Increased htTKLV was an independent risk factor for malnutrition in ADPKD. Abstract Objective: Autosomal dominant polycystic kidney disease ADPKD patients with massive organomegaly suffer from pressure-related complications including malnutrition.

Publication types Clinical Trial Research Support, Non-U. Grants and funding. Your BIA results can help guide us in creating a personalized dietary plan, including nutritional supplements when appropriate, and exercise to help you maintain optimal health and wellbeing for a lifetime.

Skip to content Share on Facebook Tweet Share on Twitter Share on Linkedin Pin it Share on Pinterest. In a matter of a few minutes the BIA provides us with very accurate measurements of your: Phase Angle: Reflects cell membrane integrity and overall cellular health.

Cell membrane is made of cholesterol and omega 3 fatty acids. Fat Mass: Excess levels are associated with all major degenerative diseases. Anyway, different screening tools may lead to different results for the risk of malnutrition, due to their different clinical significance No research has been published that focused on how to choose the optimal screening tool.

Our study aims to evaluate the prevalence of and the risk for malnutrition, as determined by the NRS screening test, the SGA and by GLIM criteria, in patients upon hospital admission from an emergency department and in hospitalized patients in the internal medicine unit and the surgery unit of a single center and, to observe whether some specific parameters used for nutritional assessment were related to NRS and SGA test scores.

All Caucasian adult patients coming from the emergency unit and admitted to either the internal medicine unit or the surgery unit were recruited in our study from September to December The exclusion criteria were transfer from an intensive or critical care unit, pregnancy or breastfeeding, and inability to communicate.

Fifty patients refused to participate, 80 presented exclusion criteria, and 30 were excluded for other reasons; finally, patients were eligible for inclusion in the study.

Informed consent was obtained just after admission, and the tests were performed during the first 48 h after admission by the same staff members to reduce the risk of bias during the measurement process.

The study staff members included three dietitians and a biologist with expertise in clinical nutrition; they were all trained, according to the good clinical practice guidelines, with theoretical and practical sessions, to perform the screening tests and the measurements.

The NRS takes into account weight loss, BMI, food intake reductions and impaired general conditions. The disease severity score considers current clinical conditions as well as chronic diseases with acute complications major abdominal surgery, stroke, head injury, or bone marrow transplantation.

Scores from 0 to 3 correspond to these conditions. The NRS has been assessed and validated in several studies, including randomized controlled trials, and has been shown to be reliable when administered by trained staff The SGA includes the patient's history weight loss, changes in food intake habits, gastrointestinal symptoms and functional capacity , a brief physical examination checking for muscle wasting, subcutaneous fat, ankle and sacral oedema, and ascites and the clinician's overall evaluation of the patient's status.

Each patient is classified as well-nourished SGA-a , suspected or moderately malnourished SGA-b , or severely malnourished SGA-c The GLIM criteria are composed of three phenotypic and two etiologic criteria.

Weight and height were measured or derived from indirect measures. Weight loss was generally self-reported by the patient. When the height of the patients was not assessed in the standing position e. Bedridden subjects moved their arms parallel to the trunk, grasped the dynamometer, and applied the maximum force possible with each hand.

The measurement was repeated three times, in 1-min intervals to avoid fatigue, with each hand or on one side only in patients undergoing intravenous therapy and in those with other limitations; the mean and the maximum of the three recorded measurements were recorded in kilograms kg. Bioimpedance analysis BIA was performed using a Human Im Touch device DS Medica srl, Milan, Italy that measures resistance, impedance and PhA at 50 kHz.

With the subject lying supine, four surface electrodes were placed on the non-dominant wrist and ankle. The patients were tested in their rooms after at least 15 min of lying during the first 48 h post hospital admission.

BIA takes into account resistance and the phase angle. It has also been demonstrated that decreases in different forms of malnutrition are associated with increased nutritional risk in various groups of patients 27 — Continuous variables are expressed as the mean values ± standard deviation Mean ± SD.

Student's t test for unpaired data was used to evaluate the differences among groups with different test scores, and the chi-squared test was used to evaluate the relative frequencies within different test score groups.

A normality test for variables has been performed, where applicable, and statistical analysis done accordingly. The Man-Whitney test was used for non-parametric variables. Independent associations among variables were assessed with stepwise regression analysis.

