Abstract
Background: Malnutrition consists of a functional and structural alteration caused by an imbalance between specific needs, intake, or utilization of foods and nutrients.
Objective: The aim of this trial is to establish whether PNI (Prognostic Nutritional Index) is related to the inflammation pattern in our patients and which type of AN gives more advantages in clinical practice in improving PNI, and so the prognosis.
Methods: During hospitalization, we have identified the presence of malnutrition and its aetiology- type, and initiated artificial nutrition (AN), enteral (EN), or parenteral (PN). For efficacy, we can use many biochemical tests, such as pre-albumin, transferrin, RBP, PINI, and albumin. The retrospective study was conducted by analyzing 145 patients. At baseline and after 7 days, the concentration of Albumin, Platelets, Neutrophils, Lymphocytes, and RCP was measured and was calculated PNI, PLR, and NLR. The patients were divided into three groups according to the treatment received with artificial nutrition: 32 Parenteral (PG), 15 Enteral (EG), and 17 Combined (CG).
Results: Between baseline and 7 days, no change was observed, while in EG a significant increase in albumin and RCP and a significant reduction in PNI were observed, and, in CG a significant increase in lymphocytes, in PNI and a significant reduction in NLR.
Conclusion: In conclusion, a short-term nutritional intervention can benefit from a combined approach to improve prognostic such as PNI.
Graphical Abstract
[1]
Wells JC, Sawaya AL, Wibaek R, et al. The double burden of malnutrition: Etiological pathways and consequences for health. Lancet 2020; 395(10217): 75-88.
[http://dx.doi.org/10.1016/S0140-6736(19)32472-9]
[http://dx.doi.org/10.1016/S0140-6736(19)32472-9]
[2]
Barker LA, Gout BS, Crowe TC. Hospital malnutrition: Prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health 2011; 8(2): 514-27.
[http://dx.doi.org/10.3390/ijerph8020514]
[http://dx.doi.org/10.3390/ijerph8020514]
[3]
Curtis LJ, Bernier P, Jeejeebhoy K, et al. Costs of hospital malnutrition. Clin Nutr 2017; 36(5): 1391-6.
[http://dx.doi.org/10.1016/j.clnu.2016.09.009] [PMID: 27765524]
[http://dx.doi.org/10.1016/j.clnu.2016.09.009] [PMID: 27765524]
[4]
Leandro-Merhi VA, Costa CL, Saragiotto L, Aquino JLB. Nutritional indicators of malnutrition in hospitalized patients. Arq Gastroenterol 2019; 56(4): 447-50.
[http://dx.doi.org/10.1590/s0004-2803.201900000-74] [PMID: 31618398]
[http://dx.doi.org/10.1590/s0004-2803.201900000-74] [PMID: 31618398]
[5]
Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27(1): 5-15.
[http://dx.doi.org/10.1016/j.clnu.2007.10.007]
[http://dx.doi.org/10.1016/j.clnu.2007.10.007]
[6]
Jensen GL, Mirtallo J, Compher C, et al. Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr 2010; 34(2): 156-9.
[http://dx.doi.org/10.1177/0148607110361910] [PMID: 20375423]
[http://dx.doi.org/10.1177/0148607110361910] [PMID: 20375423]
[7]
De Lorenzo A, Del Gobbo V, Premrov MG, Bigioni M, Galvano F, Di Renzo L. Normal-weight obese syndrome: Early inflammation? Am J Clin Nutr 2007; 85(1): 40-5.
[http://dx.doi.org/10.1093/ajcn/85.1.40] [PMID: 17209175]
[http://dx.doi.org/10.1093/ajcn/85.1.40] [PMID: 17209175]
[8]
Laviano A, Koverech A, Mari A. Cachexia: Clinical features when inflammation drives malnutrition. Proc Nutr Soc 2015; 74(4): 348-54.
[http://dx.doi.org/10.1017/S0029665115000117]
[http://dx.doi.org/10.1017/S0029665115000117]
[9]
Di Renzo L, Marchetti M, Cioccoloni G, et al. Role of phase angle in the evaluation of effect of an immuno-enhanced formula in post-surgical cancer patients: A randomized clinical trial. Eur Rev Med Pharmacol Sci 2019; 23(3): 1322-34.
[10]
Sobotka L, Ed. Basics in clinical nutrition 4th ed Galen. 2012. Available from: www.galenbooks.com/dwnld/Basics_in_ clinical_nutrition_sample.pdf
[11]
Soeters PB, Reijven PL. A rational approach to nutritional assessment. Clin Nutr 2008; 27: 706-e16.
