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Nutritional Assessment (nutritional + assessment)
Kinds of Nutritional Assessment Selected AbstractsINTEGRATION OF PROSPECTIVE QUALITY OF LIFE AND NUTRITIONAL ASSESSMENT AS ROUTINE COMPONENTS OF MULTIDISCIPLINARY CARE OF PATIENTS WITH HEAD AND NECK CANCERANZ JOURNAL OF SURGERY, Issue 1-2 2008Justine Oates Background: Quality of life (QOL) and nutritional assessment of patients with head and neck cancer can provide additional information about the effects of treatment beyond the standard measures of disease control and survival. Integrating a prospective evaluation program into a multidisciplinary service may ensure that a more holistic model of care is developed. Methods: Prospective evaluation of QOL and nutrition before and after treatment for head and neck cancer was implemented in 2001. All patients enrolled in the program were treated with curative intent. Patients completed the European Organisation for Research and Treatment of Cancer Core QOL Questionnaire and Head and Neck Specific Module before treatment and at 3, 6 and 12 months after completion of therapy. In conjunction, patients underwent nutritional assessment by body mass index, biochemical parameters and the patient-generated subjective global assessment tool. Results: Among 288 patients who consented to participate in this study, 134 patients completed the QOL assessment criteria and were eligible for evaluation. Examples of QOL and nutritional data for patients with cancers of the oral cavity, oropharynx, nasopharynx, larynx, hypopharynx, parotid gland and paranasal sinus, and also unknown primary cancers are given. Implementation of this prospective assessment program required appropriate resources and was hampered by time constraints, logistics with blood tests and patient compliance. Conclusions: Despite difficulties with implementation, the information concerning QOL and nutritional status obtained in this study provided an appreciation of the long-term functional effects of treatment for head and neck cancer. Prospective QOL assessment and nutritional evaluation should become integral components of the care of patients with cancers of the head and neck. [source] Nutritional Assessment of Athletes by J. A. Driskell and I. WolinskyEUROPEAN JOURNAL OF LIPID SCIENCE AND TECHNOLOGY, Issue 7 2003Arthur D. Stewart No abstract is available for this article. [source] Lower Systolic Blood Pressure Is Associated with Greater Mortality in People Aged 85 and OlderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2008Lena Molander Bsc OBJECTIVES: To investigate the association between blood pressure and mortality in very old people. DESIGN: Population-based cohort study. SETTING: County of Västerbotten, Sweden. PARTICIPANTS: Half of all subjects aged 85 and all of those aged 90 and 95 and older (N=348) in one urban and five rural municipalities in the north of Sweden. MEASUREMENTS: Among others, supine blood pressure, Mini-Mental State Examination, Barthel Index of activities of daily living, Mini Nutritional Assessment, and body mass index. Information on diagnoses, medications, and 4-year mortality was collected. Associations between blood pressure and mortality were investigated using Cox regression analyses, controlling for a number of diagnoses and health factors. RESULTS: Baseline systolic blood pressure (SBP), diastolic blood pressure, and pulse pressure were all inversely associated with mortality within 4 years according to univariate analysis. SBP was the strongest predictor. In Cox regression analyses, low SBP (,120 mmHg) correlated with greater 4-year all-cause mortality alone and when controlling for health status. This connection persisted after exclusion of deaths within the first year. There was a tendency toward a U-shaped mortality curve for the adjusted model, with SBP of 164.2 mmHg (95% confidence interval=154.1,183.8 mmHg) being associated with the lowest mortality. CONCLUSION: Lower SBP seems to be associated with greater mortality in people aged 85 and older, irrespective of health status. There are indications of a U-shaped correlation between SBP and mortality, and the optimal SBP for this age group could be above 140 mmHg. [source] A modified Mini Nutritional Assessment without BMI can effectively assess the nutritional status of neuropsychiatric patientsJOURNAL OF CLINICAL NURSING, Issue 13 2009Alan C Tsai Aim and objectives., To determine whether a modified version of the Mini Nutritional Assessment (MNA) without body mass index (BMI) can effectively identify individuals at risk of malnutrition among patients with neuropsychiatric