Statistical analysis was performed using SPSS for Windows, version The anthropometric and body composition characteristics of the study participants are shown in Table 1.

Age, weight and BMI were significantly higher among males than among females. HGS was lower among females, while no sex differences were observed for PhA or calf circumference.

Table 1. Anthropometric characteristics, body composition and handgrip strength in patients. On the other hand, the SGA assessed those 96 Table 2. Table 3. Anthropometric characteristics, body composition and handgrip strength according to NRS score in males, females and total sample.

The patients in the SGA-c group 3 M; 5 F were older and had lower body weights than those in the SGA-b 53 M; 50 F and the SGA-a 52 M; 44 F groups. No significant differences were observed in height or BMI Table 4.

Table 4. Anthropometric characteristics, handgrip strength and body composition according to SGA score in males, females and total sample. Both patients classified as moderate and severe malnourished according to the GLIM criteria, had significantly lower PhA and CC than not malnourished patients.

Also, after adjusting the analysis by age, the differences in the results were confirmed. In addition, SGA-c patients had significantly lower CC, HGS and PhA values than SGA-b and SGA-a patients. When considering patients with the worst scores i. In this preliminary study, nutritional risk was assessed by the NRS screening test, the SGA and the GLIM criteria in a heterogeneous sample of Caucasian patients, hospitalized in either medical or surgical units following visits to the emergency department.

Based on prevalence alone and compared to SGA, GLIM seems to represent a larger proportion of overall malnutrition but is more likely to identify a person as severely malnourished.

This apparent inconsistency in results may be primarily because the SGA classified patients into one of three levels: a well-nourished, b suspected malnutrition or moderate malnutrition, c severely malnourished , whereas the NRS addresses two categories only no nutritional risk or severe malnutrition.

Although both the NRS and the SGA consider the metabolic stress of disease and changes in food intake, the NRS classifies metabolic stress using numerical scores, while the SGA depends on the investigator's experience to indicate the metabolic stress of disease Moreover, the NRS contains questions that indicate recent or acute changes in nutritional status percent of weight loss in the last three months and age, while the SGA includes questions related to the detection of chronic malnutrition such as percent of weight loss in the last six months, change in consistency of the diet, presence of gastrointestinal symptoms, loss of subcutaneous fat, and the presence of oedema.

This variety of questions could also be responsible for the different results 6 , 30 — The NRS is a fast, easy and useful screening tool that seems well-suited to be applied in an acute phase to patients coming from an emergency department; however, the exclusive use of the NRS might underestimate the real incidence of malnutrition in hospitals 6.

Soon after patient stabilization, the SGA could be integrated into nutritional evaluations. In September , in order to build a global consensus on the diagnostic criteria for malnutrition, the GLIM criteria were proposed.

According to these criteria, patients were categorized into two groups: moderate stage 1 and severe stage 2 malnutrition. This study showed that both patients with moderate and severe malnutrition had lower PhA and CC compared with those without malnutrition.

At our best knowledge, the GLIM criteria had been still not validated in patients coming from an Emergency Department. PhA is the most clinically established impedance parameter and has been suggested to be an indicator of cellular health, and nutritional status, and be highly predictive of impaired clinical outcome and mortality in a variety of disease.

PhA represent a clinically feasible approach to body composition, free from equation inherent errors and necessary assumption. It been shown to be a superior indicator of survival and outcome and is generally used as screening tool for identification of patients at nutritional risk.

BIVA provides more detailed information on hydration and cell mass integrity and should be considered as an assessment and monitoring tool Low PhA values predict poor outcomes, long hospital stays and morbidities 16 , HGS seems to detect muscle loss, fiber quality, and functionality earlier while providing a better evaluation of nutrition repletion after therapy It may be considered a functional and nutritional indicator that adequately predicts hospitalization costs Several studies have shown that HGS is both sensitive and specific in predicting increased postoperative complications and is associated with longer length of hospital stay and long-term mortality among hospitalized patients 35 , In summary, in our study, low SGA SGA-c scores were clearly associated with the lowest values of PhA, while CC p.

