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Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition Methodology & Assessment".

Deadline for manuscript submissions: closed (5 May 2024) | Viewed by 14818

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Special Issue Editors

Prof. Dr. Maurizio Marra

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Guest Editor

Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini 5, 80138 Naples, Italy
Interests: body composition; malnutrition; nutritional status; clinical nutrition

Dr. Andrea P. Rossi

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Co-Guest Editor

Department of Medicine, Section of Geriatrics, Healthy Aging Center, University of Verona, Verona, Italy
Interests: nutritional sciences; sarcopenia; sarcopenic obesity; malnutrition; abdominal obesity; geriatrics and nutrition; ectopic adipose tissue
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Ming Yang

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Co-Guest Editor

National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
Interests: sarcopenia; frailty; geriatric syndromes; evidence-based medicine; bibliometrics

Special Issue Information

Dear Colleagues,

Malnutrition is defined as the development of undernutrition as a result of a disease process or a medical condition, and it may be present on admission or be acquired during hospitalization. Poor nutrition has been adversely associated with a wide range of adverse clinical, functional and economic outcomes.

A systematic approach to addressing malnutrition in hospitals should begin with a nutritional risk assessment of all patients at admission, followed by a detailed appraisal of the nutritional status of patients most at risk.

Although a wide range of tools, such as body composition, biological markers for malnutrition and nutritional risk detection tools are available to clinicians, the objective measurement of the malnutrition domains is hampered by limitations intrinsic to the screening and assessment tools. Examples of the issues with current technology and methods include interobserver variability, difficult reproducibility, technician experience, their long temporal duration time, the relative expense of techniques, lack of tools validation, etc. Furthermore, the heterogeneity of the populations being evaluated, as well as the setting in which malnutrition is being investigated, impacts the definition of “gold standard” screening and the assessment techniques being systematically adopted.

In summation, the aim of this Special Issue is to provide an overview of the most widely used methods for nutritional screening to identify individuals at risk of malnutrition with different chronic diseases.

Prof. Dr. Maurizio Marra
Dr. Andrea P. Rossi
Prof. Dr. Ming Yang
Guest Editors

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Keywords

body composition
malnutrition
nutritional status
chronic disease
screening tools

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Published Papers (10 papers)

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Editorial

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5 pages, 213 KiB

Open AccessEditorial

Nutritional Assessment in Patients with Chronic Diseases: Tools, Challenges, and Future Directions

by Huiyu Tang and Ming Yang

Nutrients 2023, 15(22), 4794; https://doi.org/10.3390/nu15224794 - 16 Nov 2023

Viewed by 2463

Abstract

Chronic diseases, such as cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, are leading causes of morbidity and mortality worldwide [...] Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

Research

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12 pages, 520 KiB

Open AccessArticle

The Role of Combined Muscle Ultrasound and Bioimpedentiometry Parameters for Sarcopenia Diagnosis in a Population of Hospitalized Older Adults

by Alfredo Zanotelli, Andrea P. Rossi, Letizia Del Monte, Gianluca Vantini, Giovanni Stabile, Silvia Urbani, Anna Giani, Elena Zoico, Alessio Babbanini, Francesco Fantin, Mauro Zamboni and Gloria Mazzali

Nutrients 2024, 16(15), 2429; https://doi.org/10.3390/nu16152429 - 26 Jul 2024

Viewed by 800

Abstract

Background: For the study of quantitative and qualitative muscle parameters, ultrasound and bioelectric impedance analysis are reliable, non-invasive, and reproducible. The aim of this study was to test the combined role of those techniques for the diagnosis of sarcopenia in a population of hospitalized older males and females. Methods: A total of 70 subjects were recruited, including 10 healthy adults and 60 hospitalized elderly patients with a good level of independence and cooperation, with and without sarcopenia. The rectus femoris cross-sectional area (CSA), thickness, echogenicity, and compressibility were measured with ultrasound echography. The phase angles (PhAs) and skeletal muscle mass were calculated by bioimpedence analysis. The muscle quality index (MQI) was calculated as the product of CSA and PhA. Results: Muscle compressibility was greater and PhA was lower in sarcopenic when compared with non-sarcopenic subjects. The threshold values for sarcopenia diagnosis in both sexes of CSA, of PhA, and of the MQI were identified. The obtained CSA values showed an AUC of 0.852 for women and 0.867 for men, PhA of 0.792 in women and 0.898 in men, while MQI was 0.900 for women and 0.969 for men. Conclusions: The newly calculated cut-off values of CSA, PhA, and MQI predicted the presence of sarcopenia with good sensitivity and specificity values. The use of the MQI proved to be more promising than the separate use of CSA and PhA in both male and female subjects. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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18 pages, 1583 KiB

