Systemic inflammation and nutritional insufficiency in palliative cancer patients

Aim. To study the relationship between the symptoms of nutritional insufficiency and systemic inflammation in cancer palliative patients. Methods. 106 palliative cancer patients were examined at Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine: 54 (50.9%) men and 52 (49.1%) women aged 61 [54; 67] years. All patients underwent laboratory and instrumental examination within the approved standards of specialized medical care. Systemic inflammation was assessed by the levels of acute phase proteins (C-reactive protein, fibrinogen). The study of integrated clinical and laboratory, somatometric parameters was carried out. The nutritional risk index was assessed. Results. Palliative cancer patients showed a statistically significant decrease in the concentration of hemoglobin, lymphocytes, and albumin. The activation of systemic inflammation that manifested by hyperfibrinogenemia and an increase in the level of C-reactive protein was revealed. The study of somatometric parameters revealed a statistically significant decrease in body mass index, shoulder circumference, subscapular skinfold thickness, and a tendency to reduce lean body mass. The nutritional risk index assessment showed mild nutritional insufficiency in 22 (20.8%) of the examined patients and severe nutritional insufficiency in 28 (26.4%) patients. The maximum diagnostic significance of the level of C-reactive protein for prediction the nutritional insufficiency was achieved at 80.4% sensitivity and 52.7% specificity (AUC=0.671, 95% confidence interval [0.573; 0.759], p=0.001), which corresponded to a C-reactive protein threshold of 31 mg/l. Conclusion. 50 (47.2%) of the examined patients showed signs of nutritional insufficiency, a statistically significant decrease in hemoglobin and albumin concentration, as well as lymphocyte count, activation of systemic inflammation, manifested by hyperfibrinogenemia, and an increase in the level of C-reactive protein; it was revealed a statistically significant relationship between C-reactive protein level and malnutrition.

Diet variety mediates the effect of appetite on dietary nutritional insufficiency in patients with heart failure

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): National Institutes of Health R01 NR 009280 & P20 NR 010679 Background Poor appetite is commonly reported in patients with heart failure, which may lead to a diet with limited food variety. Limited food variety, in turn, can result in dietary nutritional insufficiencies. Purpose The purpose of the study was to determine whether the relationship between appetite and dietary nutritional insufficiencies was mediated through diet variety. Methods In this secondary analysis, patients with heart failure rated appetite on a 10-point visual analog scale from 1 to 10. Nutritional insufficiency and diet variety were assessed by a four-day food diary analyzed by Nutrition Data Systems. Nutrition insufficiency was defined as the total number of 18 minerals and vitamins that were insufficient in the diet. Diet variety was calculated as the number of 23 food types consumed over the 4 days. A mediation analysis was conducted controlling for age, gender, New York Heart Association (NYHA), and body mass index using the PROCESS v3.5 macro program with 5,000 bootstrap samples in SPSS. Results A total of 238 patients (mean age 61, SD = 12; male n = 164, 69%; NYHA III/IV, n = 107, 45%) were included. The mean body mass index was 30 kg/m2 (SD = 7). The mean appetite score was 7.5 (SD = 2.3). The mean number of micronutrient insufficiencies was 4.7 (SD = 3.5), and the mean diet variety score was 12.4 (SD = 2.6). Appetite was not directly associated with nutrition insufficiency (effect = -.1802; 95% CI = -.3715, .0111) controlling co-variates. However, there was a significant indirect effect of appetite on nutrition insufficiency through diet variety controlling for covariates (effect = -.0828: 95% CI = -.1585, -.0150). Conclusions Diet variety mediated the association between appetite and dietary micronutrient insufficiency in patients with heart failure. The findings suggest that dietary intervention aimed at increasing patients’ appetite may increase diet variety and enhance the nutritional quality of diets of patients with heart failure.

Vitamin B12 Deficiency Presenting as Pancytopenia with Hepatosplenomegaly in an Infant

Deficiency of vitamin B12 due to nutritional insufficiency is common in developing part of world. Serum vitamin B12 level in infants is determined by the foetal storage during pregnancy. Therefore, evaluation on vitamin B12 level during pregnancy is essential for prevention of vitamin B12 deficiency in infancy. Here we report a vitamin B12 deficient infant who presented with hepatosplenomegaly with pancytopenia including normocytic anaemia and circulating atypical cells. It is also a reminder to clinicians about the uncommon manifestation of vitamin B12 deficiency which mimics haematological malignancy.

Nutritional Insufficiency as a Predictor for Adverse Outcomes in Adult Spinal Deformity Surgery

Study Design: Retrospective analysis of prospectively collected data. Objective: The effect of malnutrition on outcomes after general surgery has been well reported in the literature. However, there is a paucity of data on the effect of malnutrition on postoperative complications during adult deformity surgery. The study attempts to explore and quantify the association between hypoalbuminemia and postoperative complications. Methods: A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing adult deformity surgery were separated into cohorts based serum albumin (<3.5 or >3.5 g/dL). Chi-square and multivariate logistic regression models were used to identify independent risk factors. Results: A total of 2236 patients met the inclusion criteria for the study, of which 2044 (91.4%) patients were nutritionally sufficient while 192 (8.6%) patients were nutritionally insufficient. Multivariate logistic regressions revealed nutritional insufficiency as a risk factors for mortality (odds ratio [OR] = 15.67, 95% confidence interval [CI] = 6.01-40.84, P < .0001), length of stay ≥5 days (OR = 2.22, 95% CI = 1.61-3.06, P < .0001), any complications (OR = 1.82, 95% CI = 1.31-2.51, P < .0001), pulmonary complications (OR = 2.29, 95% CI = 1.29-4.06, P = .005), renal complications (OR = 2.71, 95% CI = 1.05-7.00, P = .039), and intra-/postoperative red blood cell transfusion (OR = 1.52, 95% CI = 1.08-2.12, P = .015). Conclusions: This study demonstrates that preoperative hypoalbuminemia is a significant and independent risk factor for postoperative complications, 30-day mortality, and increased length of hospital in patients undergoing adult deformity surgery surgery. Nutritional status is a modifiable risk factor that can potentially improve surgical outcomes after adult deformity surgery.