Effect of individualized nutrition interventions on clinical outcomes of pregnant women with gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)can lead to excessive pregnancy weight gain(PWG),abnormal glucolipid metabolism,and delayed lactation.Therefore,it is necessary to provide appropriate and effective interventions for pregnant women with GDM.AIM To clarify the effects of individualized nutrition interventions on PWG,glucolipid metabolism,and lactation in pregnant women with GDM.METHODS The study population consisted of 410 pregnant women with GDM who received treatment at the Northern Jiangsu People's Hospital of Jiangsu Provinceand Yangzhou Maternal and Child Health Hospital between December 2020 and December 2022,including 200 who received routine in-terventions[control(Con)group]and 210 who received individualized nutrition interventions[research(Res)group].Data on PWG,glucolipid metabolism[total cholesterol,(TC);triglycerides(TGs);fasting blood glucose(FPG);glycosylated hemoglobin(HbA1c)],lactation time,perinatal complications(cesarean section,premature rupture of membranes,postpartum hemorrhage,and pregnancy-induced hypertension),and neonatal adverse events(premature infants,fetal macrosomia,hypo-glycemia,and respiratory distress syndrome)were collected for comparative analysis.RESULTS The data revealed markedly lower PWG in the Res group vs the Con group,as well as markedly reduced TG,TC,FPG and HbA1c levels after the intervention that were lower than those in the Con group.In addition,obviously earlier lactation and statistically lower incidences of perinatal complications and neonatal adverse events were observed in the Res group.CONCLUSION Individualized nutrition interventions can reduce PWG in pregnant women with GDM,improve their glucolipid metabolism,and promote early lactation,which deserves clinical promotion.

Diagnosis of malnutrition in cancer patients

Malnutrition is a common complication in patients with malignant tumors and adversely affects treatment and prognosis1.It has been reported that the global prevalence of malnutrition in hospitalized patients with malignant tumors is approximately 70%2.Moreover,approximately 20%of cancer patient deaths are directly attributable to malnutrition3.According to the Investigation on Nutrition Status and its Clinical Outcome of Common Cancers(INSCOC)project4,the overall prevalence of malnutrition in Chinese inpatients with common malignant tumors is 80.4%.Of the 58.

The Awareness of Jazan Females about the Nutrition Related Effects of Polycystic Ovary Syndrome

Introduction: Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in premenopausal women affecting 5% - 10% women in reproductive age. Many studies show that good dietary habits and balanced diet in addition to regular exercise can significantly improve the symptoms of the syndrome. The prevalence rate in the Kingdom of Saudi Arabia reached 42.8%. This study aimed to measure the awareness of Jazan females about the nutrition related effects of polycystic ovary syndrome and investigate the association between age and awareness of nutrition related effect on PCOS. Method: Cross sectional study was conducted during a period from January 9th to February 5th 2023, by a questionnaire used to measure the awareness of female in Jazan region about the nutrition related effects of poly cystic ovary syndrome. Data was collected using Google questionnaire survey and it was randomly distributed to Jazan women from 18 to 50 years old. The questionnaire was about general information about PCOS, nutrition-related effects of PCOS, the effects of eating patterns on PCOS, physical activity, and sleeping. The sample size was 384 women. Results: The total response was about 363 women. The results showed that women in the Jazan region did not have sufficient knowledge about PCOS 51.5% and 63.4% had no knowledge about diet recommendations for PCOS. However, there was awareness about healthy eating patterns that reduce the symptoms of PCOS. The level of awareness of PCOS and its association with age among Jazan women was higher in young adult groups (21 to 29 years old). Conclusion: Based on the results of this study, the level of knowledge about PCOS among Jazan women is insufficient. Also, their awareness about diet and lifestyle interventions was low. There is a relationship between age and awareness of the nutrition-related effects of PCOS. Promoting the role of balanced nutrition and nutritional knowledge is an important requirement for all women, especially those with PCOS. The role of health, educational, and governmental institutions is important in spreading the link between nutrition and PCOS.

Malnutrition and Quality of Life in Chinese Cancer Patients: a Clinical Study of 23,994 Subjects

Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.

