población, el mismo no incluye una variable que estime el estado nutricional. La valoración global subjetiva (VGS) es una herramienta ampliamente validada para tal fin. Se evaluó mediante un estudio prospectivo y observacional, la capacidad pronóstica de mortalidad a 12 meses del índice PROFUND y VGS en PP internados en clínica médica. Ingresaron al estudio 111 pacientes. Edad 75.8 (± 9.3) años. Índice PROFUND 7.6 (± 4.7) puntos. El 60.1% presentaba desnutrición moderada-severa por VGS. Fallecieron 66 dentro del año. En el modelo de Cox, la VGS y el índice PROFUND se asocian con mortalidad a los 12 meses (p < 0.0001 y p 0.0026 respectivamente). En los desnutridos severos, el riesgo es aproximadamente 6 veces mayor en comparación a los normonutridos (HR: 6.514, IC95% 2.826-15.016) y para un mismo nivel de VGS, el riesgo es un 10% mayor por cada punto que aumenta el índice PROFUND (HR: 1.106, IC95% 1.036-1.181). El AUC para predecir mortalidad a 12 meses del índice PROFUND y VGS fue: 0.747 (IC95%: 0.656-0.838); 0.733 (IC95%: 0.651-0.816) y al combinar las dos variables: 0.788 (IC95%: 0.703-0.872, p 0.048). Como conclusión el índice PROFUND y la VGS se asocian con mortalidad y tienen un valor pronóstico similar. La combinación de ambas herramientas permitiría establecer mejor el pronóstico y el manejo en esta compleja población

Abstract The PROFUND index is one of the suggested prognostic scores in pluripathological patients (PP). Despite the prognostic value of malnutrition and its prevalence in this population, it does not include a variable that estimates nutritional status. Subjective global assessment (SGA) is a widely validated tool for this purpose. The prognostic capacity of 12-month mortality of PROFUND index and SGA in PP admitted to a medical clinic was evaluated by a prospective and observational study. 111 patients entered the study. Age 75.8 (± 9.3) years. PROFUND index 7.6 (± 4.7) points. 60.1% had moderate-severe malnutrition due to VGS. 66 died within the year. In the Cox model, SGA and PROFUND index are associated with mortality at 12 months (p <0.0001 and p 0.0026 respectively). In severe malnutrition, the risk is approximately 6 times higher compared to normonutrition (HR: 6.514, 95% CI 2.826-15.016) and for the same level of SGA, the risk is 10% higher for each point that the PROFUND index increases (HR: 1.106, 95% CI 1.036-1.181). The AUC for predicting 12-month mortality from PROFUND index and SGA was: 0.747 (95% CI: 0.656-0.838); 0.733 (95% CI: 0.651-0.816) and when combining the two variables: 0.788 (95% CI: 0.703-0.872, p 0.048). In conclusion, PROFUND index and SGA are associated with mortality and have a similar prognostic value. The combination of both tools would allow better prognosis and management in this complex population.

Investigation on nutrition status and clinical outcome of patients with common cancers in Chinese patients: a multicenter prospective study protocol

Background:Malnutrition is common in patients with cancer, whichadversely affectsthesurvival and quality of life ofcancer patients.However, there is no national data on the prevalence of malnutrition inChinese cancer patients. Thisstudy aims to evaluate the prevalenceof malnutrition and quality of life(QOL)ofChinese patients with localregional, recurrentor metastatic cancer,to address the prognostic value of nutritional status and QOLon the survival of cancer patients in China and to validate the patient-generated subjective global assessment (PG-SGA) questionnaire in Chinese cancer patients.Methods:Thisisanobservational,multi-centered,and hospital-based prospective cohort study.We aimed to recruit 50,000 cancer patients (age 18and above)overan 8-year period.Data collection will occur within 48hrafter patientsare admitted to hospital, 30-days after hospital admission, and the follow-up will be conducted1-8years after enrolment. The primary outcomeisoverall survival, and secondaryoutcomes arelength of hospital stay and hospital costs. Factors measured are demographic characteristics, tumor characteristics, anthropometry measurements,hematological measurement, body composition, PG-SGAscores,Karnofsky performance status scores,and QLQ C30 scores. This protocol wasapproved by local ethical committees of all the participant hospitals.Conclusions: This multi-centered, large-scale, long-time follow-up prospective study will help diagnose malnutrition in cancer patients in China, and identify the related risk factors associated with the negative outcomes. The anticipated results will highlight the need for a truly scientific appraisal of nutrition therapy, and help to improve outcomes among cancer patients in China.Trial Registration: The trial has been registered with the Chinese Clinical Trial Registry, ChiCTR1800020329. Registered on 19 December 2018