Low PhA and HGS values were observed in all Caucasian hospitalized patients evaluated, independent of their SGA and NRS and GLIM scores. These results confirm the need for close monitoring of all patients during hospitalization including those with initially good screening tests to detect possible changes in clinical and nutritional status early on.

Study limitations are the relatively heterogeneous population, the small sample size, the data results from a single hospital, the lack of detailed clinical information on the evaluated patients and of their clinical outcomes; these last two deficiencies are linked to the nature of the observational study.

Another study limitation is that we have not used BIVA to better define if low PhA was linked to malnutrition, fluid overload or both. Anyway, this study had not the primary aim to obtain detailed information on hydration.

With your BIA results, we can recommend a personalized dietary plan, nutritional supplements, and exercise to help support optimal health and well-being for a lifetime.

BIA is much more sophisticated than your bathroom scale, but just as painless-and almost as quick. BIA is a simple procedure performed in our clinic in a matter of minutes with the help of a sophisticated computerized analysis.

Measurements are taken with the bioimpedance analyzer, which uses electrodes similar to EKG electrodes. The analyzer calculates your tissue and fluid compartments using an imperceptible electrical current passed through pads placed on one hand and foot as you lie comfortably on a treatment couch.

Fatty tissue, which is low in water, is not. Thus, the resistance to the flow of electrical current measured by the analyzer can be used to calculate the body composition. Over independent studies conducted over the past 20 years have demonstrated that BIA can provide an accurate and clinically useful assessment of body composition.

Nutrition and Wellness Institute. Home About Us Services Appointments Insurance Dispensary Contact Us. Conclusion: The NRS, the SGA and the GLIM criteria appear to be valuable tools for the screening and assessment of nutritional status.

In particular, the lowest NRS, SGA and GLIM scores were associated with the lowest PhA and CC. Nevertheless, a weekly re-evaluation of patients with better screening and assessment scores is recommended to facilitate early detection of changes in nutritional status.

Poor nutritional status is associated with a high disease burden, a large number of comorbidities and significant economic costs 4. To identify patients who are at risk for malnutrition or who are malnourished upon hospital admission, nutritional screening should be performed as a part of standard care.

Screening tests must be quick and easy to apply; in already malnourished patients, a thorough nutritional assessment should also be performed 2 , 3. The European Society for Clinical Nutrition and Metabolism ESPEN recommends using the Nutritional Risk Screening NRS to screen adults upon hospital admission 5.

The Subjective Global Assessment SGA is a nutrition assessment test used worldwide that allows for the grading of nutritional status in different conditions; it includes a more complex set of questions and must be conducted by specially trained professionals.

Objective methods for nutritional assessment include anthropometry BMI and CC, among others body composition evaluated by BIA and functional tests. In literature, several studies have already evaluated the relation between parameters predicting malnutrition and poor clinical outcomes 6. The prevalence of nutritional risk, and the consequences of malnutrition on patient outcomes in hospital setting 7 , 8.

Regarding BMI, values lower than Unfortunately, BMI may often be biased by fluid overload and oedema; moreover, due to the obesity pandemic, patients classified as malnourished may also have BMI values still in the normal range or even in the overweight or obese categories Low values of calf circumference CC seem to be associated with malnutrition or high nutritional risk 11 , Bioelectrical impedance analysis BIA is a non-invasive, low-cost and simple method widely used to assess body composition; BIA-derived phase angle PhA is a reliable indicator commonly used for nutritional assessments 13 , It is inversely correlated with disease severity, inflammation and malnutrition in several clinical conditions 15 , Finally, handgrip strength HGS is a validated and easily implemented measure of muscle strength that has been frequently used for clinical purposes, particularly in recent years.

Low HGS values are associated with long hospitalization durations and high re-admission rates 17 , In order to standardize the diagnosis of malnutrition, the Global Leadership Initiative on Malnutrition GLIM criteria, were also applied.

The GLIM criteria are now considered as the best ones for diagnosing malnutrition in adults in clinical care settings and are based on a two-step model for the risk screening and diagnostic assessment of malnutrition Anyway, different screening tools may lead to different results for the risk of malnutrition, due to their different clinical significance No research has been published that focused on how to choose the optimal screening tool.

