Actuality and underlying mechanisms of systemic immuneinflammation index and geriatric nutritional risk index prognostic value in hepatocellular carcinoma

This editorial contains comments on the article“Correlation between preoperative systemic immune inflammation index,nutritional risk index,and prognosis of radical resection of liver cancer”in a recent issue of the World Journal of Gastrointestinal Surgery.It pointed out the actuality and importance of the article and focused primarily on the underlying mechanisms making the systemic immuneinflammation index(SII)and geriatric nutritional risk index(GNRI)prediction features valuable.There are few publications on both SII and GNRI together in hepatocellular carcinoma(HCC)and patient prognosis after radical surgery.Neutrophils release cytokines,chemokines,and enzymes,degrade extracellular matrix,reduce cell adhesion,and create conditions for tumor cell invasion.Neutrophils promote the adhesion of tumor cells to endothelial cells,through physical anchoring.That results in the migration of tumor cells.Pro-angiogenic factors from platelets enhance tumor angiogenesis to meet tumor cell supply needs.Platelets can form a protective film on the surface of tumor cells.This allows avoiding blood flow damage as well as immune system attack.It also induces the epithelial-mesenchymal transformation of tumor cells that is critical for invasiveness.High SII is also associated with macro-and microvascular invasion and increased numbers of circulating tumor cells.A high GNRI was associated with significantly better progression-free and overall survival.HCC patients are a very special population that requires increased attention.SII and GNRI have significant survival prediction value in both palliative treatment and radical surgery settings.The underlying mechanisms of their possible predictive properties lie in the field of essential cancer features.Those features provide tumor nutrition,growth,and distribution throughout the body,such as vascular invasion.On the other hand,they are tied to the possibility of patients to resist tumor progression and development of complications in both postoperative and cancer-related settings.The article is of considerable interest.It would be helpful to continue the study follow-up to 2 years and longer.External validation of the data is needed.

Correlation between preoperative systemic immune inflammation index, nutritional risk index, and prognosis of radical resection of liver cancer

BACKGROUND Radical surgery is the most commonly used treatment for hepatocellular carcinoma(HCC).However,the surgical effect remains not ideal,and prognostic evaluation is insufficient.Furthermore,clinical intervention is rife with uncertainty and not conducive to prolonging patient survival.AIM To explore correlations between the systemic immune inflammatory index(SII)and geriatric nutritional risk index(GNRI)and HCC operation prognosis.METHODS This retrospective study included and collected follow up data from 100 HCC.Kaplan–Meier survival curves were used to analyze the correlation between SII and GNRI scores and survival.SII and GNRI were calculated as follows:SII=neutrophil count×platelet count/lymphocyte count;GNRI=[1.489×albumin(g/L)+41.7×actual weight/ideal weight].We analyzed the predictive efficacy of the SII and GNRI in HCC patients using receiver operating characteristic(ROC)curves,and the relationships between the SII,GNRI,and survival rate using Kaplan–Meier survival curves.Cox regression analysis was utilized to analyze independent risk factors influencing prognosis.RESULTS After 1 year of follow-up,24 patients died and 76 survived.The area under the curve(AUC),sensitivity,specificity,and the optimal cutoff value of SII were 0.728(95%confidence interval:0.600-0.856),79.2%,63.2%,and 309.14,respectively.According to ROC curve analysis results for predicting postoperative death in HCC patients,the AUC of SII and GNRI combination was higher than that of SII or GNRI alone,and SII was higher than that of GNRI(P<0.05).The proportion of advanced differentiated tumors,tumor maximum diameter(5–10 cm,>10 cm),lymph node metastasis,and TNM stage III-IV in patients with SII>309.14 was higher than that in patients with SII≤309.14(P<0.05).The proportion of patients aged>70 years was higher in patients with GNRI≤98 than that in patients with GNRI>98(P<0.05).The 1-year survival rate of the SII>309.14 group(compared with the SII≤309.14 group)and GNRI≤98 group(compared with the GNRI>98 group)was lower(P<0.05).CONCLUSION The prognosis after radical resection of HCC is related to the SII and GNRI and poor in high SII or low GNRI patients.