Extension Protocol for the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC)Study:2021 update

Background Malnutrition is common in patients with cancer,and this adversely affects the survival and quality of life of patients.Chinese Society for Nutritional Oncology issued a multi-center,large-scale,long-term follow-up prospective study,the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC study)since 2013.This is an extension to the previous 2013-2020 study protocol.This study still sought to:①address the prognostic impact of nutritional factors and quality of life on cancer patient survival;②describe the overall and cancer-specific incidence and/or distribution of malnutrition and different measurements of patient quality of life.Methods and study design This is an observational,multi-centered,hospital-based prospective cohort study.Data collection will be performed at baseline(within 48 hours after patient admission),during the hospital stay and 30 days after hospital admission.Follow-up will be conducted for 1-20 years after enrollment.The primary outcome will be the all-cause mortality/overall survival,and secondary outcomes will be the length of hospital stay and costs of hospitalization.Study factors will include demographic characteristics,tumor characteristics,information about chronic diseases,hematological measurements(e.g.,red blood cell count,total lymphocyte counts,hemoglobin,albumin,prealbumin,creatinine,C-reactive protein,IL-6),anthropometric measurements(e.g.,height,weight,arm circumference,arm muscle circumference,triceps skinfold thickness,and waist circumference),body composition parameters,PG-SGA scores,quality of life(as indicated by the QLQ-C30 questionnaire),muscle mass(as indicated by the calf circumference),muscle strength(as indicated by the handgrip strength),muscle function(as indicated by the six-meter walking speed test)and physical status assessments(as indicated by the Karnofsky Performance Status scores).This clinical study protocol was approved by local Ethics Committees of all the participating hospitals.Written informed consent is required for each subject included.Discussion This multi-center,large-scale,long-term follow up prospective study will help improve the diagnosis of malnutrition in cancer patients and identify the risk factors associated with adverse clinical outcomes.The anticipated results of this study will highlight the need for a truly scientific appraisal of nutrition therapy in Chinese oncology populations,and finally help treat the potentially reversible elements of malnutrition in cancer patients to improve their clinical outcomes in the future.

Tofacitinib for ulcerative colitis: A promising treatment option

A single center retrospective clinical study revealed the efficacy and safety of tofa-citinib in the treatment of ulcerative colitis(UC).This study has clinical reference value but also has some limitations.Previous studies,including this clinical trial,have shown that tofacitinib could be a promising treatment option for UC,but further clinical research is required to prove this point.

Longitudinal changes in body weight of breastfeeding mothers in the first year after delivery and its relationship with human milk composition:a combined longitudinal and cross-sectional cohort study

Objective:Postpartum weight retention(PPWR)is a common problem among women after childbirth.The main objectives of this study are to understand the changes in body weight of breastfeeding mothers during long-term follow-up and preliminarily explore the relationship between maternal body weight and human milk composition,including macronutrients,leptin,and adiponectin.Methods:The study included a longitudinal cohort(122 mothers),and a cross-sectional cohort(37 mothers).The human milk,maternal weight,and dietary surveys were collected in the longitudinal cohort at different follow-up time points(1-14 days postpartum,2-4 months postpartum,5-7 months postpartum,and 12-17 months postpartum).The maternal body weight was analyzed using the responses in the survey questionnaires.A milk analyzer based on the mid-infrared spectroscopy(MIRS)was used to determine milk composition,and nutrition analysis software evaluated dietary intakes.In the cross-sectional cohort,participating mothers were asked to provide blood and human milk samples and pertinent information related to maternal body composition.Maternal body composition was measured by bioelectrical impedance analysis(BIA),while ELISA analyzed leptin and adiponectin in milk and serum.Results:At 5-7 months postpartum,the PPWR of breastfeeding mothers was(2.46±3.59)kg.At 12-17 months postpartum,the PPWR was(0.98±4.06)kg.PPWR was found to be negatively correlated with milk fat content within 14 days postpartum and positively correlated at 2-4 months postpartum.In addition,the maternal weight and body muscle mass were positively correlated with leptin and adiponectin in milk.Plasma leptin was positively correlated with the mother’s body weight,body mass index(BMI),FAT percentage,and body fat mass,while plasma adiponectin did not correlate with any parameter.The results also indicate that the PPWR did not correlate with leptin and adiponectin in plasma or milk.Conclusions:Breastfeeding mothers may retain considerable weight gain one year after delivery.Human milk composition may be related to changes in maternal body weight.Leptin and adiponectin in breast milk and leptin in plasma are associated with the maternal body composition.This study supports the notion that maternal nutritional status may affect offspring health through lactation,and future research should focus on exploring weight management of postpartum mothers.