Comparative study of prognostic nutritional index and patient-generated subjective global assessment in perioperative nutritional prediction in patients with esophageal cancer / 中国胸心血管外科临床杂志

@#Objective    To investigate the prognostic value and consistency of prognostic nutritional index (PNI) and patient-generated subjective global assessment (PG-SGA) in perioperative nutritional status of patients with esophageal cancer. Methods    Clinical data of 224 patients, including 186 males and 38 females with an average age of 63.08±8.42 years, who underwent esophageal cancer surgery in our hospital from November 2017 to August 2018 were retrospectively reviewed. The PNI was calculated according to the results of the first time blood and biochemical tests, and the PG-SGA assessment was also performed. According to the PNI value, the patients were divided into a good nutrition group (PNI≥45, 60 patients) and a malnutrition group (PNI<45, 164 patients). According to the PG-SGA score, the patients were divided into a good nutrition group (PG-SGA<4, 75 patients) and a malnutrition group (PG-SGA≥4, 149 patients). Nutrition-related haematological indexes and body mass index (BMI) were compared between the two groups, and the consistency of PNI and PG-SGA for nutritional assessment was analyzed. Results    The nutrition-related haematological indexes in different PNI groups were statistically different in the perioperative period (P<0.01). The longitudinal changes of prealbumin in patients of different PG-SGA groups were statistically different (P<0.05); the BMI of patients in different PG-SGA groups was statistically different in the perioperative period (P<0.01). The Kappa coefficient of the two indicators was 0.589 (P<0.001). Conclusion    Both PNI and PG-SGA can predict the nutritional risk of patients with esophageal cancer to some extent. PNI is an objective monitoring indicator, and PG-SGA is a subjective evaluation indicator, the combined use of which can more comprehensively reflect and predict the nutritional status of patients, and provide an important reference to the development of individualized nutrition support programs.

Determinación del estado nutricional mediante el ángulo de fase en pacientes en hemodiálisis / Determination of nutritional status by phase angle in hemodialysis patients

Resumen Introducción: La bioimpedancia eléctrica multifrecuencia (BIE) evalúa con precisión la composición corporal. Objetivo: Investigar el estado nutricional y su relación con el índice de masa corporal (IMC) o el ángulo fase obtenido por BIE en pacientes con enfermedad renal terminal (ERT) en hemodiálisis. Método: En 99 pacientes en hemodiálisis (43.6 ± 17.2 años, 58.8 % varones) se evaluó IMC, BIE y puntuación de desnutrición (DMS, Dialysis Malnutrition Score). La independencia de las asociaciones del IMC y el ángulo fase con el DMS se determinó con regresión lineal múltiple. Resultados: El riesgo de desnutrición (DMS > 13) se incrementó gradualmente entre los sujetos con IMC y ángulo fase normales (44.4 %), IMC bajo (45.8 %), ángulo fase bajo (64.0 %) y en aquellos con ambos parámetros anormales (68.0 %). El ángulo fase fue la única variable asociada independientemente con el estado nutricional de los pacientes (coeficiente beta estandarizado −0.372, p < 0.001), lo que explicó 13.8 % de la variación en el DMS. Conclusiones: El ángulo fase se asocia inversa e independientemente con el riesgo de desnutrición en pacientes con ERT, lo que sugiere que la composición corporal evaluada por BIE pudiera ser mejor que el IMC en la valoración clínica de pacientes con esta enfermedad.

Abstract Introduction: Multi-frequency bio-impedance analysis (BIA) accurately evaluates body composition. Objective: To assess nutritional status and its relationship with body mass index (BMI) or with BIA-obtained phase angle in patients with end-stage renal disease (ESRD) on hemodialysis. Method: BMI, BIA and dialysis malnutrition score (DMS) were assessed in 99 patients on hemodialysis (43.6 ± 17.2 years of age, 58.8% males). Multivariate linear regression analysis was used to determine BMI and phase angle independent associations with DMS. Results: Malnutrition risk (DMS > 13) showed a gradual increase among patients with normal BMI and phase angle (44.4%), low BMI (45.8%), low phase angle (64.0%), and in those with both parameters at abnormal ranges (68.0%). The phase angle was the only variable that was independently associated with patient nutritional status (standardized coefficient beta −0.372, p < 0.001), accounting for 13.8% of DMS variation. Conclusion: Phase angle is inversely and independently associated with malnutrition risk in patients with ESRD, which suggests that BIA-assessed body composition might be better than BMI in the clinical assessment of patients with ESRD.

