Malnutrition and Clinical Outcomes in Surgical Patients With Colorectal Disease

Abstract

BACKGROUND: Malnutrition is a frequent condition among hospitalized patients and a factor of increased risk of postoperative complication. OBJECTIVE: This study aimed to evaluate the impact of malnutrition on phase angle (PA), body water distribution and clinical outcomes in surgical patients with colorectal disease. METHODS: This retrospective study was performed in a tertiary hospital with 40 patients admitted electively. In the preoperative evaluation, global subjective assessment and bioelectrical impedance analysis were performed to determine nutritional status, PA, extracellular water (ECW), intracellular water (ICW) and total body water (TBW). In postoperative evaluation, the length of hospital stay and severe complications, according to Clavien-Dindo classification, were determined. The optimal PA cutoff for malnutrition screening was determined by ROC curve analysis. RESULTS: Seventeen (42.5%) patients were diagnosed as malnourished and 23 (57.5%) as well-nourished according to global subjective assessment. Twelve (30.0%) patients developed severe complications. The malnourished group presented lower values of serum albumin (P=0.012), hematocrit (P=0.026) and PA (P=0.002); meanwhile, ECW/ICW (P=0.019) and ECW/TBW (P=0.047) were higher. Furthermore, 58.8% of malnourished patients developed severe postoperative complications compared to 8.7% of well-nourished. Malnutrition was independent predictor of severe postoperative complications (OR=15.00, IC: 2.63-85.68, P=0.002). The optimal PA cutoff obtained was 6.0º (AUC=0.82, P=0.001), yielding sensitivity, specificity, positive predictive value and negative predictive value of 76.5%, 87.0%, 81.3% and 83.4%, respectively. CONCLUSION: Malnutrition was an independent predictive factor for severe complications in patients underwent to elective major coloproctological surgery. Besides that, malnutrition was associated with lower PA values and greater ratio of ECW. The PA provided great accuracy in nutritional screening, implying a useful marker of malnutrition.

The Association Between Extracellular Water-to-Total Body Water Ratio and Therapeutic Durability for Advanced Lung Cancer

“…Accumulation of these changes and cell damage leads to apoptosis, which subsequently causes decreased muscle strength, gait instability, falls, fractures, respiratory infections, confusion, renal failure, increased medication toxicity, and an increased risk of death (25,28,29). Based on previous studies that have indicated an association between a high ECW/TBW and postoperative complications, such as infection (30,31), we hypothesized that a high ECW/TBW might predict poor clinical outcomes after treatment for advanced lung cancer, and our findings appear to support this hypothesis.…”

Presence of dynapenia and association with anthropometric variables in cancer patients

“…Malnutrition is associated with a worse prognosis, the presence of complications and a reduced response to treatment, in addition to increasing the length of hospital stay and being an independent factor for shorter survival [4][5][6]. Anorexia is often observed, along with a rapid loss of adipose tissue, tissue loss, and skeletal muscle atrophy [7], which may or may not progress to cachexia [8].…”

The Association of Disease Activity, BMI and Phase Angle with Vitamin D Deficiency in Patients with IBD

“…Furthermore, with specific attention to vitamin D, it is possible to identify many other factors affecting vitamin D serum levels; some of them are linked with the environment, such as the season or the latitude, while others correlate with some specific patient characteristics, like age, gender or anthropometric values [37,38]. In the specific case of IBD, analyzing vitamin D levels while taking environmental factors into consideration reveals in many studies that vitamin D levels are higher in summer than in winter, and that the incidence of hypovitaminosis D is higher in the Northern than in the Southern population [1,2,21,27,39,40].…”