Open AccessArticle

A Cross-Sectional Validation Study of Camry EH101 versus JAMAR Plus Handheld Dynamometers in Colorectal Cancer Patients and Their Correlations with Bioelectrical Impedance and Nutritional Status

by Andrés Jiménez-Sánchez, José Luis Pereira-Cunill, María Luisa Limón-Mirón, Amelia López-Ladrón, Francisco Javier Salvador-Bofill and Pedro Pablo García-Luna

Nutrients 2024, 16(12), 1824; https://doi.org/10.3390/nu16121824 - 11 Jun 2024

Cited by 1 | Viewed by 972

Abstract

Background: Reduced muscle strength (dynapenia) and mass (atrophy) are prognostic factors in oncology. Measuring maximal handgrip strength with dynamometers is feasible but limited by the cost of the reference device (JAMAR). Methods: A cross-sectional study was conducted on colorectal cancer outpatients treated with chemotherapy or under active surveillance in our center from September 2022 to July 2023. Accuracy, reliability, and concordance were compared for two handheld dynamometers: the JAMAR Plus (the gold-standard device) and the Camry EH101 (a low-cost index device). A simultaneous nutritional diagnosis with GLIM criteria and bioelectrical impedance analysis (BIA) was carried out. Results: A total of 134 participants were included. The median of maximal strength for the JAMAR Plus had a non-significant difference of 1.4 kg from the Camry EH101. The accuracy and reliability of the devices were high. Bland–Altman analysis showed a 0.8 kg bias and −4.1 to 5.6 kg limits of agreement (LoA); a 0.1 kg bias and −5.3 to 5.4 kg LoA in men; a 1.5 kg bias and −2.2 to 5.3 kg LoA in women. In total, 29.85% of the participants were malnourished. Prevalence of dynapenia increased from 3.67% with the JAMAR Plus to 5.14% with the Camry EH101. Both devices had a moderate and significant correlation with BIA-estimated muscle mass. Conclusions: The Camry EH101 was a cost-effective alternative to JAMAR Plus in our sample. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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11 pages, 400 KiB

Open AccessArticle

Hospital Malnutrition in the Medicine and Neurology Departments: A Complex Challenge

by Erica Starace, Giulia De Pasquale, Emanuela Morenghi, Camilla Crippa, Sofia Matteucci, Gabriella Pieri, Fanny Soekeland, Stefano Maria Gibbi, Giuliana Lo Cricchio, Francesco Reggiani, Marta Calatroni, Manuela Pastore, Beatrice Mazzoleni and Stefano Mancin

Nutrients 2023, 15(24), 5061; https://doi.org/10.3390/nu15245061 - 11 Dec 2023

Cited by 2 | Viewed by 1613

Abstract

Hospital malnutrition is especially common among elderly patients with neurological deficits or dementia. These conditions can be exacerbated by unpalatable diets and issues such as dysphagia and presbyphagia. Our study aimed to investigate the prevalence of malnutrition in patients on a homogenized diet and to identify potential correlations with specific clinical variables. We conducted a retrospective observational study in compliance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. The study encompassed 82 patients, mainly elderly and diagnosed with neurodegenerative diseases. Upon initial assessment, 46.34% of the sample displayed a risk of malnutrition based on the Malnutrition Universal Screening Tool (MUST), and 62.20% were classified as malnourished based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Only 45.12% retained autonomy in food intake. Weight loss identified prior to the study was closely tied to malnutrition and influenced BMI. Moreover, autonomy in food intake was strongly associated with a prolonged hospital stay (LOS), and a similar trend was observed for water intake. Our findings emphasize the importance of promptly recognizing patients at risk of malnutrition, especially within such a vulnerable population. Autonomy in food intake and hydration emerge as critical indicators in the clinical management of hospitalized patients. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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12 pages, 2784 KiB