A comparative study of efficacy and safety of topical calcitriol and topical calcipotriol in stable chronic plaque type psoriasis

Background: Topical calcitriol and calcipotriol, the two vitamin D derivatives although considered efficient in treating psoriasis, their comparative studies are relatively scanty. The objective of the present study was to evaluate and compare the efficacy and safety of calcitriol and calcipotriol in stable chronic plaque-type psoriasis.Methods: Total 50 patients of chronic stable plaque-type psoriasis were randomly divided into two groups of 25 each. One group received calcitriol 3礸/g ointment and the other group received calcipotriol 50礸/g ointment twice daily for 12 weeks. Efficacy evaluations comprised global improvement (on a 4-point scale from 0: no change, to 3: clear or almost clear) assessed clinically and by the subject. Efficacy further included the 慸ermatological sum score� (DSS) at each study visit. Safety evaluations (on a 5-point scale from 0: none, to 4: very severe) included clinical assessment of cutaneous safety and assessment of cutaneous discomfort by the subject.Results: Both calcitriol and calcipotriol were significantly effective (p <0.001) in reduction of DSS but the difference between the two groups was not statistically significant. Mean score of global improvement assessed clinically was 2.20 for calcitriol and 2.16 for calcipotriol (p >0.05) and by the subject was 1.92 for calcitriol and 1.84 for calcipotriol (p >0.05). The difference between the two groups was not statistically significant. The mean worst score for cutaneous safety was higher in calcipotriol group compared to calcitriol group (0.28 vs 0.04 and 0.36 vs 0.04 by clinically and by the subject, respectively). Statistically significant better safety profile (p <0.05) was seen for calcitriol, only when assessed by the subject. 24% treatment related adverse events were reported with calcipotriol against only 4% with calcitriol.Conclusions: Topical calcitriol and calcipotriol showed similar efficacy in the treatment of chronic plaque psoriasis while calcitriol showed better safety profile in comparison with calcipotriol, in terms of local tolerance and induced less treatment related adverse events.

A multicenter survey on changes in nutritional risk and malnutrition incidence of elderly patients in Chinese large hospitals during hospitalization / 中华临床营养杂志

Objective To investigate the change of the nutritional status of elderly patients in Chinese major hospitals dynamically with nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA) during hospitalization.Methods A prospective,multi-center survey was conducted on over 65 years old patients who were admitted in departments of gastroenterology,respiratory medicine,general surgery,geriatrics,thoracic surgery,neurology,orthopedics and medical oncology of 9 large hospitals in China for 7-30 days between June 2014 and September 2014.On admission and within 24 hours after discharge,the clinical data were recorded,physical indices were measured,and laboratory examination were conducted.NRS 2002 and SGA were used to make an evaluation.The nutritional supports and clinical outcomes were also recorded and then the correlation between nutritional status and clinical outcomes were analyzed.Results A total of 2558 patients above 65 years old were included into the study.Compared with their status on admission,their grip strength,upper arm circumference and crural circumference were reduced significantly at discharge (P＜0.05).The total protein,albumin and hemoglobin levels were significantly lower than those on admission (P＜0.05).The incidence of nutritional risk (NRS 2002 score ≥ 3) and malnutrition (SGA B + C) on admission were lower than those at discharge (51.1％ vs 53.0％,32.6％ vs 35.6％).The hospitalization time and medical expenses were higher in patients with malnutrition on admission than in those with normal nutrition intakes.The nutritional status at discharge was negatively correlated with hospitalization time and medical expenses.61.3％ patients having nutritional risk did not take nutritional support during the hospital stay,while utilization rate of parenteral nutrition was higher than that of enteral nutrition in patients receiving nutritional support (19.6％ vs 11.9％).Conclusion Elderly patients have higher possibilities of facing nutritional risk or malnutrition on admission,these are associated with poor clinical outcomes and their nutritional status will not improve significantly at discharge.Therefore,the screening and evaluation of nutritional status in elderly patients during hospitalization should be conducted and their nutritional intervention should be standardized so as to improve the clinical outcomes.

