Low fat-free mass as a marker of mortality in community-dwelling healthy elderly subjects†

Background: low fat-free mass has been related to high mortality in patients. This study evaluated the relationship between body composition of healthy elderly subjects and mortality. Methods: in 1999, 203 older subjects underwent measurements of body composition by bioelectrical impedance analysis, Charlson co-morbidity index and estimation of energy expenditure through physical activity by a validated questionnaire. These measurements were repeated in 2002, 2005 and 2008 in all consenting subjects. Mortality data between 1999 and 2010 were retrieved from the local death registers. The relationship between mortality and the last indexes of fat and fat-free masses was analysed by multiple Cox regression models. Results: women's and men's data at last follow-up were: age 81.1±5.9 and 80.9±5.8 years, body mass index 25.3±4.6 and 26.1±3.4kg/m2, fat-free mass index 16.4±1.8 and 19.3±1.9kg/m2 and fat mass index 9.0±3.2 and 6.8±2.0kg/m2. Fifty-eight subjects died between 1999 and 2010. The fat-free mass index (hazard ratio 0.77; 95% confidence interval 0.63-0.95) but not the fat mass index, predicted mortality in addition to sex and Charlson index. The multiple Cox regression model explained 31% of the variance of mortality. Conclusion: a low fat-free mass index is an independent risk factor of mortality in elderly subjects, healthy at the time of body composition measuremen

Clinical evaluation of hormonal stress state in medical ICU patients: a prospective blinded observational study

Objective: To evaluate whether classification of patients as having low, moderate, or high stress based on clinical parameters is associated with plasma levels of stress hormone Design and setting: Prospective, blinded, observational study in an 18-bed medical ICU. Patients: Eighty-eight consecutive patients Interventions: Patients were classified as low (n=28), moderate (n=33) or high stress (n=27) on days 0 and 3 of ICU stay, based on 1 point for each abnormal parameter: body temperature, heart rate, systemic arterial pressure, respiratory rate, physical agitation, presence of infection and catecholamine administration. The stress categories were: high: 4 points or more, moderate 2-3 points, low 1 point. Plasma growth hormone (GH), insulin-like growth factor 1 (IGF-1), insulin, glucagon, cortisol were measured on days 0 and 3. Measurements and results: Plasma cortisol and glucagon were significantly higher and IGF-1 lower in high vs. low stress patients on days 0 and 3. High stress patients were more likely to have high cortisol levels (odds ratio 5.8, confidence interval 1.8-18.9), high glucagon (8.7, 2.1-36.1), and low IGF-1 levels (5.9, 1.8-19.0) than low stress patients on day 0. Moderate stress patients were also more likely to have high cortisol and glucagon levels than low stress patients. Insulin and GH did not differ significantly. Results were similar for day 3. Conclusions: Moderate and severe stress was significantly associated with high catabolic (cortisol, glucagon) and low anabolic (IGF-1) hormone levels. The hormonal stress level in ICU patients can be estimated from simple clinical parameters during routine clinical evaluatio

Body composition : methods of measurement, normative values and clinical use

Measurement of body composition is an important part of nutritional assessment. The low FFM associated with malnutrition has been associated with numerous infectious and noninfectious complications, increasing length of stay, morbidity and mortality. DXA and TBK are reference method for determination of FFM and BCM, but, as these methods are expensive and require extensive technique of the operator, we have focused especially on BIA, an easy, quick, safe and reliable bedside method to measure body composition. BIA formulas to routinely assess FFM and appendicular skeletal muscle mass have been developed. Normative values of total body composition have been established, according to age and gender. Longitudinal and cross-sectional studies allowed an insight on the impact of physical activity and environment on body composition. With regard to clinics, we have studied the impact of body composition, determined by BIA, on length of hospital stay and shown that a low FFM and FM index were associated with an increased length of stay. This demonstrates that prevention of FFM loss, whether through nutritional support or drugs, may improve clinical outcome and decrease hospital costs. Finally, we have shown two case reports where sequential FFM measurements guided nutritional and medical therapy. Future studies should focus on the relationship between body composition and outcome in various types of patients. They should also try to determine the characteristics of nutritional support (amount of calories, type of macronutrient intakes, timing of nutritional support), potentially associated with anabolic drugs or physical activity, necessary to limit FFM loss, in order to improve clinical outcome

Suppléments nutritionnels oraux et nutrition entérale à domicile en oncologie

La prévalence de la dénutrition peut atteindre 70 % chez les patients souffrant d’un cancer. Un support nutritionnel est indiqué : lors d’une dénutrition avérée (Nutritional Risk Score ≥ 3, tableau 1) ou en période préopératoire pendant cinq à sept jours, chez des patients non dénutris chez qui une chirurgie oncologique du tractus digestif est planifiée, sous forme d’immunonutrition