disorders. Background., Neuropsychiatric patients have an additional risk of nutritional disorder due to functional impairments and drug effects. However, their nutritional status is generally neglected. It is important to find a tool that is simple, easy to use and non-invasive. Design., The study involved 105 patients in the acute phase of confirmed neuropsychiatric disorders in an area hospital. All subjects were cognitively able to have effective verbal communication. Method., The study included serum biochemical and anthropometric measurements and an on-site, in-person interview using a structured questionnaire to elicit personal data, health condition and answers to questions in the MNA. Subjects' nutritional statuses were graded with a MNA that adopted population-specific anthropometric cut-off points or one further with the BMI question removed and its assigned score redistributed to other anthropometric questions. Results., Both versions of the modified MNA effectively graded the nutritional status of neuropsychiatric patients and showed good correlations with the major nutritional indicators such as BMI, calf circumference and the length of hospital stay. Conclusions., The MNA can effectively assess the nutritional status of neuropsychiatric patients and enhance timely detection and intervention of their nutritional disorders. A modified MNA without the BMI question can maintain the full functionality of the tool. The version does not require weight and height measurements and thus will enhance the usefulness of the instrument. Relevance to clinical practice., Neuropsychiatric patients are a high-risk group of nutritional disorders. The MNA, especially the one without BMI, has the potential to improve professional efficiency of the primary care workers. [source] Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary diseaseJOURNAL OF CLINICAL NURSING, Issue 13 2008Sigrid Odencrants MSc Aim. The aim of the study was to describe and compare nutritional status and social and medical characteristics among older patients with chronic obstructive pulmonary disease admitted to an acute care hospital ward for respiratory medicine. Background. Chronic obstructive pulmonary disease is a condition associated with risk of developing malnutrition. A body mass index <20 is predictive of hospitalisation for acute exacerbations of chronic obstructive pulmonary disease. Knowledge about patient characteristics is crucial for the identification of malnourished patients and the development of nursing care for these patients. Design. Quantitative descriptive study. Methods. Thirty-three hospitalised women and 17 men with a mean age of 75·7 years (SD 6·9) were consecutively included. A very severe case of chronic obstructive pulmonary disease was indicated in 28 out of 39 patients who underwent a lung function test. Data were collected with measurement of nutritional status using Mini Nutritional Assessment, anthropometry and lung function. Results. Nearly half of the patients (48%) were identified as malnourished, an equal part as at risk for malnutrition and two patients as well nourished. The mean Mini Nutritional Assessment score of 17·2 (SD 3·99) for all patients was near the Mini Nutritional Assessment cut-off score (i.e. 17) for malnutrition. Patients identified as malnourished had a mean body mass index of 18·9 and those at risk for malnutrition had a mean of 23·4. It was more common for those identified as malnourished to live singly, to not live in own property and to be dependent on daily community service. Seven patients identified as malnourished died during the data collection period. Conclusions. This study provides important knowledge about further risks of impaired nutritional status among older patients with chronic obstructive pulmonary disease. Relevance to clinical practice. This knowledge can provide registered nurses with the necessary knowledge to make them aware of certain patients needing particular kinds of attention. [source] An observational study of screening for malnutrition in elderly people living in sheltered accommodationJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2008D. G. Harris Abstract Background, Elderly people are particularly at risk of malnutrition. There is no consensus regarding the optimal malnutrition screening test for elderly people and little is known about the prevalence of malnutrition in elderly people living in sheltered housing. Method, An observational study comparing sensitivity, specificity and positive and negative predictive values of the following screening measures in elderly people living in sheltered accommodation: body mass