Correlation of dietary mineral intake and malnutrition in cancer patients:A multicenter cross-sectional study

Background:To examine the correlation between the dietary mineral intake and the nutritional status of patients suffering from malignan-cies.Methods:This multi-center cross-sectional study included a total of 866 patients with malignant tumors recruited from seven hospitals throughout China.The information of socio-demographic characteristics and biochemical indicators were obtained from electronic medical records of inpatients.Dietary data were collected using a 3-day 24-hour dietary recall questionnaire.The intake of energy,dietary calcium(Ca),phosphorus(P),potassium(K),sodium(Na),magnesium(Mg),iron(Fe),zinc(Zn),selenium(Se),copper(Cu)and manganese(Mn)were estimated according to the Chinese Food Composition Tables standard edition.The weight and height of patients were measured,and the body mass index(BMI)was calculated.Nutritional risk and malnutrition were assessed by the Nutritional Screening 2002(NRS 2002)and Global Leadership Initiative on Malnutrition(GLIM)diagnostic criteria.We used a multivariable logistic regression model to estimate the asso-ciations between dietary minerals and malnutrition.Results:The patients had an average age of 61.98(±15.49)years,and 40.6%(n=352)were female.Slightly less than half(44.5%)of the patients were at nutritional risk(NRS 2002≥3),and 32.7%were diagnosed with malnutrition(using the GUM criteria).Univariate analy-ses revealed that there was a statistically significant relationship between dietary mineral intake and the occurrence of nutritional risk(P<0.001).After adjusting the collinearity,we found that higher levels of P,Mn and Se intake were negatively associated with nutritional risk as-sessed by the NRS 2002 score.Moderate intake of Ca and high intake of Zn might also decrease the nutritional risk(Ca:OR,0.53,95%CI,0.32-0.88;Zn:OR,0.36,95%CI,0.19-0.68).However,no significant relationships were observed between any dietary mineral intake and malnutrition identified by the GUM criteria.Conclusions:Dietary minerals,especially P,Se,and Mn,may have a protective effect on the occurrence of nutritional risk in patients with malignant tumors.In addition,patients should maintain appropriate levels of Ca and Zn.

Efficacy of Raw Corn Starch in Insulinoma-Related Hypoglycemia:A Promising Supportive Therapy