Open AccessArticle

A Comparative Evaluation of the Caloric Intake and Economic Efficiency of Two Types of Homogenized Diets in a Hospital Setting

by Camilla Crippa, Sofia Matteucci, Manuela Pastore, Emanuela Morenghi, Erica Starace, Giulia De Pasquale, Gabriella Pieri, Fanny Soekeland, Stefano Maria Gibbi, Giuliana Lo Cricchio, Andrea Zorloni, Beatrice Mazzoleni and Stefano Mancin

Nutrients 2023, 15(22), 4731; https://doi.org/10.3390/nu15224731 - 9 Nov 2023

Cited by 2 | Viewed by 1287

Abstract

The prevalence of malnutrition is increasing globally due to factors such as age-related pathological conditions and diseases that impact food and beverage intake. In hospital settings, older adult patients often require homogenised diets, which can lead to malnutrition due to poor palatability and limited variety. This study compared the Standard Homogenised Diet (HSD) and a Modified Homogenized Diet (HMD) proposed in a tertiary hospital in Northern Italy. A retrospective and observational design was used to analyse data from 86 adult patients with various conditions requiring a homogenised diet. The primary goal was to compare food intake, rheological characteristics, and palatability of the two diets. The secondary objective was to evaluate the economic impact by comparing costs and quantifying food waste from unused meals. Patients on HMD had a median daily caloric intake of 852 kcal (IQR 787–926 kcal) compared to 631 kcal (IQR 506–797 kcal) in the HSD group. Taste, texture, palatability, and ease of intake for HMD outperformed HSD with scores such as 3.7 ± 0.6 vs. 2.5 ± 0.4 for taste. Economically, HMD was EUR 0.53 less expensive per day than HSD, and food wastage costs were significantly lower for HMD (EUR 2.66 ± 0.81) than HSD (EUR 4.66 ± 1.27). Overall, HMD presented substantial benefits in patient satisfaction and cost-efficiency. This insight may aid diverse care settings to enhance meal acceptance and nutritional intake for patients needing homogenised diets. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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13 pages, 610 KiB

Open AccessArticle

High Nutritional Risk Is Associated with Poor Functional Status and Prognostic Biomarkers in Stroke Patients at Admission to a Rehabilitation Unit

by Olivia Di Vincenzo, Ermenegilda Pagano, Mariarosaria Cervone, Raffaele Natale, Annadora Morena, Alessandra Esposito, Fabrizio Pasanisi and Luca Scalfi

Nutrients 2023, 15(19), 4144; https://doi.org/10.3390/nu15194144 - 25 Sep 2023

Cited by 5 | Viewed by 1504

Abstract

Considering that malnutrition (undernutrition) is common in stroke patients and may negatively impact body function, the aim of this study was to determine the relationship between nutritional risk and functional status in stroke patients at admission to a rehabilitation unit. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score. Functional status was assessed using the Barthel Index, the modified Rankin Scale, the Trunk Control Test and the Sitting Balance Scale, and cognitive function was assessed using the Short Portable Mental Status Questionnaire. C-reactive protein, fibrinogen and D-dimer were also evaluated as established prognostic biomarkers. Stroke patients (n = 245; age 69.7 ± 12.8 years; 47%, women; 82% ischemic stroke) at admission to a rehabilitation unit were included in this study. A high prevalence of nutritional risk was detected with each tool and was found to be greater using the GNRI and in patients aged ≥75 years. Multiple logistic regression analysis showed that age and dysphagia were independent predictors of high nutritional risk. High risk groups performed worse on all functional tests compared to the low-risk groups (p < 0.05). Nutritional risk with each tool was associated with functional and cognitive statuses (with the highest correlation being with the Trunk Control Test). Significant associations were also found with C-reactive protein, fibrinogen and D-dimer. In conclusion, a high nutritional risk, as evaluated with the GNRI, the PNI and the CONUT score, was detected in stroke patients at admission to a rehabilitation unit. High nutritional risk was associated with functional status and with predictors of clinical outcomes (and specifically in older patients). Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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11 pages, 289 KiB