[12]
White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of nutrition and dietetics and american society for parenteral and enteral nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Parenter Enteral Nutr 2012; 36: 275-83.
[13]
Dessì M, Noce A, Agnoli A, et al. The usefulness of the prognostic inflammatory and nutritional index (PINI) in a haemodialysis population. Nutr Metab Cardiovasc Dis 2009; 19(11): 811-5.
[http://dx.doi.org/10.1016/j.numecd.2009.01.009] [PMID: 19361965]
[http://dx.doi.org/10.1016/j.numecd.2009.01.009] [PMID: 19361965]
[14]
Dupire S, Wemeau M, Debarri H, et al. Prognostic value of PINI index in patients with multiple myeloma. Eur J Haematol 2012; 88(4): 306-13.
[http://dx.doi.org/10.1111/j.1600-0609.2011.01740.x] [PMID: 22126676]
[http://dx.doi.org/10.1111/j.1600-0609.2011.01740.x] [PMID: 22126676]
[15]
Rault JP, Adam F, Simon F. Limits of PINI (prognostic nutritional anf inflammatory index) in the evaluation of nutritional status in children. Med Trop (Mars) 1995; 55(4): 343-6.
[PMID: 8830217]
[PMID: 8830217]
[16]
Nelson KA, Walsh D. The cancer anorexia-cachexia syndrome: A survey of the Prognostic Inflammatory and Nutritional Index (PINI) in advanced disease. J Pain Symptom Manage 2002; 24(4): 424-8.
[http://dx.doi.org/10.1016/S0885-3924(02)00508-0] [PMID: 12505211]
[http://dx.doi.org/10.1016/S0885-3924(02)00508-0] [PMID: 12505211]
[17]
SINPE guidelines for hospital artificial nutrition 2002. Italian J Parenteral Enteral Nutr 20(S5): S17-22.
[18]
Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017; 36(1): 49-64.
[http://dx.doi.org/10.1016/j.clnu.2016.09.004] [PMID: 27642056]
[http://dx.doi.org/10.1016/j.clnu.2016.09.004] [PMID: 27642056]
[19]
Mohri Y, Inoue Y, Tanaka K, Hiro J, Uchida K, Kusunoki M. Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg 2013; 37(11): 2688-92.
[http://dx.doi.org/10.1007/s00268-013-2156-9] [PMID: 23884382]
[http://dx.doi.org/10.1007/s00268-013-2156-9] [PMID: 23884382]
[20]
Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 2016; 26(3): 372-6.
[http://dx.doi.org/10.3109/14397595.2015.1091136] [PMID: 26403379]
[http://dx.doi.org/10.3109/14397595.2015.1091136] [PMID: 26403379]
[21]
a. Edington J, Kon P, Martyn CN. Prevalence of malnutrition in patients in general practice. Clin Nutr 1996; 15: 60-3. b.Mc Wirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994; 308: 945-8.
[22]
Klein S, Kinney J, Jeejeebho K, et al. Nutrition support in clinical practice: Review of published data and recommendations for future research directions. National Institutes of health, American society for parenteral and enteral nutrition, and American society for clinical nutrition. JPEN J Parenter Enteral Nutr 1997; 21(3): 133-56.
[http://dx.doi.org/10.1177/0148607197021003133] [PMID: 9168367]
[http://dx.doi.org/10.1177/0148607197021003133] [PMID: 9168367]
[23]
Jensen GL, Mirtallo J, Compher C, et al. Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. Clin Nutr 2010; 29(2): 151-3.
[http://dx.doi.org/10.1016/j.clnu.2009.11.010] [PMID: 20071059]
[http://dx.doi.org/10.1016/j.clnu.2009.11.010] [PMID: 20071059]
[24]
Jeejeebhoy KN. Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia. Curr Op Clin Nutr Metabol Care 2012; 15: 213-e9.
[http://dx.doi.org/10.1097/MCO.0b013e328352694f]
[http://dx.doi.org/10.1097/MCO.0b013e328352694f]
[25]
Fletcher JP, Little JM, Guest PK. A comparison of serum transferrin and serum prealbumin as nutritional parameters. JPEN J Parenter Enteral Nutr 1987; 11(2): 144-7.
[http://dx.doi.org/10.1177/0148607187011002144] [PMID: 3108533]
[http://dx.doi.org/10.1177/0148607187011002144] [PMID: 3108533]
[26]
Heymsfield SB, Tighe A, Wang Z-M. Nutritional assessment by anthropometric and biochemical methods. In: Shils ME, Olson JA, Shike M, Eds. Modern nutrition in health and disease. Philadelphia: Lea &Febiger Publishers 1994; pp. 812-41.