Analysis of nutritional risk,skeletal muscle depletion,and lipid metabolism phenotype in acute radiation enteritis

BACKGROUND Radiation enteritis,which often occurs during radiation-induced acute intestinal symptoms(RIAIS),is the most common and important complication during radiotherapy for cervical cancer.RIAIS caused by abdominal and pelvic radiotherapy will affect nutrient intake,digestion,absorption,and metabolism,leading to malnutrition or poorer nutritional status.In patients with malignant tumors,malnutrition can adversely affect the curative effect and response of radiotherapy by reducing radiosensitivity,affecting the precision of radiotherapy placement and increasing the incidence of radiotherapy-related adverse reactions.AIM To analyze nutritional risk,skeletal muscle depletion,and lipid metabolism phenotype in acute radiation enteritis.METHODS Fifty patients with cervical cancer received external beam radiotherapy,and 15 patients received brachytherapy after external beam radiotherapy.Body weight,body composition parameters,nutritional risk screening(NRS)2002 score,and blood biochemical indices of patients with cervical cancer during periradiation were tested by a one-way repeated measures analysis of variance.Metabolomics analysis was used to identify characteristic lipid metabolism pathways.Clinical factors that affect linoleic acid changes were screened using the generalized evaluation equation.RESULTS Among the 50 patients,37 had RIAIS,including 34 patients with grade 1-2 RIAIS and 3 patients with grade 3 RIAIS.The NRS 2002 score of patients who underwent cervical cancer radiotherapy continued to increase during the periradiation period,and 42 patients who underwent cancer radiotherapy had nutritional deficits(NRS 2002 score≥3 points)at the end of radiotherapy.Correlation analyses revealed that body weight and body mass index changes were closely associated with body fat content(R2=0.64/0.51).The results of the univariate analysis showed that radiotherapy time,percentage reduction of serum albumin,and percentage reduction of serum prealbumin were the key factors affecting skeletal muscle exhaustion(P<0.05).Metabolomic analysis of fecal supernatants of cervical cancer patients during the periradiation period revealed the involvement of linoleic acid,cholic acid,arachidonic acid,and N-acetyl-L-benzene alanine in the metabolic pathway of linoleic acid.CONCLUSION Cervical cancer radiotherapy patients faced nutritional risks,decreased serum albumin synthesis,and increased risk of skeletal muscle exhaustion.Linoleic acid was a biomarker of high nutritional risk.

Analysis on Nutritional Risk Screening and Influencing Factors of Hospitalized Patients in Central Urban Area

Rational nutritional support shall be based on nutritional screening and nutritional assessment. This study is aimed to explore nutritional risk screening and its influencing factors of hospitalized patients in central urban area. It is helpful for the early detection of problems in nutritional supports, nutrition management and the implementation of intervention measures, which will contribute a lot to improving the patient＇s poor clinical outcome. A total of three tertiary medical institutions were enrolled in this study. From October 2015 to June 2016, 1202 hospitalized patients aged ≥18 years were enrolled in Nutrition Risk Screening 2002（NRS2002） for nutritional risk screening, including 8 cases who refused to participate, 5 cases of same-day surgery and 5 cases of coma. A single-factor chi-square test was performed on 312 patients with nutritional risk and 872 hospitalized patients without nutritional risk. Logistic regression analysis was performed with univariate analysis（P〈0.05）, to investigate the incidence of nutritional risk and influencing factors. The incidence of nutritional risk was 26.35% in the inpatients, 25.90% in male and 26.84% in female, respectively. The single-factor analysis showed that the age ≥60, sleeping disorder, fasting, intraoperative bleeding, the surgery in recent month, digestive diseases, metabolic diseases and endocrine system diseases had significant effects on nutritional risk（P〈0.05）. Having considered the above-mentioned factors as independent variables and nutritional risk（Y=1, N=0） as dependent variable, logistic regression analysis revealed that the age ≥60, fasting, sleeping disorders, the surgery in recent month and digestive diseases are hazardous factors for nutritional risk. Nutritional risk exists in hospitalized patients in central urban areas. Nutritional risk screening should be conducted for inpatients. Nutritional intervention programs should be formulated in consideration of those influencing factors, which enable to reduce the nutritional risk and to promote the rehabilitation of inpatients.