Objective To investigate the efficacy of raw corn starch(RCS)in clinical management of insulinoma-induced hypoglycemia.Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively,and analyzed the therapeutic effects of the RCS intervention on blood glucose control,weight change,and its adverse events.Results The study population consisted of 24 cases of insulinoma patients,7 males and 17 females,aged 46.08±14.15 years.Before RCS-supplemented diet,all patients had frequent hypoglycemic episodes(2.51±3.88 times/week),concurrent with neuroglycopenia(in 83.3% of patients)and autonomic manifestations(in 75.0% of patients),with the median fasting blood glucose(FBG)of 2.70(interquartile range[IQR]:2.50-2.90)mmol/L.The patients'weight increased by 0.38(IQR:0.05-0.65)kg per month,with 8(33.3%)cases developing overweight and 7(29.2%)cases developing obesity.All patients maintained the RCS-supplemented diet until they underwent tumor resection(23 cases)and transarterial chemoembolization for liver metastases(1 case).For 19 patients receiving RCS throughout the day,the median FBG within one week of nutritional management was 4.30(IQR:3.30-5.70)mmol/L,which was a significant increase compared to pre-nutritional level[2.25(IQR:1.60-2.90)mmol/L;P<0.001].Of them,10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment[3.20(IQR:2.60-3.95)mmol/L vs.2.15(IQR:1.83-2.33)mmol/L;P<0.001].Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management[3.50(IQR:2.50-3.65)mmol/L vs.2.20(IQR:1.80-2.60)mmol/L;P<0.001],but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG.No improvement in weight gain was observed upon RCS supplementation.Mild diarrhea(2 cases)and flatulence(1 case)occurred,and were relieved by reduction of RCS dose.Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength,as well as a decline in functional ability,which is associated with malnutrition,hormonal changes,chronic inflammation,distur-bance of intestinal flora,and exercise quality.Pancreatoduodenectomy is a com-monly employed clinical intervention for conditions such as pancreatic head cancer,ampulla of Vater cancer,and cholangiocarcinoma,among others,with a notably high rate of postoperative complications.Sarcopenia is frequent in patients undergoing pancreatoduodenectomy.However,data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy(PD)are both limited and inconsistent.The PubMed,Cochrane Library,Web of Science,and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD.Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria.Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted.Forest and funnel plots were used,respectively,to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias.RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis.The patients in the sarcopenia group(n=833)had higher overall postoperative complication rates[odds ratio(OR)=3.42,95%confidence interval(CI):1.95-5.99,P<0.0001],higher Clavien-Dindo class≥Ⅲ major complication rates(OR=1.41,95%CI:1.04-1.90,P=0.03),higher bacteremia rates(OR=4.46,95%CI:1.42-13.98,P=0.01),higher pneumonia rates(OR=2.10,95%CI:1.34-3.27,P=0.001),higher pancreatic fistula rates(OR=1.42,95%CI:1.12-1.79,P=0.003),longer hospital stays(OR=2.86,95%CI:0.44-5.28,P=0.02),higher mortality rates(OR=3.17,95%CI:1.55-6.50,P=0.002),and worse overall survival(hazard ratio=2.81,95%CI:1.45-5.45,P=0.002)than those in the non-sarcopenia group(n=1548).However,no significant inter-group differences were observed regarding wound infections,urinary tract infections,biliary fistulas,or postoperative digestive bleeding.CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD.Patients with preoperative sarcopenia have increased rates of complications and mortality,in addition to a poorer overall survival rate and longer hospital stays after PD.

Identification of male schizophrenia patients using brain morphology based on machine learning algorithms

BACKGROUND Schizophrenia is a severe psychiatric disease,and its prevalence is higher.However,diagnosis of early-stage schizophrenia is still considered a challenging task.AIM To employ brain morphological features and machine learning method to differentiate male individuals with schizophrenia from healthy controls.METHODS The least absolute shrinkage and selection operator and t tests were applied to select important features from structural magnetic resonance images as input features for classification.Four commonly used machine learning algorithms,the general linear model,random forest(RF),k-nearest neighbors,and support vector machine algorithms,were used to develop the classification models.The performance of the classification models was evaluated according to the area under the receiver operating characteristic curve(AUC).RESULTS A total of 8 important features with significant differences between groups were considered as input features for the establishment of classification models based on the four machine learning algorithms.Compared to other machine learning algorithms,RF yielded better performance in the discrimination of male schizophrenic individuals from healthy controls,with an AUC of 0.886.CONCLUSION Our research suggests that brain morphological features can be used to improve the early diagnosis of schizophrenia in male patients.

Preoperative controlling nutritional status as an optimal prognostic nutritional index to predict the outcome for colorectal cancer