Our study aims to evaluate the prevalence of and the risk for malnutrition, as determined by the NRS screening test, the SGA and by GLIM criteria, in patients upon hospital admission from an emergency department and in hospitalized patients in the internal medicine unit and the surgery unit of a single center and, to observe whether some specific parameters used for nutritional assessment were related to NRS and SGA test scores.

All Caucasian adult patients coming from the emergency unit and admitted to either the internal medicine unit or the surgery unit were recruited in our study from September to December The exclusion criteria were transfer from an intensive or critical care unit, pregnancy or breastfeeding, and inability to communicate.

Fifty patients refused to participate, 80 presented exclusion criteria, and 30 were excluded for other reasons; finally, patients were eligible for inclusion in the study. Informed consent was obtained just after admission, and the tests were performed during the first 48 h after admission by the same staff members to reduce the risk of bias during the measurement process.

The study staff members included three dietitians and a biologist with expertise in clinical nutrition; they were all trained, according to the good clinical practice guidelines, with theoretical and practical sessions, to perform the screening tests and the measurements.

The NRS takes into account weight loss, BMI, food intake reductions and impaired general conditions. The disease severity score considers current clinical conditions as well as chronic diseases with acute complications major abdominal surgery, stroke, head injury, or bone marrow transplantation.

Scores from 0 to 3 correspond to these conditions. The NRS has been assessed and validated in several studies, including randomized controlled trials, and has been shown to be reliable when administered by trained staff The SGA includes the patient's history weight loss, changes in food intake habits, gastrointestinal symptoms and functional capacity , a brief physical examination checking for muscle wasting, subcutaneous fat, ankle and sacral oedema, and ascites and the clinician's overall evaluation of the patient's status.

Each patient is classified as well-nourished SGA-a , suspected or moderately malnourished SGA-b , or severely malnourished SGA-c The GLIM criteria are composed of three phenotypic and two etiologic criteria. Weight and height were measured or derived from indirect measures.

Weight loss was generally self-reported by the patient. When the height of the patients was not assessed in the standing position e. Bedridden subjects moved their arms parallel to the trunk, grasped the dynamometer, and applied the maximum force possible with each hand.

The measurement was repeated three times, in 1-min intervals to avoid fatigue, with each hand or on one side only in patients undergoing intravenous therapy and in those with other limitations; the mean and the maximum of the three recorded measurements were recorded in kilograms kg.

Bioimpedance analysis BIA was performed using a Human Im Touch device DS Medica srl, Milan, Italy that measures resistance, impedance and PhA at 50 kHz.

With the subject lying supine, four surface electrodes were placed on the non-dominant wrist and ankle. The patients were tested in their rooms after at least 15 min of lying during the first 48 h post hospital admission.

BIA takes into account resistance and the phase angle. It has also been demonstrated that decreases in different forms of malnutrition are associated with increased nutritional risk in various groups of patients 27 — Continuous variables are expressed as the mean values ± standard deviation Mean ± SD.

Student's t test for unpaired data was used to evaluate the differences among groups with different test scores, and the chi-squared test was used to evaluate the relative frequencies within different test score groups. A normality test for variables has been performed, where applicable, and statistical analysis done accordingly.

The Man-Whitney test was used for non-parametric variables. Independent associations among variables were assessed with stepwise regression analysis.

Statistical analysis was performed using SPSS for Windows, version The anthropometric and body composition characteristics of the study participants are shown in Table 1. Age, weight and BMI were significantly higher among males than among females.

HGS was lower among females, while no sex differences were observed for PhA or calf circumference. Table 1. Anthropometric characteristics, body composition and handgrip strength in patients. On the other hand, the SGA assessed those 96 Table 2.

Table 3. Anthropometric characteristics, body composition and handgrip strength according to NRS score in males, females and total sample. The patients in the SGA-c group 3 M; 5 F were older and had lower body weights than those in the SGA-b 53 M; 50 F and the SGA-a 52 M; 44 F groups.

No significant differences were observed in height or BMI Table 4. Table 4. Anthropometric characteristics, handgrip strength and body composition according to SGA score in males, females and total sample.