[27]
Pichard C, Genton L, Jolliet P. Measuring body composition: A landmark of quality control for nutritional support services. Curr Opin Clin Nutr Metab Care 2000; 3(4): 281-4.
[http://dx.doi.org/10.1097/00075197-200007000-00007] [PMID: 10929674]
[http://dx.doi.org/10.1097/00075197-200007000-00007] [PMID: 10929674]
[28]
Malbrain ML, Huygh J, Dabrowski W, De Waele JJ, Staelens A, Wauters J. The use of bio-electrical impedance analysis (BIA) to guide fluid management, resuscitation and deresuscitation in critically ill patients: A bench-to-bedside review. Anaesthesiol Intensive Ther 2014; 46(5): 381-91.
[http://dx.doi.org/10.5603/AIT.2014.0061]
[http://dx.doi.org/10.5603/AIT.2014.0061]
[29]
Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr 2016; 35: 370-e80.
[http://dx.doi.org/10.1016/j.clnu.2015.05.010]
[http://dx.doi.org/10.1016/j.clnu.2015.05.010]
[30]
Sarr MG. Appropriate use, complications and advantages demonstrated in 500 consecutive needle catheter jejunostomies. Br J Surg 2002; 86(4): 557-61.
[http://dx.doi.org/10.1046/j.1365-2168.1999.01084.x] [PMID: 10215836]
[http://dx.doi.org/10.1046/j.1365-2168.1999.01084.x] [PMID: 10215836]
[31]
Ye Y, Xu Y, Fu Q, et al. Enteral nutrition support does not improve PNI in radiotherapy patients with locally advanced esophageal cancer. Nutr Cancer 2019; 71(2): 223-9.
[http://dx.doi.org/10.1080/01635581.2018.1559939] [PMID: 30663378]
[http://dx.doi.org/10.1080/01635581.2018.1559939] [PMID: 30663378]
[32]
Canadian Institutes for Health Information. Quick Stats Available from :https://www.cihi.ca/en/quick-stats
Accessed 18 June 2016].
[33]
Geng Y, Qi Q, Sun M, Chen H, Wang P, Chen Z. Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer. Eur J Surg Oncol 2015; 41(11): 1508-14.
[http://dx.doi.org/10.1016/j.ejso.2015.07.022] [PMID: 26343824]
[http://dx.doi.org/10.1016/j.ejso.2015.07.022] [PMID: 26343824]
[34]
Sun JK, Yuan ST, Mu XW, et al. Effects of early enteral nutrition on T helper lymphocytes of surgical septic patients. Medicine (Baltimore) 2017; 96(32): e7702.
[http://dx.doi.org/10.1097/MD.0000000000007702] [PMID: 28796054]
[http://dx.doi.org/10.1097/MD.0000000000007702] [PMID: 28796054]
[35]
Passador J, Toffoli LV, Fernandes KB, Neves-Souza RD, Pelosi GG, Gomes MV. Dietary ingestion of calories and micronutrients modulates the DNA methylation profile of leukocytes from older individuals. J Nutr Health Aging 2018; 22(10): 1281-5.
[36]
Wischmeyer PE. Nutrition therapy in sepsis. Crit Care Clin 2018; 34(1): 107-25.
[http://dx.doi.org/10.1016/j.ccc.2017.08.008]
[http://dx.doi.org/10.1016/j.ccc.2017.08.008]
[37]
Elke G, van Zanten AR, Lemieux M, et al. Enteral versus parenteral nutrition in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials. Crit Care 2016; 20(1): 117.
[http://dx.doi.org/10.1186/s13054-016-1298-1]
[http://dx.doi.org/10.1186/s13054-016-1298-1]
[38]
Marik PE. Enteral nutrition in the critically ill: Myths and misconceptions. Crit Care Med 2014; 42(4): 962-9.
[http://dx.doi.org/10.1097/CCM.0000000000000051]
[http://dx.doi.org/10.1097/CCM.0000000000000051]
[39]
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011; 365(6): 506-17.
[http://dx.doi.org/10.1056/NEJMoa1102662] [PMID: 21714640]
[http://dx.doi.org/10.1056/NEJMoa1102662] [PMID: 21714640]
[40]
Soldati L, Di Renzo L, Jirillo E, Ascierto PA, Marincola FM, De Lorenzo A. The influence of diet on anti-cancer immune responsiveness. J Transl Med 2018; 16(1): 75.
[http://dx.doi.org/10.1186/s12967-018-1448-0]
[http://dx.doi.org/10.1186/s12967-018-1448-0]