The Role of the PNI and NLR in Nutritional Risk Screening and Assessment of Gastric Cancer Patients

Background The use of nutritional risk screening and assessment is becoming increasingly common in cancer patients.The Nutritional Risk Screening 2002(NRS 2002)is a nutritional risk screening programe with good utility.The patient generated-subjective global assessment(PG-SGA)is a method used to assess the nutritional status of cancer patients.The prognostic nutritional index(PNI)and neutrophil to lymphocyte ratio(NLR)are considered to be predictors of the prognosis following treatment for patients with a variety of cancers.However,the relationship between the PNI and NLR in the nutritional screening and assessment in patients with gastric cancer is unknown.Methods A retrospective analysis was performed on 378 patients with gastric cancer who underwent surgery at the First Affiliated Hospital of Guangxi Medical University from August 2019 to December 2020.NRS 2002 and PG-SGA were performed within 24 hours of admission,and indicators such as the serum albumin level,body mass index(BMI),PNI and NLR were measured.Results In the grouping based on the NRS2002,patients in the positive group(NRS 2002≥3)had a higher platelet value,a higher median NLR,and a lower PNI than those in the negative group(NRS 2002<3)(295.50±118.49×10^(9)/L vs.269.36±93.52×10^(9)/L,2.38 vs.1.77,42.36±5.96 vs.46.64±4.29).Based on the PG-SGA grouping,the serum albumin level and lymphocyte count were highest in the mild group(PG-SGA:score 2-3),(36.94±3.51 g/L and 1.91±0.7610^(9)/L)and lowest within the severe group(PG SGA score≥9)(34.09±4.18 g/L and 1.51±0.6410^(9)/L).The BMI was highest in the mild group(23.35±3.00 kg/m^(2))and lowest in the severe group(20.63±2.97 kg/m^(2)),and the PNI was also highest in the mild group(46.50±5.17)and lowest in the severe group(41.64±5.53).However,the NLR was lowest in the mild group(median 1.91)and highest in the severe group(median 2.44).Conclusion The PNI and NLR in gastric cancer patients are closely related to the results of the nutritional risk screening and assessment,suggesting that they may be useful to guide the nutritional interventions for gastric cancer patients.

Nutritional Risk Screening with NRS2002 among Hospitalized Cancer Patients in China

Objective The Nutritional Risk Screening 2002(NRS 2002)was used to assess the nutritional risk of hospitalized oncology patients in China.This study explored the factors affecting the risk of nutrition to provide a scientific basis for the assessment and treatment of malnutrition in oncology patients.Methods We used the NRS 2002 to evaluate the nutritional risk in 48,831 hospitalized cancer patients.Descriptive statistical methods were used to describe the general patient information.A Chi-squared test was applied to analyze the relationship between NRS 2002 scores and different demographic characteristics,and the NRS 2002 scores of cancer patients with different characteristics were compared by one-way ANOVA.Results Among 48,831 patients,43.3%were women and 57.7%were men,and 36.5%(17,802)of patients were at risk of nutrition(score≥3).The NRS 2002 score was the highest in leukemia patients(2.93±1.28).A one-way ANOVA revealed that the differences in NRS 2002 scores among patients of different gender,ages,TNM stages,education levels,occupations and areas of residence were statistically significant(P<0.001).Male patients had slightly higher NRS 2002 scores than females(2.33 vs.2.17).The lowest NRS 2002 scores were in patients aged 45-59(2.00±1.26)years and the highest scores were in patients aged≥70(2.76±1.43)years.The NRS 2002 score of patients receiving surgery was the highest(2.45±1.41),and patients receiving surgery plus radiotherapy/chemotherapy was the lowest(2.00±1.26).The risk of nutrition was highest in patients who were farmers(2.34±1.37 scores)and lowest in office staff(2.15±1.32 scores).Patients living in rural areas had the highest risk of nutrition(2.32±1.37 scores).There were significant differences in the NRS 2002 scores for different cancer sub-types for different ethnic groups(P<0.05),except for Zhuang individuals(P=0.124).The risk of nutrition was highest in Uyghur patients(3.35±1.33 scores)and lowest in Mongolians(2.04±1.37 scores).Conclusion More attention should be paid to people at high risk of nutrition,such as elderly patients,patients with a high TNM stage,patients receiving surgical treatment,and patients living in rural areas.Active nutritional interventions should be carried out to improve the nutritional status of malnourished patients.

Clinical Significance of Preoperative Nutritional Risk Screening and Support in the Perioperative Period of Gastric Cancer Patients

Objective:To investigate the clinical value of using preoperative nutritional risk screening and support in gastric cancer patients.Methods:In this paper,70 gastric cancer patients selected from July 2017 to July 2020 treated in our hospital were grouped concerning the lottery method,and the reference group(n=35)used conventional nutritional support,while the experimental group(n=35)used preoperative dietary risk screening and support,comparing the clinical treatment differences between gastric cancer patients in the experimental group and the reference group.Results:After the intervention,IgA,IgM,IgG,serum albumin,complication rate,NRS score,hospitalization time and anal exhaust time of gastric cancer patients in the experimental group were compared with those in the reference group,P<0.05,and there was statistical validation analysis significance between the data indicators.P<0.05 for the comparison of IgA,IgM,IgG,serum albumin after the intervention and pre-intervention for gastric cancer patients in the experimental group and the reference group,with statistical validation analysis significance between the data indicators.Conclusion:Preoperative nutritional risk screening and support is of significant value in gastric cancer patients and can improve patients’nutritional status.

Validation of nutritional risk index method against patientgenerated subjective global assessment in screening malnutrition in colorectal cancer patients

Objective：To validate malnutrition screening tool of nutrition risk index （NRI） against patent-generated subjective global assessment （PG-SGA） as a gold standard tool in colorectal cancer patients before radiotherapy.Methods：Nutritional status of 52 volunteer colorectal cancer patients with a mean age of 54.1±16.8 years who referred to radiotherapy center were assessed by PG-SGA （gold standard method） and NRI.Serum albumin levels of patients were determined by colorimetric method.A contingency table was used to determine the sensitivity,specificity,and predictive value of the NRI in screening patients at risk of malnutrition,in comparison with the PG-SGA in patients before radiotherapy.Results：The findings of PG-SGA and NRI showed that 52％ and 45％ of patients in our study were moderately or severely malnourished respectively.The NRI had a sensitivity of 66％ and a specificity of 60％ against PG-SGA.The positive predictive value was 64％ and the negative predicative value was 62％.The agreement between NRI and PG-SGA was statistically insignificant （kappa =0.267; P＞0.05）.Conclusions：The findings of present study showed that the prevalence of malnutrition was high in patients with colorectal cancer.Moreover,NRI method had low sensitivity and specificity in assessing nutritional status of patients with cancer.It seems that the combination of anthropometric,laboratory parameters and a subjective scoring system may be helpful tools in screening of malnutrition in cancer patients.

Triceps skinfold thickness trajectories and the risk of all-cause mortality:A prospective cohort study

BACKGROUND The measurement of triceps skinfold(TSF)thickness serves as a noninvasive metric for evaluating subcutaneous fat distribution.Despite its clinical utility,the TSF thickness trajectories and their correlation with overall mortality have not been thoroughly investigated.AIM To explore TSF thickness trajectories of Chinese adults and to examine their associations with all-cause mortality.METHODS This study encompassed a cohort of 14747 adults sourced from the China Health and Nutrition Survey.Latent class trajectory modeling was employed to identify distinct trajectories of TSF thickness.Subjects were classified into subgroups reflective of their respective TSF thickness trajectory.We utilized multivariate Cox regression analyses and mediation examinations to explore the link between TSF thickness trajectory and overall mortality,including contributory factors.RESULTS Upon adjustment for multiple confounding factors,we discerned that males in the‘Class 2:Thin-stable’and‘Class 3:Thin-moderate’TSF thickness trajectories exhibited a markedly reduced risk of mortality from all causes in comparison to the‘Class 1:Extremely thin’subgroup.In the mediation analyses,the Geriatric Nutritional Risk Index was found to be a partial intermediary in the relationship between TSF thickness trajectories and mortality.For females,a lower TSF thickness pattern was significantly predictive of elevated all-cause mortality risk exclusively within the non-elderly cohort.CONCLUSION In males and non-elderly females,lower TSF thickness trajectories are significantly predictive of heightened mortality risk,independent of single-point TSF thickness,body mass index,and waist circumference.

Prognostic impact of preoperative nutritional and immune inflammatory parameters on liver cancer

The immune response to tissue damage or infection involves inflammation,a multifaceted biological process distinguished by immune cell activation,mediator secretion,and immune cell recruitment to the site of injury.Several blood-based immune-inflammatory biomarkers with prognostic significance in malignancies have been identified.In this issue of the World Journal of Gastrointestinal Surgery,they examined the prognosis of liver cancer radical resection in relation to pre-operative systemic immune-inflammation and nutritional risk indices.Comparing older and younger individuals often reveals compromised nutritional and immu-nological statuses in the former.Therefore,performing preoperative evaluations of the nutritional status and immunity in geriatric patients is critical.In addition to being a primary treatment modality,radical resection is associated with a sig-nificant mortality rate following surgery.Insufficient dietary consump-tion and an elevated metabolic rate within tumor cells contribute to the increased proba-bility of malnutrition associated with the ailment,consequently leading to a sub-stantial deterioration in prognosis.Recent studies,reinforce the importance of nu-tritional and immune-inflammatory biomarkers.Prior to surgical intervention,geriatric nutritional risk and systemic immune-inflammatory indices should be prioritized,particularly in older patients with malignant diseases.

Associations between Geriatric Nutrition Risk Index,bone mineral density and body composition in type 2 diabetes patients

BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.

Nutritional status and prognostic factors for mortality in patients admitted to emergency department observation units:a national multi-center study in China

BACKGROUND:Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical outcomes.Despite its large population,few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units(EDOUs).METHODS:Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were enrolled.Demographic information,laboratory parameters,nutritional support therapies,and 28-day mortality were recorded.Risk factors for mortality were examined using multi-variateadjusted logistic regression analysis.Receiver operating characteristic(ROC)curves for each predictor of mortality were plotted,and the area under the ROC(AUROC)curves was compared.RESULTS:A total of 2,005 eligible patients were finally enrolled.At the 28-day follow-up,1,911 patients survived,and 94 died.The group with a Nutritional Risk Screening 2002(NRS 2002)score of 3-4 points was the largest(52.01%).The number of patients receiving oral nutritional supplements,enteral nutrition(EN),parenteral nutrition(PN),and the combination of EN and PN was 425,314,853,and 413,respectively.Among the total,77.55%of patients had nutritional risk(NRS 2002≥3).The proportion of patients with high nutritional risk(NRS2002≥5)in the age group>80 years was significantly higher than that in the age group 66-80 years(29.00%vs.23.93%,P=0.032),but not significantly higher than that in the age group 18-65 years(29.00%vs.26.54%,P=0.449).Logistic regression analysis revealed that heart failure(odds ratio[OR]1.856,95%confidence interval[CI]1.087-3.167,P=0.023),consciousness(OR 2.967,95%CI 1.894-4.648,P<0.001),Acute Physiology and Chronic Health Evaluation II(APACHE II)score(OR 1.037,95%CI 1.017-1.058,P<0.001),NRS 2002 score(OR 1.286,95%CI 1.115-1.483,P=0.001),and Mini Nutritional Assessment-Short Form score(OR 0.946,95%CI 0.898-0.997,P=0.039)were all independent risk factors for 28-day mortality.APACHE II and NRS 2002 scores were superior to other predictors according to the comparison of AUROC.CONCLUSIONS:Nutritional risk is prevalent among older patients in EDOUs in China.APACHE II and NRS 2002 scores are important risk factors for mortality in patients admitted to the EDOU.Timely and appropriate nutritional screening and support measures are critical to reduce patients’length of hospital stay and mortality.