Open AccessArticle

Validity and Applicability of the Global Leadership Initiative on Malnutrition (GLIM) Criteria in Patients Hospitalized for Acute Medical Conditions

by Laia Fontane, Maria Helena Reig, Sonika Garcia-Ribera, Miriam Herranz, Mar Miracle, Juan Jose Chillaron, Araceli Estepa, Silvia Toro, Silvia Ballesta, Humberto Navarro, Gemma Llaurado, Juan Pedro-Botet and David Benaiges

Nutrients 2023, 15(18), 4012; https://doi.org/10.3390/nu15184012 - 16 Sep 2023

Cited by 2 | Viewed by 1282

Abstract

(1) Background: The objectives of this study were to evaluate the concurrent and predictive validity and the applicability of the global leadership initiative on malnutrition (GLIM) criteria in patients hospitalized for acute medical conditions. (2) Methods: prospective cohort study with patients hospitalized for acute medical conditions. For validation, the methodology proposed by the GLIM group of experts was used. Sensitivity and specificity values greater than 80% with respect to those for the subjective global assessment (SGA) were necessary for concurrent validation. The time necessary to complete each nutritional assessment test was determined. (3) Results: A total of 119 patients were evaluated. The SGA was applied to the entire cohort, but the GLIM criteria could not be applied to 3.4% of the patients. The sensitivity and specificity of the GLIM criteria with respect to those for the SGA to detect malnutrition were 78.0 and 86.2%, respectively. The GLIM predictive validity criterion was fulfilled because patients with malnutrition more frequently had a hospital stay >10 days (odds ratio of 2.98 (1.21–7.60)). The GLIM criteria required significantly more time for completion than did the SGA (p = 0.006). (4) Conclusion: The results of this study do not support the use of the GLIM criteria over the SGA for the diagnosis of malnutrition in patients hospitalized for acute medical conditions. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

15 pages, 3298 KiB

Open AccessArticle

Detection of Sarcopenia in Patients with Liver Cirrhosis Using the Bioelectrical Impedance Analysis

by Dorotea Bozic, Ivica Grgurevic, Bisera Mamic, Vesna Capkun, Josipa Bilandzic-Ivisic, Tomislav Ivanovic, Ivona Bozic, Ivan Zaja, Kristian Podrug, Zeljko Puljiz, Zdravko Perko and Ivana Mikolasevic

Nutrients 2023, 15(15), 3335; https://doi.org/10.3390/nu15153335 - 27 Jul 2023

Cited by 3 | Viewed by 1498

Abstract

Bioelectrical impedance analysis (BIA) is a body composition assessment method. We aimed to determine its accuracy in the detection of sarcopenia in patients with liver cirrhosis (LC), using skeletal muscle index (SMI) at the level of third lumbar vertebra (L3-SMI) obtained using multislice computed tomography as the reference method. Patients with LC were enrolled in the period October 2019–March 2022 and follow-ups were conducted until January 2023. Their BIA parameters were compared against L3-SMI, and BIA cut-off values were proposed using AUROC analysis. Patients underwent outcome analysis based on obtained clinical characteristics. A total of 106 patients were included. We found a fair correlation between BIA parameters with the L3-SMI. We determined cut-off values of ≤11.1 kg/m² for BIA-SMI (Se 73%, Sp 66%, AUROC 0.737, p < 0.001) and ≤5.05° for phase angle (PA) (Se 79%, Sp 60%, AUROC 0.762, p < 0.001) in the detection of sarcopenia. The relative risk of death was 2.2 times higher in patients with skeletal muscle mass (SMM) ≤ 36.5 kg. SMM was significantly associated with outcome in Kaplan–Meier analysis. This non-invasive and simple method that showed fair performances and a very good outcome prediction could provide for the unmet need for fast and affordable detection of sarcopenia in patients with LC and should be further evaluated. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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18 pages, 659 KiB