Both patients classified as moderate and severe malnourished according to the GLIM criteria, had significantly lower PhA and CC than not malnourished patients. Also, after adjusting the analysis by age, the differences in the results were confirmed. In addition, SGA-c patients had significantly lower CC, HGS and PhA values than SGA-b and SGA-a patients.

When considering patients with the worst scores i. In this preliminary study, nutritional risk was assessed by the NRS screening test, the SGA and the GLIM criteria in a heterogeneous sample of Caucasian patients, hospitalized in either medical or surgical units following visits to the emergency department.

Based on prevalence alone and compared to SGA, GLIM seems to represent a larger proportion of overall malnutrition but is more likely to identify a person as severely malnourished.

This apparent inconsistency in results may be primarily because the SGA classified patients into one of three levels: a well-nourished, b suspected malnutrition or moderate malnutrition, c severely malnourished , whereas the NRS addresses two categories only no nutritional risk or severe malnutrition.

Although both the NRS and the SGA consider the metabolic stress of disease and changes in food intake, the NRS classifies metabolic stress using numerical scores, while the SGA depends on the investigator's experience to indicate the metabolic stress of disease Moreover, the NRS contains questions that indicate recent or acute changes in nutritional status percent of weight loss in the last three months and age, while the SGA includes questions related to the detection of chronic malnutrition such as percent of weight loss in the last six months, change in consistency of the diet, presence of gastrointestinal symptoms, loss of subcutaneous fat, and the presence of oedema.

This variety of questions could also be responsible for the different results 6 , 30 — The NRS is a fast, easy and useful screening tool that seems well-suited to be applied in an acute phase to patients coming from an emergency department; however, the exclusive use of the NRS might underestimate the real incidence of malnutrition in hospitals 6.

Soon after patient stabilization, the SGA could be integrated into nutritional evaluations. In September , in order to build a global consensus on the diagnostic criteria for malnutrition, the GLIM criteria were proposed. According to these criteria, patients were categorized into two groups: moderate stage 1 and severe stage 2 malnutrition.

This study showed that both patients with moderate and severe malnutrition had lower PhA and CC compared with those without malnutrition. At our best knowledge, the GLIM criteria had been still not validated in patients coming from an Emergency Department.

PhA is the most clinically established impedance parameter and has been suggested to be an indicator of cellular health, and nutritional status, and be highly predictive of impaired clinical outcome and mortality in a variety of disease.

PhA represent a clinically feasible approach to body composition, free from equation inherent errors and necessary assumption. It been shown to be a superior indicator of survival and outcome and is generally used as screening tool for identification of patients at nutritional risk.

BIVA provides more detailed information on hydration and cell mass integrity and should be considered as an assessment and monitoring tool Low PhA values predict poor outcomes, long hospital stays and morbidities 16 , HGS seems to detect muscle loss, fiber quality, and functionality earlier while providing a better evaluation of nutrition repletion after therapy It may be considered a functional and nutritional indicator that adequately predicts hospitalization costs Several studies have shown that HGS is both sensitive and specific in predicting increased postoperative complications and is associated with longer length of hospital stay and long-term mortality among hospitalized patients 35 , In summary, in our study, low SGA SGA-c scores were clearly associated with the lowest values of PhA, while CC p.

Low PhA and HGS values were observed in all Caucasian hospitalized patients evaluated, independent of their SGA and NRS and GLIM scores. These results confirm the need for close monitoring of all patients during hospitalization including those with initially good screening tests to detect possible changes in clinical and nutritional status early on.

Study limitations are the relatively heterogeneous population, the small sample size, the data results from a single hospital, the lack of detailed clinical information on the evaluated patients and of their clinical outcomes; these last two deficiencies are linked to the nature of the observational study.

Another study limitation is that we have not used BIVA to better define if low PhA was linked to malnutrition, fluid overload or both. Anyway, this study had not the primary aim to obtain detailed information on hydration. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Ethical Committee of the Federico II University Hospital. FP, GD, and FC conceived and designed the study.

ES, OD, CD, and MN collected research data. OD, DM, and MM analyzed the results. ES and MM drafted the manuscript. LS and FP made critical revisions to the manuscript for important intellectual content. All authors have read and approved the final manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease related malnutrition. Clin Nutr. doi: PubMed Abstract CrossRef Full Text Google Scholar. Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality.