Measurements of body fat is associated with markers of inflammation, insulin resistance and lipid levels in both overweight and in lean, healthy subjects

Background & aims: Low-grade inflammation is associated with fat mass in overweight. Whether this association exists in lean persons is unknown. Aims were to investigate associations between anthropometric measures of fat distribution and fat mass (% and kg) assessed by bioelectrical impedance analysis (BIA). Furthermore we wanted to investigate the relationship between fat mass and markers of insulin resistance, inflammation, and lipids in healthy subjects in different BMI categories. Methods: We compared 47 healthy overweight adults (BMI 26e40 kg/m2) and 40 lean (BMI 17e25 kg/ m2) matched for age and sex. Waist and hip circumferences, waist-to-hip ratio, waist-to-height ratio and triceps skinfold were used to evaluate fat distribution. BIA was used to estimate fat mass (% and kg). Markers of insulin resistance, lipids, inflammation and adipokines were measured. Results: Hip circumference was associated (P < 0.01) with BIA-assessed fat mass (%) in both groups (lean: regression coefficient B ¼ 0.4; overweight: B ¼ 0.5). An increase in hip circumference in all tertiles was associated with higher plasma levels of leptin, CRP and C-peptide in both groups. Conclusions: Fat mass may play a role in low-grade inflammation also in subjects within the normal range of BMI. Hip circumference may be a surrogate measure for fat mass in subjects in different BMI categories, and may be useful for identification of people with risk of developing overweight-related chronic disease

Inflammation and body composition in over- and undernutrition: Overweight and cancer cachexia

This thesis focuses on the association between inflammation and body composition and consists of one cross sectional study in healthy overweight and in lean subjects (paper I), and one prospective study in patients with pancreatic cancer (papers II and III). In paper I, the relationship between inflammatory markers and body composition measured with anthropometry and bioelectrical impedance analysis (BIA) was examined in healthy individuals. Increasing hip circumference (HC) was associated with increasing levels of leptin and C-reactive protein (CRP) in both groups. CRP increased with increasing body mass index (BMI), also in the lean group. HC may be a proxy for fat percent measured with BIA in lean and overweight individuals, and may be useful for identification of people at risk of developing overweight-related disorders. In paper II the level of inflammatory markers, body composition, energy intake and development of cachexia was examined. Pancreatic cancer patients had higher levels of inflammatory markers compared with a healthy reference population at inclusion, and the levels increased as death approached. Weight, fat- and muscle mass were reduced during follow-up. At inclusion, there were no differences in the levels of inflammatory markers between patients who were classified as cachectic and those who were not. These results indicate that the increased levels of inflammation may be caused by the tumor and the tumor-host reactions. The third paper compared two classifications of cancer cachexia; the 3-factor classification that includes CRP as a criterion, and the consensus classification that includes sarcopenia as a criterion. Patients were categorized as cachectic and non-cachectic according to both classifications. Consistency across definitions was examined, as well as their ability to predict survival. The two classifications of cancer cachexia showed good overall agreement in defining cachectic patients, and cachexia was associated with poorer survival according to both. Inflammation in the body may be caused by fat mass and tumors. Overweight increases the risk for chronic diseases and pancreatic cancer. In cancer patients, the tumor may cause systemic inflammation, and cytokines may trigger weight loss and might be a driving force behind cachexia. Among pancreatic cancer patients, those with neither weight loss, reduced energy intake, systemic inflammation nor sarcopenia have the longest survival. We suggest that clinical interventions should be directed towards optimizing these risk factors in these patients

Experiences and challenges of the use Subacute and Acute Dysfunction in the Elderly‐SAFE Work team coordinators experiences and challenges in the introduction and use of SAFE of in home‐based nursing: A qualitative study from the Norwegian context

Abstract Old age is the leading cause of impaired bodily function, which gradually increases healthcare service needs. To offer the best possible care in the home and to be able to detect health‐related functional impairment at an early stage, it is necessary to carry out systematic and structured observations. The assessment tool Subacute and Acute Dysfunction in the Elderly (SAFE) has been developed explicitly for these structured observations. This study aims to explore the experiences and challenges of home‐based care work team coordinators (WTCs) regarding the introduction and use of SAFE. Method The present qualitative study was performed following Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The data were collected through individual interviews (n = 3) and focus group (FG) interviews (n = 7). The interview transcripts were analysed using the Gioia method. Results Five aggregated dimensions were identified: Varying acceptance of SAFE, Structuring and quality‐assurance of home‐based nursing practice, Obstacles for the integration of SAFE in daily practice, Acceptance and use of SAFE require continuous supervision and SAFE contributes to increased quality of nursing care. Conclusion The introduction of SAFE contributes to a structured follow‐up of functional status in patients receiving home care. In order to incorporate the tool into home care practice, it is essential to set aside time to introduce the tool and to support nurses' use of it by offering continuous supervision

Home Care Nurses’ Experiences of the Use and Introduction of the Subacute Functional Decline in the Elderly Instrument

Introduction Registered nurses are crucial in home care nursing for elderly patients, as detecting geriatric conditions can be difficult due to age-related changes or communication barriers. Disability is often overlooked in elderly care, requiring different assessment tools to determine patient status and necessary nursing interventions. During the COVID-19 pandemic, the subacute functional decline in the elderly (SAFE) instrument was implemented in some Oslo districts to detect early signs of sub acute functional decline in hospital and home care settings. However, the nurses’ perception of this new assessment tool and its effectiveness has not been evaluated. Objectives This study aims to explore home care nurses’ experiences and perceptions regarding the introduction and use of the new assessment tool, SAFE. Objectives were to conduct focus group interviews and perform qualitative analysis. Method The study followed Consolidated Criteria for Reporting Qualitative Research guidelines, had a qualitative design, and included 15 out of 60 permanently employed RNs at Oslo municipality's home care service in Frogner district. Data was collected via three focus group interviews and analyzed thematically. Results The study identified three themes: (1) Nurses learned to use SAFE through direct experience due to a lack of standard introduction or training. (2) SAFE supported patient-centred care by enabling communication, preventive work, and identifying patients’ needs. (3) Integrating SAFE into electronic databases and daily clinical work could improve nursing efficiency. Conclusion Overall, using SAFE can improve patient outcomes and care quality in home care, but clear guidelines, ongoing support, and standardized procedures are crucial for its effectiveness. Regular updates and complete management support are also necessary. The study's findings align with previous research and can guide the development and implementation of tools in home care to enhance patient outcomes and the quality of care delivered

Female university academics' reflections on the development of their academic careers in the Norwegian higher education context

The present study aims to get insight into how female university academic staff in teaching positions at various levels reflect on the development of their careers in higher education. A qualitative method was used with a participatory action research approach. The data were collected in the form of a workshop and analysed using the story dialogue method. Academic jobs, which are a mixture of teaching and research-related tasks, require that individuals prioritize their time well to be able to do research. In addition, the understanding and support of colleagues and management are crucial to achieving expected research results

Comparing two classifications of cancer cachexia and their association with survival in patients with unresected pancreatic cancer

Cancer cachexia is characterized by reduced weight and muscle mass, poor treatment tolerance and short survival. A universally accepted definition of this condition lacks. Two classifications have recently been proposed; the 3-factor classification requiring ≥two of three factors; weight loss ≥10%, food intake ≤1500 kcal/d, and C-reactive protein ≥10 mg/l, and the consensus classification defining cachexia by either weight loss >5% the past 6 months, or BMI 2%. Furthermore, cachexia may be considered a trajectory with pre-cachexia as the initial stage identified by weight loss ≤5%, anorexia and metabolic change. We examined the consistency between the two classifications, and their association with survival in a palliative cohort of pancreatic cancer patients. Patients with unresected pancreatic cancer were recruited. CT-images were used to determine sarcopenia. Height/weight/C-reactive protein and survival were extracted from medical records. Food intake was estimated from patients’ self-report. Forty-five patients (25 males, median age 72 years, range 35-89) were included. The agreement for cachexia and non-cachexia was 78% across classifications. Overall survival was poorer in cachectic compared to non-cachectic patients (3-factor classification, P=0.0052; consensus classification, P=0.056; when pre-cachexia was included in the consensus classification, P=0.027). Both classifications showed a trend towards lower median survival (P<0.05) with the presence of cachexia. In conclusion, the two classifications showed good overall agreement in defining cachectic pancreatic cancer patients, and cachexia was associated with poorer survival according to both

Comparing two Classifications of Cancer Cachexia and Their Association with Survival in Patients with Unresected Pancreatic Cancer

There is no universally accepted definition of cancer cachexia. Two classifications have been proposed; the 3-factor classification requiring ≥2 of 3 factors; weight loss ≥10%, food intake ≤1500 kcal/day, and C-reactive protein ≥10 mg/l, and the consensus classification requiring weight loss >5% the past 6 mo, or body mass index 2%. Precachexia is the initial stage of the cachexia trajectory, identified by weight loss ≤5%, anorexia and metabolic change. We examined the consistency between the 2 classifications, and their association with survival in a palliative cohort of 45 (25 men, median age of 72 yr, range 35–89) unresected pancreatic cancer patients. Computed tomography images were used to determine sarcopenia. Height/weight/C-reactive protein and survival were extracted from medical records. Food intake was self-reported. The agreement for cachexia and noncachexia was 78% across classifications. Survival was poorer in cachexia compared to noncachexia (3-factor classification, P = 0.0052; consensus classification, P = 0.056; when precachexia was included in the consensus classification, P = 0.027). Both classifications showed a trend toward lower median survival (P < 0.05) with the presence of cachexia. In conclusion, the two classifications showed good overall agreement in defining cachectic pancreatic cancer patients, and cachexia was associated with poorer survival according to both

Alterations in inflammatory biomarkers and energy intake in cancer cachexia: a prospective study in patients with inoperable pancreatic cancer

Chronic systemic inflammatory response is proposed as an underlying mechanism for development of cancer cachexia. We conducted a prospective study to examine changes in inflammatory biomarkers during the disease course and the relationship between inflammatory biomarkers and cachexia in patients with inoperable pancreatic cancer. Twenty patients, median (range) age 67.5 (35–79) years, 5 females, were followed for median 5.5 (1–12) months. Cachexia was diagnosed according to the 2011 consensus-based classification system (weight loss >5 % past six months, BMI 2 %, or sarcopenia) and the modified Glasgow Prognostic score (mGPS) that combines CRP and albumin levels. Inflammatory biomarkers were measured by enzyme immunoassays. The patients had increased levels of most inflammatory biomarkers, albeit not all statistically significant, both at study entry and close to death, indicating ongoing inflammation. According to the consensus-based classification system, eleven (55 %) patients were classified as cachectic upon inclusion. They did not differ from non-cachectic patients with regard to inflammatory biomarkers or energy intake. According to the mGPS, seven (35 %) were defined as cachectic and had a higher IL-6 (p < 0.001) than the non-cachectic patients. They also had a slightly, but insignificantly longer survival than non-cachectic patients (p = 0.08). The mGPS should be considered as an additional framework for identification of cancer cachexia