Relationship of visceral proteins to nutritional status in chronic and acute stress

Boosalis, Maria G.; Ott, Linda; Levine, Allen S.; Slag, Michael F.; Morley, John E.; Young, Byron; McClain, Craig J.

doi:10.1097/00003246-198908000-00004

Cited by 84 publications

(36 citation statements)

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“…[21][22][23] Serum albumin, not surprisingly, was a poor indicator of nutrient intake during the early posttx period and was not maintained by TPN because it is affected by non-nutritional factors, such as the acute inflammatory response, hydration status, and liver function. [24][25][26] While a good nutritional status is considered beneficial in HCT patients, in this study, a more intact nutritional status posttx, specifically more adequate calorie and protein intake, less weight loss, and less decrease in MAMC and HGS, did not impact clinical outcomes such as engraftment, LOS, infection, or survival. This may reflect the initial nutritional status of the patients as well, since they were well nourished and, in general, over their IBW.…”

Section: Survival Datamentioning

confidence: 63%

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Roberts

Miller

Piñeiro

et al. 2003

Bone Marrow Transplant

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Summary:Autologous HCT patients often have poor oral intake for 2-4 weeks post transplant. To compare outcomes between patients provided prophylactic total parenteral nutrition (TPN) or an oral diet (OD), 55 well nourished breast cancer/ hematopoietic cell transplantation (HCT) patients were randomized to TPN (n ¼ 27), beginning day À1, or OD (n ¼ 28). Parameters studied include length of stay (LOS), engraftment, infections, survival, weight, anthropometrics, handgrip strength, and quality of life (QOL) In all, 50% of OD patients were given TPN due to poor oral intake for 10 consecutive days. No significant differences were found between the groups for any of the above parameters except weight and anthropometrics, which were better maintained in the TPN group than the OD group. Trends were seen for increased infections, more stable handgrip strength, and improved QOL in the TPN group vs the OD group. Prophylactic TPN did result in a more intact nutritional status and preservation of lean body mass post transplant but did not impact LOS or survival when compared to OD. For this reason, TPN should be reserved for autologous HCT patients with pretransplant nutritional depletion, complications post transplant, or prolonged poor oral intake. These results should not be extrapolated to allogeneic HCT patients but are likely applicable to other well nourished autologous HCT patients. The nutrition problems associated with high-dose chemotherapy and hematopoietic cell transplantation (HCT) are well known. 1-3 Most patients' oral intake is minimal for at least 2-3 weeks post transplant (posttx) and use of total parenteral nutrition (TPN) during this period is common. The preparative regimens utilized at our center typically result in significant pancytopenia and gastrointestinal (GI) toxicities, including mucositis, leading to the intuitive conclusion that TPN is necessary. Weisdorf et al 4 showed that provision of prophylactic TPN was beneficial to marrow transplant recipients. At the time our study was initiated, TPN was a standard of care posttx at our center. However, since HCT for breast cancer (CA) is relatively new, no breast CA patients were included in the aforementioned trial. Also, several advances have been made since that trial was conducted (cytokine growth factors and peripheral blood stem cell transplants), which have shortened the neutropenic period in this patient population, which, in turn, may lead to more rapid return to normal GI function. While currently the use of autologous HCT in breast CA is controversial and not currently carried out at our center, interest in HCT for breast CA still exists. [5][6][7][8] This study was carried out to compare clinical, and nutritional outcomes, as well as sense of well-being and survival, in breast CA patients undergoing HCT randomized to an oral diet vs prophylactic TPN. Patients and methodsA total of 55 females with stage II-IV breast CA undergoing high-dose chemotherapy and HCT were prospectively randomized to an oral diet (OD) (n ¼ 28) or TPN (n ¼ 27). Inst...

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Section: Survival Datamentioning

confidence: 63%

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Roberts

Miller

Piñeiro

et al. 2003

Bone Marrow Transplant

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“…It is well known that serum proteins (Fleck, 1988;Boosalis et al, 1989;Rosenthal et al, 1998) and anthropomerty (Gibson, 1990;de Onis & Habicht, 1996;Thuluvath & Triger, 1995) are affected by other factors in addition to nutritional status. To minimize these influences on the objective assessment, two or more parameters below reference values were used, including one anthropometrical parameter and one serum protein measurement.…”

Section: Discussionmentioning

confidence: 99%

“…However, the measurement of both anthropometric and biochemical values has its shortcomings (Charney, 1995) and the presence of only one parameter has, in some circumstances, low specificity (Jeejeebhoy et al, 1990). Anthropometry, which is the core-measurement (de Onis & Habicht, 1996;Lansey et al, 1993), is affected by for example, fluid retention and serum proteins by, for example, the function of the liver (Thuluvath & Triger, 1995), inflammation (Rosenthal et al, 1998) and chronic stress (Fleck, 1988;Boosalis et al, 1989). When malnutrition has been estimated using a combination of at least one anthropometrical and one biochemical variable, the sensitivity increases (Symreng et al, 1983;Lansey et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care

2002

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Objectives: To evaluate the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) with regard to validity using a combination of anthropometric and serum-protein measurements as standard criteria to assess protein-energy malnutrition (PEM). Design: Cross-sectional study with consecutive selection of residents aged ! 65 y. Setting: A municipality in the south of Sweden. Subjects: During a year, starting in October 1996, 148 females and 113 males, aged ! 65 -104 y of age, newly admitted to special types of housing for the elderly, were included in the study. Results: According to SGA, 53% were assessed as malnourished or moderately malnourished on admission. The corresponding figure from MNA was 79% malnourished or at risk of malnutrition. Both tools indicated that anthropometric values and serum proteins were significantly lower in residents classified as being malnourished (P < 0.05). Sensitivity in detecting PEM was in SGA 0.93 and in MNA 0.96 and specificity was 0.61 and 0.26, respectively. Using regression analysis, weight index and serum albumin were the best objective nutritional parameters in predicting the SGA-and MNA classifications. Item 'muscle wasting' in SGA and 'self-experienced health status' in MNA showed most predictive power concerning the odds of being assessed as malnourished. Conclusions: SGA was shown to be the more useful tool in detecting residents with established malnutrition and MNA in detecting residents who need preventive nutritional measures.

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“…Schlichtig and Ayres pointed out the better sensitivity of fibronectin in acute nutritional disturbances in critically ill adults 3 . There have been only few studies in pediatrics in which 18,27 . Several hormones function as mediators of intermediary metabolic alterations in patients with severe infections.…”

Section: Discussionmentioning

confidence: 99%

“…Feeding evaluation and anthropometric measurements are fundamental to the diagnosis. Laboratory tests are indicated according to the clinical situation of the patient; serum proteins (transferrin, retinol binding protein, prealbumin, and fibronectin), serum amino acids, and number of lymphocytes have special importance [14][15][16][17][18][19] .…”

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confidence: 99%

Nutritional follow-up of critically ill infants receiving short term parenteral nutrition

et al. 2000

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SUMMARY: Few studies have tried to characterize the efficacy of parenteral support of critically ill infants during short period of intensive care. We studied seventeen infants during five days of total parenteral hyperalimentation. Subsequently, according to the clinical conditions, the patients received nutritional support by parenteral, enteral route or both up to the 10 th day. Evaluations were performed on the 1 st , 5 th , and 10 th days. These included: clinical data (food intake and anthropometric measurements), haematological data (lymphocyte count), biochemical tests (albumin, transferrin, fibronectin, prealbumin, retinol-binding protein) and hormone assays (cortisol, insulin, glucagon).Anthropometric measurements revealed no significant difference between the first and second evaluations. Serum albumin and transferrin did not change significantly, but mean values of fibronectin (8.9 to 16 mg/dL), prealbumin (7.7 to 18 mg/dL), and retinol-binding protein (2.4 to 3.7 mg/dL) increased significantly (p < 0.05) from the 1 st to the 10 th day. The hormonal study showed no difference for insulin, glucagon, and cortisol when the three evaluations were compared. The mean value of the glucose/insulin ratio was of 25.7 in the 1 st day and 15.5 in the 5 th day, revealing a transitory supression of this hormone. Cortisol showed values above normal in the beginning of the study.We conclude that the anthropometric parameters were not useful due to the short time of the study; serum proteins, fibronectin, prealbumin, and retinol-binding protein were very sensitive indicators of nutritional status, and an elevated glucose/insulin ratio, associated with a slight tendency for increased cortisol levels suggest hypercatabolic state. The critically ill patient can benefit from an early metabolic support.

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Relationship of visceral proteins to nutritional status in chronic and acute stress

Cited by 84 publications

References 0 publications

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care

Nutritional follow-up of critically ill infants receiving short term parenteral nutrition

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