Malnutrition and Its Association with the Mortality of Patients with Femoral Intertrochanteric Fractures: A Retrospective Analysis of Japanese Patients

Background: The incidence of femoral intertrochanteric fractures in older adults is higher than that of femoral neck fractures;however, both conditions are often analyzed together as proximal femoral fractures. Considering the difference in treatment, postoperative complication, and mortality risk, these two fractures should be analyzed separately. This study aimed to analyze 1-year mortality and its risk factors in patients with surgically treated femoral intertrochanteric fractures. Methods: Consecutive patients with intertrochanteric fractures who underwent surgical interventions at our institution between January 2017 and December 2021 were retrospectively reviewed. A total of 238 patients were eligible for inclusion in this study. Patients’ demographic and clinical information were retrospectively collected. Patients were divided into the 1-year mortality (n = 16) and survival (n = 222) groups. The incidence of 1-year mortality and its independent risk factors were investigated using univariate and multivariate logistic regression analyses. Results: The mean age of patients was 85.6 ± 8.5 years. The 1-year mortality rate was 6.7% (16/238). Preoperative albumin level, the Geriatric Nutritional Risk Index (GNRI), and malnutrition status (GNRI p = 0.02, p = 0.02, and p = 0.0011, respectively). Multivariate analysis showed that malnutrition status (GNRI p = 0.035) was an independent risk factor for 1-year mortality. Conclusion: Malnutrition status assessed using GNRI (GNRI < 92) was an independent risk factor for 1-year mortality. Our findings suggest that GNRI may be an effective screening tool for predicting postoperative 1-year mortality of patients with surgically treated femoral intertrochanteric fractures.

Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients

AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student's t test and oneway analysis of variance. Spearman's rank correlation coefficients were calculated to evaluate the association between the scores and variables. RESULTS: The prevalence of malnutrition at admissionwas 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status. CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status in case of gastric cancer patients after gastrectomy.

Comprehensive evaluation of nutritional status before and after hematopoietic stem cell transplantation in 170 patients with hematological diseases