Efficacy of Adding Kampo Medicine for Rheumatoid Arthritis / 日本東洋医学雑誌

We added Kampo medicine (Japanese traditional herbal medicine) to disease-­modifying anti-­rheumatic drugs (DMARDs) to treat rheumatoid arthritis (RA) in 41 patients. After 1 year, disease activity assessments showed improvement in the number of tender joints and DAS 28-­CRP, and Boolean remission increased from 3 cases to 6 cases. However, 16 of 41 patients had an insufficient therapeutic effect with Kampo medicine ; therefore, their DMARD treatment was strengthened. Disease activity in the 16 patients with strengthened DMARD therapy (Western group) was compared with that in the 25 patients who did not require strengthened DMARD therapy (Kampo group). The Western group had high disease activity at the beginning of Kampo medicine, and a year later CRP and DAS 28­-CRP improved. In the Kampo group, disease activity was relatively good at the beginning of Kampo medicine, and patient global assessment (PGA) improved. We believe that combination therapy, with DMARDs controlling synovitis and Kampo medicine improving PGA, is an effective way to achieve Boolean remission.

Nutritional status and hospital outcomes of in-patients in a tertiary hospital

Introduction@#Malnutrition is a widespread condition that impacts millions of people across the world annually. The World Health Organization defines malnutrition as the deficiency, excess or imbalance in a person’s intake of energy and/or nutrients. It has been highly prevalent in hospitalized patients and is often overlooked as it continues to be an unrecognized problem. It is also associated with increased risk of complications, higher mortality rate, longer hospital stay, and higher hospitalization costs. The researchers aim to determine in-patients’ nutritional status using the Subjective Global Assessment (SGA) and their outcomes in a tertiary hospital.@*Methods@#A cross-sectional study was conducted in a tertiary hospital in Cebu city for three months. A total of 453 patients were selected through simple random sampling from those assessed to be at risk for malnutrition. The nutritional status was obtained using the SGA tool and correlated with the demographic, nutritional and clinical profiles. @*Results@#In the study, the mean age was 54 years with a female predominance (54.1%). A larger percentage belonged to the obese 1 category (34.9%). Fifty-eight percent had moderate risk for malnutrition and 57.2% had an SGA grade of B which corresponded to moderate malnutrition. The most common reason of admission was due to respiratory causes (25%) and the leading comorbidities were hypertension (48.79%), diabetes mellitus (36.42%) and chronic kidney disease (10.38%). The mean number of hospital stay was 6.8 days (98.9%) were discharged improved with a mortality rate of only one percent. The following factors had a positive relationship with the SGA grade: those in the older age group (p=0.000), those with more comorbidities (p=0.000), patients with diabetes (p=0.027) and chronic kidney diseases (0.001), those with higher nutritional risk on screening (p=0.000), those with pulmonologic (p=0.035) and oncologic cases (p=0.012) upon admission. The study results showed that the higher the SGA grade, the longer hospital stay (p=0.000).@*Conclusion@#In this study, the prevalence of malnutrition was 86% wherein 57.2% of the study population had moderate malnutrition, 28.9% had severe malnutrition and 13.9% had no malnutrition. The degree of malnutrition was associated with longer hospital stay, but not with mortality.

Prevalence of nutritional risk and malnutrition in hospitalized patients with different stages of lung cancer in a tertiary hospital in Chongqing: a cross-sectional survey / 中华临床营养杂志

Objective To investigate the prevalence of nutritional risk and malnutrition in hospitalized lung cancer patients in a tertiary A hospital in Chongqing.Methods From December 2013 to July 2017,2 735 consecutive lung cancer patients were admitted to the Department of Pneumology at Daping Hospital for planned anti-cancer treatment.Patients who did not complete a nutritional status assessment and who had repeated admission wcrc excluded from the study.The demographic and tumor characteristics were investigated in the 548 lung cancer inpatients who completed the study.The nutritional risk screening 2002 (NRS 2002) was used to evaluate the nutritional risk.The individual nutritional status was also evaluated using the patient-generated subjective global assessment (PG-SGA) questionnaire,anthropometry measurements and hematological measurements.The physical status was assessed by the Karnofsky performance status (KPS).Results According to the NRS 2002 score,29.56％ (162/548) of the cancer patients had nutritional risk (score ≥3).The prevalence of nutritional risk was 17.39％,15.00％,22.00％ and 36.86％,respectively,for patients with stage Ⅰ,Ⅱ,Ⅲ and Ⅳ lung cancer.Forty-four patients (9.67％) had a body mass index＜ 18.5 kg/m2 and poor general condition,and the prevalence was 6.52％,5.00％,8.67％ and 11.22％,respectively,for stages I,Ⅱ,Ⅲ and Ⅳ.A total of 107 cases (19.53％) had impaired nutritional status (indicated by a severity score of 3 in the NRS 2002).The prevalence by different stages was 10.87％ (stage Ⅰ),5.00％ (stage Ⅱ),14.67％ (stage Ⅲ) and 25.00％ (stage Ⅳ).One hundred and twenty-five patients (22.81％) had PG-SGA scores ≥ 9,with 2.19％,2.50％,12.67％,and 33.33％ of patients in stages Ⅰ,Ⅱ,Ⅲ and Ⅳ having these high scores.The KPS scores were lower in the patients with nutritional risk and malnutrition than in the patients with a normal nutritional status.Conclusions The prevalence of nutritional risk and malnutrition in patients with lung cancer were mediom.Nutritional risk screening and nutritional status assessment should be considered at the time of admission for lung cancer patients in order to ensure better outcomes of treatment.