index, mid-arm circumference, albumin, haemoglobin, lymphocyte count, cholesterol and the Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment (MNA). A dietitian assessment was used as the gold standard to establish whether there was a risk of malnutrition. Results, Of 100 people recruited (31 male and 69 female with average age 79.3 years) ten were categorized at risk by the dietitian assessment. The MUST score was the most sensitive and specific screening measure (100% and 98% respectively) with a negative predictive value of 1. The sensitivity and specificity of the other measures were: MNA 80% and 90%, mid-arm circumference 70% and 99%, BMI 60% and 90%, albumin 30% and 77%, haemoglobin 50% and 61%, lymphocyte count 20% and 86%, low cholesterol 30% and 90%. Conclusions, Ten per cent of elderly people in sheltered housing are at risk of malnutrition. The MUST screening tool is a sensitive and specific method of identifying those requiring further nutritional assessment. [source] Meal patterns and meal quality in patients with leg ulcersJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2000U. Wissing Background Wound healing is a complex process, which requires adequate energy sources, proteins, and specific minerals and vitamins. If an individual is unable to get or to eat the nutrients required, the wound healing process might be disrupted. The aim of this study was to investigate food-related factors, meal patterns and meal quality in relation to nutritional status in elderly out-patients with leg ulcers. Methods Nutritional status was assessed by use of the Mini Nutritional Assessment in 70 patients living in their own homes. Fifty-six of the patients recorded actual meals and snacks over four consecutive days. Meal patterns and meal quality were evaluated with the help of a qualitative classification system, the Food Based Concept for Classification of Eating Episodes. Results Thirty-six patients were classified as well-nourished, 32 were at risk of malnutrition and two were malnourished. More patients in the risk group for malnutrition did not buy their own food, and usually ate alone. Incomplete Meals and Low Quality Snacks were the most common eating types. The patients at risk of malnutrition had significantly fewer prepared Complete Meals than the well-nourished patients. Conclusion The results show a diet and meal quality which hardly meets the requirements for nutrients that are important in wound healing, especially for those patients assessed at risk of malnutrition. [source] Mini Nutritional Assessment in geriatric rehabilitation: Inter-rater reliability and relationship to body composition and nutritional biochemistryNUTRITION & DIETETICS, Issue 3 2007Sonja A. NEUMANN Abstract Aim:, To determine the inter-rater reliability of the Mini Nutritional Assessment (MNA) and relationship with body composition and nutritional biochemistry among older Australians undergoing rehabilitation. Methods:, Thirty-eight adults aged ,65 years were prospectively and consecutively recruited from an Australian rehabilitation ward. Two dietitians independently administered the 18-item MNA to determine inter-rater reliability. MNA classifications (well nourished, at risk of malnutrition, malnourished) were compared with body composition (using dual-energy X-ray absorptiometry) and serum albumin. These analyses were also performed for the short-form version of the MNA (six items). Results:, In this cross-sectional study, inter-rater reliability of the 18-item MNA score, estimated by the intraclass correlation coefficient, was 0.833, while inter-rater reliability estimated by the weighted kappa index was 0.53. The two raters reached agreement on MNA classification for 26 of 38 cases (68%). Women classified as malnourished/at risk of malnutrition using the 18-item MNA had lower total body fat (11 kg vs 29 kg, P < 0.01) and per cent body fat (25% vs 40%, P < 0.01), compared with women classified as well nourished. Similar findings were not apparent for men, although men classified as malnourished/at risk of malnutrition had lower serum albumin (32 g/L vs 36 g/L, P = 0.04) compared with men classified as well nourished. Similar findings were evident for the short-form version of the MNA. Conclusion:, The MNA was found to be useful for identifying older women with lower body fat in the Australian rehabilitation setting. The 18-item MNA score has substantial inter-rater reliability, and fair inter-rater reliability when used according to the classifications. Inclusion of subjective and self-reported items in surveys can be problematic for optimal reliability as can the use of such items in