Open AccessArticle

Nutritional Status of People with a Coexisting Chronic Wound and Extended Assessment Using Bioelectrical Impedance

by Mateusz Skórka, Paweł Więch, Joanna Przybek-Mita, Anna Malisiewicz, Kamila Pytlak and Dariusz Bazaliński

Nutrients 2023, 15(13), 2869; https://doi.org/10.3390/nu15132869 - 25 Jun 2023

Cited by 4 | Viewed by 1724

Abstract

The diagnosis of malnutrition should be one of the pillars of comprehensive patient care, especially in the case of patients with large wounds, prolonged healing, or comorbidities. The condition for a reliable and accurate nutritional diagnosis is to link it with the parameters of nutritional status assessment at the basic level (anthropometric measurements and clinical assessment) and in depth (biochemical tests and bioelectrical impedance). A prospective study included a sample of 60 patients with coexisting chronic wounds (venous ulcers, diabetic foot syndrome, pressure injury) treated at the Wound Treatment Clinic of Fr. B. Markiewicz Podkarpackie Oncology Center (Poland). The method of estimation and diagnostic survey was used; the research tool was a scientific research protocol consisting of four parts. Self-care capacity was assessed based on the Barthel scale, nutritional status using blood biochemical parameters, and electrical bioimpedance. Wounds were classified according to the extent, depth of tissue structures, and potential infection. Subjects with pressure ulcers had statistically significantly lower fat-free mass component indices compared to those with diabetic foot syndrome and venous ulceration. The subjects with pressure ulcers had significantly lower values of body composition components compared to those with diabetic foot syndrome and venous ulcers. In the group of patients with pressure ulcers, the lowest values of albumin (3.20 g/dL), hemoglobin (10.81 g/dL), and nutritional risk index (NRI) (88.13 pts.) scores were confirmed. Subjects with pressure ulcers with limited self-care presented a non-physiological nutritional status, indicating a risk of malnutrition. Local actions related to wound treatment should be preceded by a general examination, considering the state of augmented nutrition with the use of electrical bioimpedance. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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15 pages, 1345 KiB

Open AccessSystematic Review

Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review

by Susy Dal Bello, Stefano Mancin, Sara Morales Palomares, Diego Lopane, Luca Di Gianfrancesco, Chiara Soligo, Tommaso Tarantino, Paolo Perdonò, Rodolfo Hurle, Bruno Bernardini, Federico Piccioni, Manuela Pastore, Alvarez Pellegrinelli, Angelo Porreca and Beatrice Mazzoleni

Nutrients 2024, 16(11), 1682; https://doi.org/10.3390/nu16111682 - 29 May 2024

Viewed by 868

Abstract

Background/Aim: Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation before cystectomy. Methods: A systematic literature review was conducted in PubMed, the Cochrane Library, CINAHL, Scopus and the Web of Science databases. Quality and risk of bias assessment was conducted adhering to the JBI framework and evidence was evaluated according to the Oxford Centre for Evidence Based Medicine levels of evidence. Results: Out of 586 records identified, six studies were included. Among them, only two were randomized controlled trials. Immunonutrition has been shown to improve postoperative bowel function (3.12 vs. 3.74 days; RR 0.82; CI, 0.73–0.93; p = 0.0029) and decrease postoperative complications (−36.7%; p = 0.008) and readmission rates (−15.38%; p = 0.03). Furthermore, oral nutritional supplements combined with nutritional counseling demonstrated an accelerated recovery of bowel function (−1 day; p < 0.01), a reduction in the length of hospital stay (−1.75 days; p = 0.01), an improvement in handgrip strength (+6.8%, p < 0.001), an increase in bone mass (+0.3 kg, p = 0.04), and a better BMI value (+2.3%, p = 0.001). Conclusions: Nutritional prehabilitation demonstrates potential in enhancing postoperative outcomes following radical cystectomy. Oral supplements, immunonutrition, and counseling exhibit efficacy in improving postoperative results. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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