BACKGROUND The controlling nutritional status(CONUT)score effectively reflects a patient’s nutritional status,which is closely related to cancer prognosis.This study invest-igated the relationship between the CONUT score and prognosis after radical surgery for colorectal cancer,and compared the predictive ability of the CONUT score with other indexes.AIM To analyze the predictive performance of the CONUT score for the survival rate of colorectal cancer patients who underwent potentially curative resection.METHODS This retrospective analysis included 217 patients with newly diagnosed colorectal.The CONUT score was calculated based on the serum albumin level,total lymphocyte count,and total cholesterol level.The cutoff value of the CONUT score for predicting prognosis was 4 according to the Youden Index by the receiver operating characteristic curve.The associations between the CONUT score and the prognosis were performed using Kaplan-Meier curves and Cox regression analysis.RESULTS Using the cutoff value of the CONUT score,patients were stratified into CONUT low(n=189)and CONUT high groups(n=28).The CONUT high group had worse overall survival(OS)(P=0.013)and relapse-free survival(RFS)(P=0.015).The predictive performance of CONUT was superior to the modified Glasgow prognostic score,the prognostic nutritional index,and the neutrophil-to-lymphocyte ratio.Meanwhile,the predictive performances of CONUT+tumor node metastasis(TNM)stage for 3-year OS[area under the receiver operating characteristics curve(AUC)=0.803]and 3-year RFS(AUC=0.752)were no less than skeletal muscle mass index(SMI)+TNM stage.The CONUT score was negatively correlated with SMI(P<0.01).CONCLUSION As a nutritional indicator,the CONUT score could predict long-term outcomes after radical surgery for colorectal cancer,and its predictive ability was superior to other indexes.The correlation between the CONUT score and skeletal muscle may be one of the factors that play a predictive role.

Influence of the continuing COVID-19 epidemic on sleep quality and psychological status of healthcare workers in private institutions

BACKGROUND On January 22,2020,Macao reported its first case of coronavirus disease 2019(COVID-19)infection.By August 2021,the situation had escalated into a crisis of community transmission.In response,the government launched a recruitment campaign seeking assistance and services of healthcare workers(HCWs)from the private sector throughout Macao.These participants faced concerns about their own health and that of their families,as well as the responsibility of maintaining public health and wellness.This study aims to determine whether the ongoing epidemic has caused them physical and psychological distress.AIM To examine the influence of COVID-19 on the sleep quality and psychological status of HCWs in private institutions in Macao during the pandemic.METHODS Data were collected from December 2020 to January 2022.Two consecutive surveys were conducted.The Pittsburgh Sleep Quality Index(PSQI)scale,Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were employed as investigation tools.RESULTS In the first-stage survey,32%of HCWs experienced a sleep disorder,compared to 28.45%in the second-stage survey.A total of 31.25%of HCWs in the first-stage survey and 28.03%in the second had varying degrees of anxiety.A total of 50.00%of HCWs in the first-stage survey and 50.63%in the second experienced varying degrees of depression.No difference in PSQI scores,SAS scores,or SDS scores were observed between the two surveys,indicating that the COVID-19 epidemic influenced the sleep quality and psychological status of HCWs.The negative influence persisted over both periods but did not increase remarkably for more than a year.However,a positive correlation was observed between the PSQI,SAS,and SDS scores(r=0.428-0.775,P<0.01),indicating that when one of these states deteriorated,the other two tended to deteriorate as well.CONCLUSION The sleep quality,anxiety,and depression of HCWs in private institution in Macao were affected by the COVID-19 epidemic.While these factors did not deteriorate significantly,the negative effects persisted for a year and remained noteworthy.

Development and validation of a nomogram for predicting the probability of serious complication in esophageal cancer patients after esophagectomy

Background:Esophagectomy remains a procedure with one of the highest complication rates.This study aimed to develop and validate a model of nomogram for predicting the probability serious postoperative complications for the postoperative esophageal cancer(EC)patients.Methods:An observational study was conducted at Daping Hospital,China,encompassing 529 postoperative EC patients from December 2014 to November 2023.Weintegrated independent prognostic factors to craft a predictivemodel,specifically a nomogram,designed to forecast the risk of severe postoperative complications.Results:The incidence of serious complications for postoperative EC patients was 58.1%.A total of seven variables,including age,gender,bleeding volume during the operation(P=0.035),operating time(P=0.031),the Nutritional Risk Screening 2002(NRS 2002)score(P=0.027),the perioperative nutrition screen(PONS)score(P=0.018),and cystatin C levels(P<0.001),were applied to draw the nomogram of predicting serious complications after esophagectomy.The accuracy of predictive value for the model was quantified by Harrell’s C index at 0.690(95%confidence interval=0.596-0.785,P<0.001).Conclusion:We developed a nomogram system to demonstrate exceptional predictive capabilities for postoperative EC patients in forecasting the risk of serious complications.These results also emphasize the predictive value of the preoperative nutritional risk screening with NRS 2002 and PONS in EC patients undergoing esophagectomy.

Investigation on quality of life of hospitalized patients in China with digestive system malignancy

Background:The purpose of this study is to evaluate the quality of life(QoL)of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.Methods:The European Organization for Research and Treatment Core Quality of Life questionnaire(EORTC QLQ-C30)was applied to evaluate the QoL of 23,519 patients with six digestive malignancies(esophageal cancer,gastric cancer,colorectal cancer,liver cancer,biliary tract cancer,and pancreatic cancer).A t test or analysis of variance was employed to analyze the total EORTC QLQ-C30 scale scores and domain scores of the EORTC QLQ-C30 scale among patients in different subgroups.Results:The average QoL score was 50.4±10.8.The tumor type,age,sex,and TNM stage all had an impact on QoL ratings.Colorectal cancer patients had a better total QoL score(49.3±10.3)and scores in the domains of functioning,withmilder symptoms,except for diarrhea.Patients with biliary tract cancer(54.2±12.3)and pancreatic cancer(54.2±12.3)reported a poorer QoL,significant functional impairment,and more pronounced symptoms.Patients with esophageal cancer experienced the most severe financial difficulties(35.2±27.5).Patients aged≥65 years,women,and those with TNM stage III/IV reported lower QoL.In addition,the disparities in total QoL scores and scores in specific domains were significant among patients with some types of tumors,and based on ethnicity,educational level,occupation,treatment(s)received,and place of residence.Conclusions:There is a need to focus on elderly individuals,those with low educational levels,and patients with progressivemalignant tumors and to improve routine disease monitoring and symptom management to enhance the quality of life for patients with malignancies of the digestive system.

Development and validation of a nutrition-related genetic-clinical-radiological nomogram associated with behavioral and psychological symptoms in Alzheimer’s disease

Background:Few evidence is available in the early prediction models of behavioral and psychological symptoms of dementia(BPSD)in Alzheimer’s disease(AD).This study aimed to develop and validate a novel genetic-clinical-radiological nomogram for evaluating BPSD in patients with AD and explore its underlying nutritional mechanism.Methods:This retrospective study included 165 patients with AD from the Chinese Imaging,Biomarkers,and Lifestyle(CIBL)cohort between June 1,2021,and March 31,2022.Data on demographics,neuropsychological assessments,single-nucleotide polymorphisms of AD risk genes,and regional brain volumes were collected.A multivariate logistic regression model identified BPSD-associated factors,for subsequently constructing a diagnostic nomogram.This nomogram was internally validated through 1000-bootstrap resampling and externally validated using a time-series split based on the CIBL cohort data between June 1,2022,and February 1,2023.Area under receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA)were used to assess the discrimination,calibration,and clinical applicability of the nomogram.Results:Factors independently associated with BPSD were:CETP rs1800775(odds ratio[OR]=4.137,95%confidence interval[CI]:1.276-13.415,P=0.018),decreased Mini Nutritional Assessment score(OR=0.187,95%CI:0.086-0.405,P<0.001),increased caregiver burden inventory score(OR=8.993,95%CI:3.830-21.119,P<0.001),and decreased brain stem volume(OR=0.006,95%CI:0.001-0.191,P=0.004).These variables were incorporated into the nomogram.The area under the ROC curve was 0.925(95%CI:0.884-0.967,P<0.001)in the internal validation and 0.791(95%CI:0.686-0.895,P<0.001)in the external validation.The calibration plots showed favorable consistency between the prediction of nomogram and actual observations,and the DCA showed that the model was clinically useful in both validations.Conclusion:A novel nomogram was established and validated based on lipid metabolism-related genes,nutritional status,and brain stem volumes,which may allow patients with AD to benefit from early triage and more intensive monitoring of BPSD.Registration:Chictr.org.cn,ChiCTR2100049131.