a subject population that is experiencing rapid progress in recovery. [source] Osteoporosis in adults with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2009KEVIN J SHERIDAN MD Life expectancy for the 400 000 adults with cerebral palsy (CP) in the USA is increasing. Although there is a perception of increased fractured rate in the adult with CP, it has not been well studied. Low bone mineral density is found in more than 50% of adults with a variety of disabilities, including CP. Dual-energy X-ray absorptiometry scanning is commonly used to assess bone mineral density, but is limited by positioning and other artifacts in adults with CP. Novel scanning regions of interest, such as the distal femur, are not yet standardized in adults. Nutritional assessment and physical activity, the basis of most fracture prevention programs, are difficult to do in the adult with CP. A better understanding of the ,muscle-bone unit' physiology and its exploitation may lead to better treatment modifications. Clinical research trials with bisphosphonates (e.g. pamidronate), estrogen, selective estrogen receptor modulators, parathyroid hormone analogs, and growth hormone need to be targeted to the adult with CP. Longitudinal studies of fracture risk factors, genetic research in bone and neuromuscular biology, and the development of treatment surrogates for physical activity are additional areas of needed expertise. This could be facilitated by an adult CP registry and the centralization of clinical research efforts. [source] Nutritional status of children with coeliac diseaseACTA PAEDIATRICA, Issue 7 2010B Aurangzeb Abstract Aims:, The main aim of this study was to assess the nutritional status of children with newly diagnosed Coeliac disease (CD)with comparison to matched controls. A further aim was to assess relationships between presentation patterns and nutrition in childhood CD. Methods:, The nutritional status of newly diagnosed CD was assessed by anthropometry, Bioelectrical Impedance and serum leptin levels, and contrasted to age and gender matched controls. Results:, Twenty-five children with CD (mean age of 8.2 ± 4.5 years) and 25 control children (mean age 8.1 ± 4.4.) were enrolled. Thirteen (52%) children with CD had gastrointestinal symptoms with 14 having a family history of CD. At presentation 8.7% were wasted, 4.2% were stunted and 20.8% overweight, although none were obese. Mean height and weight for age, other nutritional parameters and serum leptin did not differ between the groups. Serum leptin correlated with BMI in both groups. Conclusions:, Children with CD more commonly present with atypical symptoms than with classical features. Variations in nutrition (under to overnutrition) may be seen at diagnosis, without relationship to the presence of symptoms. Leptin levels were not altered specifically in the setting of CD. Nutritional assessment remains important in the assessment and management of CD in children. [source] Major nutritional issues in the management of Parkinson's disease,MOVEMENT DISORDERS, Issue 13 2009Michela Barichella MD Abstract As with other neurodegenerative diseases, neurologic and nutritional elements may interact affecting each other in Parkinson's disease (PD). However, the long-term effects of such interactions on prognosis and outcome have not been given much attention and are poorly addressed by current research. Factors contributing to the clinical conditions of patients with PD are not only the basic features of PD, progression of disease, and the therapeutic approach but also fiber and nutrient intakes (in terms of both energy and protein content), fluid and micronutrient balance, and pharmaconutrient interactions (protein and levodopa). During the course of PD nutritional requirements frequently change. Accordingly, both body weight gain and loss may occur and, despite controversy, it seems that both changes in energy expenditure and food intake contribute. Nonmotor symptoms play a significant role and dysphagia may be responsible for the impairment of nutritional status and fluid balance. Constipation, gastroparesis, and gastro-oesophageal reflux significantly affect quality of life. Finally, any micronutrient deficiencies should be taken into account. Nutritional assessments should be performed routinely. Optimization of pharmacologic treatment for both motor and nonmotor symptoms is essential, but nutritional interventions and counseling could and should also be planned with regard to nutritional balance designed to prevent weight loss or gain; optimization of levodopa pharmacokinetics and avoidance of interaction with proteins; improvement in