Nutritional support for lung transplant over the perioperative period / 中华临床营养杂志

Objective To evaluate the effect of perioperative nutritional support on the prognosis of lung transplant.Methods Retrospective analysis was carried out on nutritional support for 6 lung transplant recipients in the Department of Thoracic Surgery in Henan Provincial People's Hospital between September 2015 and September 2016.The recipients were all males,with ages ranging from 28 to 60 (40± 12.1).The recipients' body mass index (BMI),serum albumin and pulmonary function at the first test after admission (t1),the last test before surgery (t2) and the last test after surgery (t3) were compared.The recipients' nutritional status was assessed with subjective global assessment.Results The 6 patients had successful single-lung transplant,without mortality or severe complications.At t3,all of them had increases in BMI by (2.4±1.4) kg/m2,weight by (3.2±1.2) kg,deltoid skin-fold thickness by (3.0±0.35) mm,prealbumin by (30±10.4) g/L,total protein (15.2±6.4) g/L,albumin by (6.4±4.1) g/L,triglyceride by (0.2± 1.4) mmoL/L,and total cholesterol by (1.4± 0.9) mmol/L (P＜0.01).The patients were followed up for 6 to 12 months.SGA results suggested no abnormality in their nutrition,and the patients were well able to function independently.Conclusion Nutritional support is vital for patients with severe malnutrition during the perioperative period of lung transplant,and can significantly improve the patient's quality of life.

Kaempferia parviflora ethanol extract improves self-assessed sexual health in men: a pilot study / 中西医结合学报

<p><b>BACKGROUND</b>Sexual health positively correlates with overall wellbeing. Existing therapeutics to enhance male sexual health are limited by factors that include responsiveness, adherence and adverse effects. As the population ages, safe and effective interventions that preserve male sexual function are needed. Published research suggests that various preparations of Kaempferia parviflora, a plant in the Zingiberaceae (ginger) family, support cardiovascular health and may ameliorate erectile function.</p><p><b>OBJECTIVE</b>The aim of this study was to examine the effects of KaempMax™, an ethanol extract of the K. parviflora rhizome, on erectile function in healthy middle-aged and older men.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>We conducted an open-label, one-arm study on 14 generally healthy males aged 50-68 years with self-reported mild erectile dysfunction, who were not using prescription treatments. Participants took 100 mg KaempMax™ daily for 30 days.</p><p><b>MAIN OUTCOME MEASURES</b>Evaluations were conducted at baseline and on the final study assessment. Primary efficacy analyses included the International Index of Erectile Function (IIEF); secondary efficacy analyses included the Global Assessment Question about erectile function.</p><p><b>RESULTS</b>Thirteen participants completed the 30-day study. Supplementation with KaempMax™ resulted in statistically significant improvements in erectile function, intercourse satisfaction and total scores on the IIEF questionnaire. KaempMax™ was well tolerated and exhibited an excellent safety profile.</p><p><b>CONCLUSION</b>Our results suggest that KaempMax™ may improve erectile function in healthy middle-aged and older men. While the effects were not as pronounced as what might be seen with prescription medication, most participants found them satisfactory. Additional, longer and placebo-controlled clinical trials will be needed.</p><p><b>TRIAL REGISTRATION</b>Clinicaltrials.gov identifier NCT03389867.</p>

Investigation on Nutritional Status and Nutritional Intervention of Inpatients with Malignant Tumor in Our Hospital / 中国药房