Objective： To investigate the nutritional status of patients before and after hematopoietic stem cell transplantation（HSCT）, and explore optimal methods for assessing nutritional status in patients with hematological diseases.Methods： This cohort study enrolled 170 patients who were diagnosed with hematological diseases and underwent allogeneic HSCT in the Department of Hematology, Peking University People＇s Hospital between May2011 and April 2013. We used fixed-point continuous sampling and four nutritional screening tools, Nutritional Risk Screening 2002（NRS-2002）, Mini Nutritional Assessment（MNA）, Subjective Global Assessment（SGA） and Malnutrition Universal Screening Tools（MUST）, in combination with body measurements, to extensively screen and evaluate nutritional risks and status in patients receiving HSCT before entering and after leaving laminar air flow rooms.Results： After HSCT, patients had significant reduction in weight, hip circumference, waist-hip ratio, calf circumference, mid-upper arm circumference, and suprailiac skinfold thickness compared with pre-HSCT measurements. Before HSCT, NRS-2002 identified that 21.2% of patients were at nutritional risks, compared with100% after HSCT. MUST indicated that before HSCT, 11.77% of patients were at high nutritional risk,compared with 59.63% after HSCT. MNA assessed that 0.06% of patients were malnourished before HSCT,compared with 19.27% after HSCT. SGA identified that before HSCT, 1.76% of patients had mild to severe malnutrition, which increased to 83.3% after HSCT. There is a significant increase in the nutritional risk and malnutrition in patients who received HSCT.Conclusions： Before HSCT, some patients already had nutritional risk or nutritional deficiencies, and prompt and close nutritional screening or assessment should be performed. The nutritional status of patients after HSCT was generally deteriorated compared with that before transplantation. Body measurements should be taken more frequently during the subsequent treatment window in the laminar air flow rooms. After HSCT, it is recommended to combine MNA and SGA to fully evaluate the nutritional status, and thus provide timely and reasonable nutritional support.

Comparison of two nutritional assessment methods in gastroenterology patients

AIM:To investigate and compare efficacy and differences in the nutritional status evaluation of gastroenterology patients by application of two methods:subjective global assessment(SGA) and nutritional risk index(NRI).METHODS:The investigation was performed on 299 hospitalized patients,aged 18-84 years(average life span 55.57 ± 12.84),with different gastrointe-stinal pathology,admitted to the Department of Gastroenterohepatology,Clinical and Hospital Center "Bezanijska Kosa" during a period of 180 d.All the patients,after being informed in detail about the study and signing a written consent,underwent nutritional status analysis,which included two different nutritional indices:SGA and NRI,anthropometric parameters,bioelectrical impedance analysis,and biochemical markers,within 24 h of admission.RESULTS:In our sample of 299 hospitalized patients,global malnutrition prevalence upon admission varied from 45.7% as assessed by the SGA to 63.9% by NRI.Two applied methods required different parameters for an adequate approach:glucose level(5.68 ± 1.06 mmol/L vs 4.83 ± 1.14 mmol/L,F = 10.63,P = 0.001);body mass index(26.03 ± 4.53 kg/m2 vs 18.17 ± 1.52 kg/m2,F = 58.36,P < 0.001);total body water(42.62 ± 7.98 kg vs 36.22 ± 9.32 kg,F = 7.95,P = 0.005);basal metabolic rate(1625.14 ± 304.91 kcal vs 1344.62 ± 219.08 kcal,F = 9.06,P = 0.003) were very important for SGA,and lymphocyte count was relevant for NRI:25.56% ± 8.94% vs 21.77% ± 10.08%,F = 11.55,P = 0.001.The number of malnourished patients rose with the length of hospital stay according to both nutritional indices.The discriminative function analysis(DFA) delineated the following parameters as important for prediction of nutritional status according to SGA assessment:concentration of albumins,level of proteins,SGA score and body weight.The DFA extracted MAMC,glucose level and NRI scores were variables of importance for the prediction of whether admitted patients would be classif ied as well or malnourished.CONCLUSION:SGA showed higher sensitivity to predictor factors.Assessment of nutritional status requires a multidimensional approach,which includes different clinical indices and various nutritional param eters.

The Values of the Prognostic Nutrition Index and the Patient Generated-Subjective Global Assessment during the Nutritional Assessment of Patients with Gastrointestinal Tumors