gastrointestinal dysfunction (e.g., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micronutrients or vitamins). A balanced Mediterranean-like dietary regimen should be recommended before the introduction of levodopa; afterward, patients with advanced disease may benefit considerably from protein redistribution and low-protein regimens. © 2009 Movement Disorder Society [source] An observational study of screening for malnutrition in elderly people living in sheltered accommodationJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2008D. G. Harris Abstract Background, Elderly people are particularly at risk of malnutrition. There is no consensus regarding the optimal malnutrition screening test for elderly people and little is known about the prevalence of malnutrition in elderly people living in sheltered housing. Method, An observational study comparing sensitivity, specificity and positive and negative predictive values of the following screening measures in elderly people living in sheltered accommodation: body mass index, mid-arm circumference, albumin, haemoglobin, lymphocyte count, cholesterol and the Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment (MNA). A dietitian assessment was used as the gold standard to establish whether there was a risk of malnutrition. Results, Of 100 people recruited (31 male and 69 female with average age 79.3 years) ten were categorized at risk by the dietitian assessment. The MUST score was the most sensitive and specific screening measure (100% and 98% respectively) with a negative predictive value of 1. The sensitivity and specificity of the other measures were: MNA 80% and 90%, mid-arm circumference 70% and 99%, BMI 60% and 90%, albumin 30% and 77%, haemoglobin 50% and 61%, lymphocyte count 20% and 86%, low cholesterol 30% and 90%. Conclusions, Ten per cent of elderly people in sheltered housing are at risk of malnutrition. The MUST screening tool is a sensitive and specific method of identifying those requiring further nutritional assessment. [source] Principles of nutritional assessmentJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2006Ailsa M. Brotherton PhD RD [source] Validation of a nutrition screening tool: testing the reliability and validityJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2001S. T. Burden Background The aim of this study was to validate a nutrition screening tool for use in South Manchester University Hospitals Trust. Method A sample of 100 patients was selected from medical, surgical and elderly care wards. To test the reliability of the screening tool, nurses and dietitians completed the screening tool on the same patient. These results were compared for interobserver error to determine whether the screening tool was reproducible with different observers. To ascertain if the screening tool identified malnutrition at ward level, four markers commonly used to assess nutritional status were collected. These included body mass index (BMI), mid upper arm circumference MUAC, percentage weight loss, and energy intake calculated from the patient's first full day in hospital and expressed as a percentage of their estimated average requirements (EAR). Results There was a 95% level of agreement between nurses and dietitians within ±3. The screening tool had a sensitivity level of 78% and a specificity of 52% when compared to all patients who had one or more markers indicating malnutrition. This association was found to be statistically significant (P < 0.005). Conclusion The screening tool is reliable when completed by different observers and is valid for wide scale nutritional assessment. The screening tool identifies an acceptable number of patients who are malnourished but overestimates patients at moderate risk. [source] Monitoring nutritional status accurately and reliably in adolescents with anorexia nervosaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2009Andrew C Martin Aim: Accurate assessment of nutritional status is a vital aspect of caring for individuals with anorexia nervosa (AN) and body mass index (BMI) is considered an appropriate and easy to use tool. Because of the intense fear of weight gain, some individuals may attempt to mislead the physician. Mid-upper arm circumference (MUAC) is a simple, objective method of assessing nutritional status. The setting is an eating disorders clinic in a tertiary paediatric hospital in Western Australia. The aim of this study is to evaluate how well MUAC correlates with BMI in adolescents with AN. Methods: Prospective observational study to evaluate nutritional status in adolescents with AN. Results: Fifty-five adolescents aged 12,17 years