OBJECTIVE:To provide reference for strengthening the rational nutritional intervention of patients with malignant tumor. METHODS:From Sept. 2016 to Oct. 2017,191 inpatients diagnosed as malignant tumor in our hospital were targeted. Nutritional support pharmacist used Nutritional Risk Screening 2002 (NRS 2002) and Patient-generated Subjective Global Assessment(PG-SGA)to conduct nutritional status assessment within 48 h of admission;at the same time,nutritional intervention for patients during hospitalization was investigated. RESULTS:Among 191 patients,NRS 2002 score ≥3 (with nutritional risk) was classified in 123 cases,and total incidence of nutritional risk was 64.40％. Totally 129 cases were classified into grade B and C(malnutrition)by PG-SGA,and total incidence of malnutrition was 67.54％. There was statistical significance in the incidence of malnutrition among patients aged below 60 years old and patients aged more than 60 years old(P<0.05). NRS 2002 and PG-SGA showed a consistency of Kappa=0.557 (P<0.001), with moderate consistency degree. Of 191 patients, only 46 received nutritional intervention(only 2 cases received total enteral nutrition),and the overall intervention rate was 24.08％. Among them, the intervention rate of patients with nutritional risk was only 34.15％(42/123), and the intervention rate of patients with malnutrition was 31.78％(41/129). CONCLUSIONS:The incidence of nutritional risk and malnutrition among patients with malignant tumors is high, especially in elderly patients. But clinical nutrition interventions are obviously inadequate and the application rate of enteral nutrition support is low. Therefore,nutritional support pharmacists are required to assist and cooperate with physicians,combined two tools as NRS 2002 and PG-SGA that can promptly and effectively screen patients who already have nutritional risk or malnutrition on admission and comprehensively evaluate their nutritional status, so as to give appropriate nutritional intervention.

Prevalence of Malnutrition in Hospitalized Patients: a Multicenter Cross-sectional Study

BACKGROUND: Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition. METHODS: A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated. RESULTS: The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001). CONCLUSION: Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.

Comparación de la valoración global subjetiva y valoración global subjetiva modificada con marcadores antropométricos y de laboratorio para la detección de riesgo de malnutrición en pacientes críticamente enfermos / Comparation between subjective global assessment and modified subjective global assessment with anthropometric and laboratory markers for detecting risk of malnutrition in critically ill patients / Comparação da avaliação subjetiva global e avaliação global subjetiva modificada com marcadores antropométricos e de laboratório para detecção do risco de desnutrição em pacientes em estado crítico

Resumen: La malnutrición es un problema importante en pacientes ambulatorios y hospitalizados, especialmente en el área de cuidados intensivos. Hay varias escalas para diagnosticar la malnutrición que generalmente requieren medidas complicadas y/o la toma de biomarcadores. La valoración global subjetiva es una escala que ayuda al clínico a valorar la malnutrición de manera sencilla y al pie de la cama y que ofrece buena correlación con los estudios mencionados. Han sido necesarios ajustes en la valoración para adaptarla a ciertos grupos de pacientes. La valoración nutricional subjetiva modificada en nuestra unidad puede ser de utilidad para el diagnóstico correcto y para guiar la conducta terapéutica. Para su obtención se comparó con los dos parámetros más sensibles para el diagnóstico de malnutrición y su escala original.

Abstract: Malnutrition is an importantproblem among ambulatory and hospitalized patients, specially en the setting of Intensive Care Units. There are several scales for diagnosing malnutrition, that require complicated measures and/or the use of biomarkers. The Subjective Global Assessment es a tool that help the clinician to assess malnutrition in a very simple way at the bedside, and offers a good correlation with the aforementioned trials. Adjustments in the Subjective Global Assessment have been made in order to make it fit to certain group of patients. The Modified Subjective Gobal Assessment in our facilities may be useful for correct diagnosis and therapeutic guidance. To assess this new scale it was compared with the two most sensible parameters for the malnutrition diangosis and its original scale.

Resumo: A desnutrição é um problema importante entre os pacientes ambulatoriais e hospitalizados, especialmente na unidade de terapia intensiva. Existem várias escalas para o diagnóstico de desnutrição que exigem medidas complicadas e/ou o uso de biomarcadores. A avaliação subjetiva global é uma ferramenta que ajuda o clínico a avaliar a desnutrição de uma maneira muito simples e à beira do leito, que oferece uma boa correlação com os estudos acima mencionados. Ajustes na avaliação subjetiva global foram feitos a fim de ajustá-lo a determinado grupo de pacientes. A avaliação nutricional subjetiva em nossas instalações pode ser útil para o diagnóstico correto e orientação terapêutica. Para avaliar esta nova escala comparamos com os dois parâmetros mais sensíveis para o diagnóstico de desnutrição e sua escala original.