FODMAP beim Reizdarmsyndrom : Langzeitwirking der FODMAP-armen Diät

Das Reizdarmsyndrom ist charakterisiert durch rezidivierende Bauchschmerzen und eine Störung der Defäkation. Die Prävalenz ist mit 4 bis 10% recht häufig. Es handelt sich um eine chronische Krankheit mit wiederholten Phasen der Verschlechterung. Durch eine FODMAP-arme Diät lassen sich die Beschwerden bei rund 60% der Patienten lindern. Es stellt sich die Frage, welche Langzeitfolgen diese Diät hat, ob sie primär eingesetzt und wie lange sie belbehalten werden soll

Nutrition-dénutrition-mobilité

La dénutrition est associée à plusieurs maladies chroniques et augmente avec le vieillissement. Elle a une prévalence de 10 à 30 % chez les patients avec maladies cardiovasculaires, respiratoires et oncologiques et entraîne une augmentation de la morbidité et de la mortalité. Une des caractéristiques principales de la dénutrition est la perte de masse musculaire, composante majeure de la masse non grasse et reliée à une perte de fonction musculair

EASL Clinical Practice Guidelines on nutrition in chronic liver disease

A frequent complication in liver cirrhosis is malnutrition, which is associated with the progression of liver failure, and with a higher rate of complications including infections, hepatic encephalopathy and ascites. In recent years, the rising prevalence of obesity has led to an increase in the number of cirrhosis cases related to non-alcoholic steatohepatitis. Malnutrition, obesity and sarcopenic obesity may worsen the prognosis of patients with liver cirrhosis and lower their survival. Nutritional monitoring and intervention is therefore crucial in chronic liver disease. These Clinical Practice Guidelines review the present knowledge in the field of nutrition in chronic liver disease and promote further research on this topic. Screening, assessment and principles of nutritional management are examined, with recommendations provided in specific settings such as hepatic encephalopathy, cirrhotic patients with bone disease, patients undergoing liver surgery or transplantation and critically ill cirrhotic patients

Dénutrition chez la personne âgée : À quoi penser et quelle prise en charge par le médecin de premier recours ?

La prévalence du risque de dénutrition des personnes de plus de 65 ans atteint 80 % en milieu hospitalier, 65 % en EMS et 35 % dans la communauté. Les facteurs de risque sont par exemple une dysphagie, une altération de l’état buccodentaire, la prise de médicaments entraînant une dysgueusie, une xérostomie ou une anorexie, une diminution de la mobilité, ce qui affecte les achats alimentaires et la préparation des repas, ainsi que des facteurs psychosociaux (dépression, isolement), et environnementaux (par exemples les limitations financières). La dénutrition entraîne de multiples complications, comme une perte fonctionnelle, une augmentation des infections, du risque d’escarre et de la mortalité. Dernièrement, la définition de la dénutrition a été revue et nécessite un critère phénotypique et un critère étiologique</p

Protein catabolism and requirements in severe illness

Reduced total body protein mass is a marker of protein-energy malnutrition and has been associated with numerous complications. Severe illness is characterized by a loss of total body protein mass, mainly from the skeletal muscle. Studies on protein turnover describe an increased protein breakdown and, to a lesser extent, an increased whole-body protein synthesis, as well as an increased flux of amino acids from the periphery to the liver. Appropriate nutrition could limit protein catabolism. Nutritional support limits but does not stop the loss of total body protein mass occurring in acute severe illness. Its impact on protein kinetics is so far controversial, probably due to the various methodologies and characteristics of nutritional support used in the studies. Maintaining calorie balance alone the days after an insult does not clearly lead to an improved clinical outcome. In contrast, protein intakes between 1.2 and 1.5 g/kg body weight/day with neutral energy balance minimize total body protein mass loss. Glutamine and possibly leucine may improve clinical outcome, but it is unclear whether these benefits occur through an impact on total body protein mass and its turnover, or through other mechanisms. Present recommendations suggest providing 20 - 25 kcal/kg/day over the first 72 - 96 hours and increasing energy intake to target thereafter. Simultaneously, protein intake should be between 1.2 and 1.5 g/kg/day. Enteral immunonutrition enriched with arginine, nucleotides, and omega-3 fatty acids is indicated in patients with trauma, acute respiratory distress syndrome (ARDS), and mild sepsis. Glutamine (0.2 - 0.4 g/kg/day of L-glutamine) should be added to enteral nutrition in burn and trauma patients (ESPEN guidelines 2006) and to parenteral nutrition, in the form of dipeptides, in intensive care unit (ICU) patients in general (ESPEN guidelines 2009)