with AN were assessed between January 1, 2004 and January 1, 2006. MUAC was highly correlated with BMI (r = 0.79, P < 0.001) and individuals with MUAC ,20 cm rarely required hospitalisation (negative predictive value 93%). Conclusions: MUAC reflects nutritional status as defined by BMI in adolescents with AN. Lack of consistency between longitudinal measurements of BMI and MUAC should be viewed suspiciously and prompt a more detailed nutritional assessment. [source] Nutritional status and prognosis in cirrhotic patientsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2006F. GUNSAR SUMMARY Background and Aim, The potential prognostic value for survival of nutritional status in cirrhotics after adjusting Child,Pugh classification and Model for End-Stage Liver Disease has not been evaluated. Methods, We used Kaplan,Meier and Cox proportional hazards regression models to identify factors associated with mortality in a cohort of 222 cirrhotics [M/F:145/77 median age 52 (18,68) years] with prospectively collected nutritional parameters as well as modified subjective global nutritional assessment, Royal Free Hospital-Subjective Global Assessment index. Follow-up was censored at the time of transplantation. Other variables were ones in Child,Pugh and Model for End-Stage Liver Disease scores, age, aetiology of cirrhosis and renal function, Results, Pretransplant mortality (Kaplan,Meier) was 21% by 2 years (135 patients were transplanted). Among the nutritional parameters, only Royal Free Hospital-Subjective Global Assessment remained significantly associated with mortality in multivariable models (P = 0.0006). The final model included the following variables: urea (P = 0.0001), Royal Free Hospital-Subjective Global Assessment (P = 0.003), age (P = 0.0001), Child,Pugh grade (P = 0.009) and prothrombin time (P = 0.003). The results were similar when the Child,Pugh grade was replaced by the Model for End-Stage Liver Disease score in the model, and whether a competing risks model was used. Conclusions, Nutritional indices add significantly to both Child,Pugh grade and Model for End-Stage Liver Disease scores when assessing the patient prognosis. [source] Deficiencies in nutritional intake in patients admitted with diabetes-related foot complicationsNUTRITION & DIETETICS, Issue 3 2007Sarah PITT Abstract Aim:, Adequate nutritional intake is an essential component for timely wound healing. The present research aimed to identify the frequency of inadequate dietary intake, including the specific nutritional elements most frequently lacking, in a group of patients admitted with diabetes-related foot complications. Methods:, Consecutive patients admitted to a diabetic foot unit underwent a dietary assessment, which included the retrospective collection of a seven-day food history for the period just prior to admission. The collected data were entered into FoodWorks, and comparisons were made with recommendations made by national guidelines. Results:, Thirty-five patients underwent nutritional assessment, 74% male and 26% having impaired renal function. Protein consumption was in excess of daily recommended intake, and although the overall fat intake as a percentage of total calories consumed was in keeping with national guidelines, the intake of saturated fat was inappropriately high. Of the 12 micronutrients assessed, niacin and vitamin C were appropriately consumed by all; average intake of potassium, phosphorus and thiamine approached recommended levels, while the intake of magnesium, calcium, zinc, riboflavin, folate and vitamin A all fell short of recommended daily requirements. No dietary differences were identified between individuals with normal and abnormal renal function, but deficiencies in calcium and iron were identified only in women. Conclusion:, Dietary deficiencies of macronutrients were not identified in individuals admitted with diabetes-related foot complications, but many patients were found to be consuming well below the daily recommended daily intake of one or more of the micronutrients deemed necessary for normal wound healing. [source] Estimation of height in elderly Japanese using region-specific knee height equationsAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2002Barbara Lohse Knous Two knee height equations to predict standing height of Japanese elderly were cross-validated with Joetsu City elders. One equation was derived with Hawaiian residents of Japanese ancestry and the other with elders from the Kumamoto Prefecture in Japan. Subjects included 40 men and 39 women free-dwelling, healthy elders with mean ages of 68.0 ± 2.2 years and 68.0 ± 2.7 