Changes in nutritional status of patients with different diseases during hospitalization / 中华外科杂志

Objective@#To evaluate changes in nutritional status of hospitalized patients with different diseases by subjective global assessment (SGA) and nutritional risk screening (NRS-2002).@*Methods@#A prospective and parallel research done by multi-center collaboration from 34 hospitals in China from June to September 2014. Hospitalized patients with the following diseases were investigated: malignant tumor (2 487 cases), benign disease of the digestive system (1 358 cases), benign disease of the nervous system (1 043 cases), benign bone disease (451 cases), benign disease of the respiratory system(395 cases), cardiovascular disease (227 cases), benign thyroid and breast disease (179 cases), and endocrine disease (149 cases). Patients above the age of 18 and hospitalization time between 7-30 days were included. Physical indexes were measured, the NRS-2002 and SGA scores were recorded, the nutritional support were recorded during hospitalization and 24 hours after discharge from hospital. Measurement data between groups were analyzed using t test or Wilcoxon rank sum test, enumeration data and ranked data between groups were analyzed using chi-square test or Fisher exact test.@*Results@#There were 6 638 cases of hospitalized patients, 3 861 cases were males and 2 777 were females, the male/female ratio was 1.4∶1.0; the median age was 60 years; the median height was 1.66 m; the median weight was 62 kg; the median body mass index (BMI)was 22.89 kg/m2. At discharge, compared with that of admission, the body weight, BMI, grip strength, upper arm and calf circumferences of patients with malignant tumor were significantly decreased (t=20.15-259.67, all P<0.01); the body weight and calf circumference were significantly decreased (t=35.27, 60.40, P<0.01)of patients with digestive benign disease; the body weight of patients with benign bone diseases was decreased (t=2.12, P=0.033); the body weight, grip strength and upper arm circumference were decreased in patients with benign thyroid and breast disease (t=2.79-10.18, all P<0.01); nutritional risk incidence rate (from NRS-2002) of patients with malignant tumor was significantly higher(χ2=21.275, P=0.000); moderate malnutrition (from SGA) incidence rate was significantly higher(χ2=62.318, P=0.000; χ2=11.312, P<0.01) in patients with malignant tumor and with orthopedics diseases. Compared with that of admission, records of the patients with other diseases had no statistically difference at discharge, no more than 50% of the patients under risk of nutritional deficiency(except those with digestive benign diseases )received nutritional support, while the proportion of non-parenteral nutrition application was higher.@*Conclusion@#The patients with malignant tumor have higher incidence rate of malnutrition on admission and at discharge. Doctors should pay more attention to the nutritional status(screening and evaluation) of patients before discharge and use appropriate and adequate nutrition support in order to prevent the weight loss and improve the life quality of patients.

Comparison of three nutritional screening tools for assessment of dialysis-related protein-energy wasting in maintenance hemodialysis patients / 肠外与肠内营养

Objective:To compare three nutritional screening tools in predicting dialysis-related pro tein-energy wasting(PEW) among maintenance hemodialysis(MHD) patients and to find a more rapid,accurate,and feasible screening tool.Methods:The nutrtional risk screening 62002 (NRS 2002),7-point subjective global assessment(SGA) and malnutrition inflammation scores (MIS) were compared among 205 MHD patients.Correlations between the serum biochemistry,anthropometry and different screening tools were analyzed,and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW.Results:A total of 31.2％ of HD patients had PEW by ISRNM criteria,whilst using NRS 2002,7-point SGA and MIS,58％,40.8％ and 46.8％ of MHD patients exhibited PEW respectively.The results of three screening tools were closely related to those by serum biochemistry and anthropometry (P ＜ 0.05),but the composite correlation coefficient between the screening tools for PEW and the objective nutritional index commonly used was higher in NRS 2002(r =0.787,P ＜ 0.001) than in 7-Point SGA or MIS.NRS 2002 had higher sensitivity and accuracy values (87.5％ and 59.1％,respectively) in MHD Patients.Conclusion:MIS,7-PointSGA and NRS 2002 are valid tools for nutrition screening of dialysis patients,and NRS 2002 may be the best one.