Objective To compare the value and consistency among the Patient Generated-Subjective Global Assessment(PG-SGA)and the Prognostic Nutrition Index(PNI)for assessing nutritional status in gastrointestinal tumor patients.Methods 251 patients from gastric cancer surgical ward from January 2019 to January 2020 were recruited through convenience sampling in this respective study.Nutritional screening and assessment were conducted for 251 gastrointestinal tumor patients using the nutritional risk screening 2002(NRS 2002)PG-SGA,and the PNI.PNI was calculated using the serum albumin level and the total lymphocyte count obtained from the patients’routine laboratory examination when they were admitted to the hospital.The receiver operating characteristic(ROC)of the PG SGA and the PNI were plotted with the NRS 2002 used as the gold standard,and the diagnostic value of the PG-SGA and PNI was reflected by the area under the curve(AUC),sensitivity,specificity and Youden index.We then determined the optimal cut-off for the PNI and tested the consistency of the PG-SGA and PNI.Results The optimal cut-off point for the PNI was calculated to be 50.78.The AUC of the PG-SGA was 0.908(95%CI 0.871-0.944).The sensitivity was 89.9%,specificity was 76.2%and the Youden index was 0.661.The AUC of the PNI was 0.594(95%CI 0.516-0.572).The sensitivity was 73.8%,specificity was 44.3%and the Youden index was 0.181.In the consistency test,the kappa value was 0.838(P<0.001).Conclusion The PNI is of limited value for assessing malnutrition,although it did have good consistency with the PG-SGA.The combination of the PNI and PG-SGA can be used for diagnosing assessing malnutrition in clinical practice.

Nutritional support strategies for cancer cachexia

Tumor cachexia is widely seen in patients with various stages of cancer,manifested by inadequate intake or abnormal hypermetabolism resultingin negative nitrogen and energy balance. Early intervention of nutritionaltherapy and penetrate it into other anti-cancer treatment processes cansignificantly benefit cancer patients who receiving palliative treatment.Nutritional therapy for cancer is a process of planning, implementing, evaluatingand nutritional intervention to treat cancer and its complications orphysical condition, to improve the prognosis of cancer patients, includingnutritional diagnosis (screening/evaluation), nutritional intervention, efficacyevaluation (including follow-up) three stages. In practice, we shouldchoose appropriate nutritional risk assessment tools and interventionmethods according to the actual situation of patients, avoid over-treatment,reduce complications, and maximize patients'interests as far as possible.Nutritional support therapy for cancer involves ethics, morality and thewishes of patients and their families, and needs further exploration andimprovement. The best nutritional support strategy often requires the jointparticipation of many disciplines, including clinicians, nurses, nutritionistsand psychosocial workers. Nutritional support group and multidisciplinarycollaboration group on cancer are gradually becoming a trend. With theaccumulation of experience in cancer nutrition therapy, the developmentand application of drugs and nutritional preparations, and the deepening ofmulti-disciplinary collaboration, more cancer patients will benefit in clinicalwork.

Impact of Three-month Home Enteral Nutritional Supplementation on the Nutritional Status of Patients with Malignancy

Objective We analysed the impact of home nutritional interventions on the nutritional risk and the incidence and severity of malnutrition in patients with malignancy.Methods In this prospective interventional study,we recruited 60 patients with malignancy who were at nutritional risk(NRS 2002≥3 scores).These patients were given home enteral nutritional supplementation(HES)for 3 months.The HES included nutritional counselling,oral nutritional supplements(ONS)and tube feeding.The incidence and severity of nutritional risk and malnutrition,as well as the body composition and results of routine blood tests,were compared before and after the intervention.Results A total of 58 patients completed the study.After three months of home enteral nutritional intervention,the incidence and severity of nutritional risk and malnutrition were significantly reduced(the NRS 2002 score was reduced from 3 to 1,the PG-SGA score was reduced from 8.00 to 3.00,P<0.05).The patients’body mass index(BMI)and upper arm circumference increased(P<0.05),the muscle mass,appendicular skeletal muscle mass index(ASMI)and phase angle(PA)increased(P<0.05).The serum albumin,pre-albumin and haemoglobin levels increased significantly,while the neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)decreased significantly(P<0.05).The incidence of hypoproteinaemia and anaemia also decreased significantly(P<0.05).Conclusion HES can effectively improve the nutritional status of patients and reduce the risk and severity of malnutrition.

Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis

BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.