years, respectively. Heights of the subjects were representative of Japanese elderly. Experienced nurses, trained to measure knee height, also measured standing height with an automatic stadiometer. A pilot study refined measurement skills. Differences between actual and predicted heights for both equations were significant. Multiple linear regression was used to derive knee height equations specific for elderly males and females living in Joetsu City: women, 63.06 + (2.38 × knee height in cm) ,(0.34 × age in years); men, 71.16 + (2.61 × knee height in cm) - (0.56 × age in years). Geographic-specific knee height equations for Japanese elderly and cross-validation with other locations are suggested to facilitate the accurate use of knee height in nutritional assessment of Japanese elders. Am. J. Hum. Biol. 14:300,307, 2002. © 2002 Wiley-Liss, Inc. [source] INTEGRATION OF PROSPECTIVE QUALITY OF LIFE AND NUTRITIONAL ASSESSMENT AS ROUTINE COMPONENTS OF MULTIDISCIPLINARY CARE OF PATIENTS WITH HEAD AND NECK CANCERANZ JOURNAL OF SURGERY, Issue 1-2 2008Justine Oates Background: Quality of life (QOL) and nutritional assessment of patients with head and neck cancer can provide additional information about the effects of treatment beyond the standard measures of disease control and survival. Integrating a prospective evaluation program into a multidisciplinary service may ensure that a more holistic model of care is developed. Methods: Prospective evaluation of QOL and nutrition before and after treatment for head and neck cancer was implemented in 2001. All patients enrolled in the program were treated with curative intent. Patients completed the European Organisation for Research and Treatment of Cancer Core QOL Questionnaire and Head and Neck Specific Module before treatment and at 3, 6 and 12 months after completion of therapy. In conjunction, patients underwent nutritional assessment by body mass index, biochemical parameters and the patient-generated subjective global assessment tool. Results: Among 288 patients who consented to participate in this study, 134 patients completed the QOL assessment criteria and were eligible for evaluation. Examples of QOL and nutritional data for patients with cancers of the oral cavity, oropharynx, nasopharynx, larynx, hypopharynx, parotid gland and paranasal sinus, and also unknown primary cancers are given. Implementation of this prospective assessment program required appropriate resources and was hampered by time constraints, logistics with blood tests and patient compliance. Conclusions: Despite difficulties with implementation, the information concerning QOL and nutritional status obtained in this study provided an appreciation of the long-term functional effects of treatment for head and neck cancer. Prospective QOL assessment and nutritional evaluation should become integral components of the care of patients with cancers of the head and neck. [source] Nutritional Effect of Dialysis TherapyARTIFICIAL ORGANS, Issue 3 2003Tsutomu Sanaka Abstract: The prognosis of patients with end-stage renal disease has been improved by the recent remarkable advances in medical and engineering technology. However, there are still many unsolved problems in the clinical field. One of the problems is an intractable malnutrition characterized by clinical manifestations including hypoproteinemia and decrease in muscular volume, which is associated with deterioration in the quality of the patient's life. Malnutrition in hemodialysis patients involves abnormal energy metabolism and aberrant amino acid metabolism. In the most malnourished patients, immunodefense mechanisms and homeostasis are disrupted, greatly influencing the prognosis. Moreover, when the performance of dialyzer used is too high, the dialysis treatment might remove a necessary nutrient for the patient. There is also a possibility that the protein catabolism is accelerated when the biocompatibility is inferior. On the other hand, in malnutri-tion, the circulating level of insulin-like growth factor-1 (IGF-1) falls while the level of insulin-like growth factor binding protein-1 (IGFBP-1) is remarkably increased. It has been recognized that IGF-1 and IGFBP-1 are indicators reflecting the initiation of a malnutritional state in patients with chronic renal failure, although there are many indicators such as albumin, prealbumin, and anthropometric measurement for nutritional assessment. We have suggested that r-hGH and IGF-1 improve the malnutritional state by alleviating hypoproteinemia and abnormality of serum amino acid profile in uremic patients on hemodialysis. The serum IGF-1/IGFBP-1 ratio is useful not only as a