The incidence and risk factors associated with sarcopenia in maintenance hemodialysis patients / 肠外与肠内营养

Objective:To investigate the incidence and related factors with sarcopenia in maintenance hemodialysis patients.Methods:A total of 131 patients with non-hospitalized maintenance hemodialysis who had been maintained for at least 3 months and in a stable condition were enrolled in a cross-sectional study.Bioelectric impedance analysis (BIA) method was employed to examine the muscle mass.MQSGA questionnaire was used to evaluate patients'nutrition status as well as related laboratory indicators.Logistic regression was used to analyze the risk factors of sarcopenia in MHD patients.Results:The incidence of sarcopenia in 131 MHD patients was 41.22％ (54/131).Significant differences were observed in gender,duration of hemodialysis,hs-CRP and the score of M(Q)SGA between the two groups.The incidence of sarcopenia in male was 43.67 times compared with female.And with the increase of hs-CRP levels and MQSGA score,the incidence of sarcopenia was increased as well (P ＜0.05).Conclusion:Sarcopenia has a high incidence in MHD patients,and male,micro-inflammatory state and malnutrition were the risk factors.

Value of patient global assessment on evaluating disease activity in patients with axial spondyloarthritis / 中华风湿病学杂志

Objective To explore the value of patient global assessment (PGA) on evaluating disease activity in patients with axial spondyloarthritis (SpA),Methods A total of 222 patients with axial SpA were recruited.Scores of PGA,disease activity index [Bath ankylosing spondylitis disease activity index (BASDAI),ankylosing spondylitis disease activity score (ASDAS)crp] and spondyloarthritis research consortium of Canada (SPARCC) were calculated.Differences of PGA scores between different disease activity groups in axial SpA were compared and correlations between different disease activity index with PGA scores were analyzed.Statistical analyses were performed using Statistical Product and Service Solutions (SPSS) software (version 17.0).Comparison of frequency among different groups was performed by x2 test.Rank-sum test was used to compare the median of measurement data in different groups when the data were skewed in distribution.Cut-off value of PGA for assessing disease activity in axial SpA was calculated by ROC curve.Results Medians of PGA score in groups with BASDAI remission[3(1,4) vs 5(4,7)] and ASDAScrp remission [1(1,2) vs 4(2,5)] were lower than that in disease activity group (P＜0.01).BASDAI scores [1.80(1.20,2.90) vs 3.40(2.28,4.63) vs 5.15 (4.08,5.88)] and ASDAScrp scores [2.19(1.34,2.76) vs 2.86(2.08,3.54) vs 4.08(2.96,4.41)] were significant different among PGA groups (≤3,4-6 and ≥7) (P＜0.01).Differences of SPARCC scores [6.00(0,18.00) vs 7.50(3.75,18.00) vs 18.50(6.75,24.50)] were statistically significant among PGA groups (Z=7.427,P=0.037).Erythrocyte sedimentation rate (ESR) [12.00(5.00,23.00) mm/1 h vs 19.50(7.00,44.50) mm/1 h vs 18.00(7.75,54.75) mm/1 h],C-reactive protein (CRP) [7.85(2.37,22.49) mg/L vs 10.07(3.02,28.51) mg/L vs 21.28(7.14,37.74) mg/L] and Bath ankylosing spondylitis functional index (BASFI) [0.70(0.10,1.30) vs 2.25(0.60,3.30) vs 2.85(0.83,6.53)] were also different among PGA groups (P＜0.01,separately).Proportion of axial SpA patients in BASDAI disease activity group or ASDAScrp higher disease activity group were different among PGA groups (P＜0.01,separately),while represented as positive correlations (P＜0.01,separately).Correlation analyses revealed that PGA was positively correlated with ASDAScrp (r=0.694),BASDAI(r=0.616),SPARCC (r=0.271),ESR (r=0.288),CRP(r=0.215),occipital wall distance (r=0.196),finger-floor distance (r=0.385) and negatively correlated with Sschober's test (r=-0.195) (P＜0.05).Receiver operator characteristic (ROC) curve analysis found that PGA-BASDAI AUC was 0.813,the cut off value of PGA was 3.5 and PGA-ASDAScrp AUC was 0.860,the cut off value of PGA was 2.5.Conclusion PGA has good correlations with the disease activity indexes in axial SpA patients.It can also reflect the degree of inflammation in iconography.PGA may reflect disease activity especially when the value of PGA is around 3.

Human body composition and energy metabolism and their correlations with nutritional status in hepatocarcinoma patients undergoing surgical treatment / 中华临床营养杂志

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.