NRS2002 assesses nutritional status of leukemia patients undergoing hematopoietic stem cell transplantation

Objective： To discuss whether nutritional risk screening 2002 （NRS2002） is appropriate for nutritional risk screening for leukemia patients before and after hematopoietic stem cell transplantation （HSCT）, and whether there are risk differences in other conditions, such as age, gender and matching degree; to find the methods and indicators of nutritional risk screening for these patients before and after HSCT, in order to give timely intervention to guarantee the successful completion of the entire transplantation process. Methods： Nutritional risk of 99 leukemia patients was screened with NRS2002 before and after HSCT. The ^（2 test was applied to compare the risk differences between groups such as age, gender and matching degree, while the differences of other enumeration data, such as recent （1-3 months） weight loss, reduced food intake within one week and BMI, were compared by continuity correction. Results： Of the 99 leukemia patients, 22 cases （22.2 %） had nutritional risk before HSCT, while all patients had nutritional risk after ttSCT; there is no significant difference in nutritional risk between male and female, and patients of less than 30 years old, not-full matched, recent （1-3 months） weight loss, reduced food intake within a week or BMI 〈18.5 were more likely to have nutritional risk; and 77 cases （77.8%） had weight loss, among which 49 patients （63.6%） had more than 5% weight loss within one month. Conclusions= This study showed that leukemia patients should receive the nutritional risk screening conventionally before and after HSCT, and NRS2002 was only appropriate for nutritional risk screening before HSCT. More attention should be paid to the patients less than 30 years old or not-full matched. Weight change was one of the important nutritional indicators for patients after HSCT.

Evaluating the Nutritional Status of Oncology Patients and Its Association with Quality of Life

Objective The primary aim of the study was to compare two nutritional status evaluation tools： the Patient-Generated Subjective Global Assessment（PG-SGA） and Nutritional Risk Screening（NRS-2002）. Using the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30（EORTC QLQ-C30）, the second aim was to provide constructive advice regarding the quality of life of patients with malignancy. Methods This study enrolled 312 oncology patients and assessed their nutritional status and quality of life using the PG-SGA, NRS-2002, and EORTC QLQ-C30. Results The data indicate that 6% of the cancer patients were well nourished. The SGA-A had a higher sensitivity（93.73%） but a poorer specificity（2.30%） than the NRS-2002（69.30% and 25.00%, respectively） after comparison with albumin. There was a low negative correlation and a high similarity between the PG-SGA and NRS-2002 for evaluating nutritional status, and there was a significant difference in the median PG-SGA scores for each of the SGA classifications（P 〈 0.001）. The SGA-C group showed the highest PG-SGA scores and lowest body mass index. The majority of the target population received 2 points for each item in our 11-item questionnaire from the EORTC QLQ-C30. Conclusion The data indicate that the PG-SGA is more useful and suitable for evaluating nutritional status than the NRS-2002. Additionally, early nutrition monitoring can prevent malnutrition and improve the quality of life of cancer patients.

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.

Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer

AIM： To investigate the role of subjective global assessment （SGA） in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer. METHODS： A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study. Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient. The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained.RESULTS： Based on the results of SGA, 389 （51.8%）, 332 （44.2%）, and 30 （4.0%） patients were classified into well nourished group （SGA-A）, mildly to moderately malnourished group （SGA-B）, and severely malnourished group （SGA-C）, respectively. The prevalence of malnutrition classified by SGA, triceps skinfold thickness （TSF）, mid-upper arm muscle circumference （MAMC）, albumin （ALB）, prealbumin （PA）, and body mass index （BMI） was 48.2%, 39.4%, 37.7%, 31.3%, 21.7%, and 9.6%, respectively. In addition, ANOVA tests revealed significant differences in body mass index （BMI）, TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were （P 〈 0.05）. x^2 tests showed a significant difference in SGA classification between patients receiving different types of treatment （surgery vs chemotherapy/radiotherapy）. As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly. Furthermore, multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery. The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group （23.3%） and the lowest in the SGA-A group （16.8%）. CONCLUSION： SGA is a reliable assessment too and helps to predict the hospital stay and medica expenditures of Chinese surgical gastrointestina cancer patients.