nutritional parameter but also as a predicting index of responsiveness to r-hGH. It is necessary to examine the problem from various angles to improve malnutrition in the dialysis patient, while considering the above mentioned. [source] Chapter 6: Maize with Increased Lysine (Lysine Maize,LY038)COMPREHENSIVE REVIEWS IN FOOD SCIENCE AND FOOD SAFETY, Issue 1 2008Article first published online: 30 JAN 200 ABSTRACT:, Data and information provided in this case study relate to a crop derived by modern biotechnology, in which a specific nutrient (lysine) has been increased in maize grain.Lysine maize is a feed ingredient with enhanced nutritional characteristics for poultry and swine and provides an alternative to adding supplemental lysine to diets for these animals. Lysine maize is in an advanced state of development; therefore, extensive unpublished data and information are presented to demonstrate that (1) Lysine maize,and the feeds and foods derived from it,are as safe as those derived from conventional maize,and (2) the increased lysine in Lysine maize grain produces the intended nutritional benefit for broiler chickens when compared to a diet containing conventional maize grain and a crystalline lysine supplement. These conclusions are based on a detailed molecular characterization of Lysine maize,a safety assessment of the introduced protein,a safety and nutritional assessment of the LY038 crop,and a comparison of the agronomic and phenotypic properties of maize hybrids with and without the Lysine maize trait. Although Lysine maize is a specialty crop for use in animal feed,its safety for both animals and humans must be demonstrated. Free lysine is significantly increased in Lysine maize by the introduction of the dapA gene (cordapA) from Corynebacterium glutamicum that encodes a form of dihydrodipicolinate synthase (cDHDPS) that is insensitive to lysine feedback inhibition.Analysis of lysine anabolic and catabolic pathways in maize identified 6 metabolites that might change as a consequence of the introduction of cDHDPS insensitive to lysine-feedback inhibition. The results of compositional analysis demonstrated that Lysine maize grain is comparable to conventional maize, with the exception of the intended increase in lysine and a corresponding increase in 2 products of lysine catabolism,saccha-ropine and -aminoadipic acid. Therefore, the safety and/or nutritional implication of these 3 compounds under the conditions of use were the focus of additional assessments and found to not present either a safety or nutritional problem. [source] Two new potent and convenient predictors of mortality in older nursing home residents in JapanGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2004Orie Tajima Background: Malnourishment is closely connected with poor health outcomes in frail elderly. However, the relative importance of specific nutritional predictors of mortality remains unclear in the Japanese population. We investigated the potent nutritional factors associated with mortality from nutritional assessments of three parameters in Japanese frail elderly. Methods: Ninety residents in a nursing home in Japan, aged 65 and over (18 men, 72 women; mean age 82.2 ± 8.0 years) were enrolled in a 38-month follow-up study. The eligibility condition for analysis was having lived at the nursing home for more than 30 days, so three participants were excluded. Three nutritional parameters, which included: anthropometric measurements (body mass index, mid-arm circumference, triceps skinfold thickness and calf circumference); serum markers (albumin, total protein, prealbumin, retinol binding protein and total cholesterol); and food intake, were assessed. After categorizing each putative factor according to tertile distribution, risk of mortality was analyzed using Cox proportional hazard models. Results: At the end of the 38-month follow-up period, 29 participants had died. After adjustment for gender, age, clinical status, and functional status, three indicators (i.e. mid-arm circumference, triceps skinfold thickness and lipid intake) showed a significant relationship with mortality. When all of the putative factors were included in a stepwise procedure, mid-arm circumference and lipid intake were significantly associated with adjusted mortality. Conclusion: Among institutionalized Japanese frail elderly, lower levels of mid-arm circumference and lipid intake could potently predict an increased risk of mortality. These two indicators may be useful for many kinds of assessments and intervention for the improvement of health conditions in Japanese frail elderly. [source] | ||||||||||||||||||||||