Clinical and Seasonal Variations of Nutritional Risk Screening in Patients Scheduled for Rehabilitation after Heart Surgery
Background: Current knowledge on the pervasiveness of increased nutritional risk in cardiovascular diseases is limited. Our aim was to analyze the characteristics of nutritional risk screening in patients scheduled for rehabilitation after heart surgery. Prevalence and extent of nutritional risk were studied in connection with patients' characteristics and seasonal climate effects on weight loss dynamics.
Methods: The cohort included 65 consecutive patients with an age range of 25-84 years, 2-6 months after surgical treatment for ischemic or valvular heart disease. Nutritional risk screening was appraised using a standardized NRS-2002 questionnaire. Groups were analyzed according to a timeline of rehabilitation according to the "cold" and "warm" seasons of the moderate Mediterranean climate in Opatija, Croatia.
Results: Increased nutritional risk scores (NRS-2002) of >3 were found in 96% of studied patients. Mean NRS-2002 of patients was 5.0 ± 1.0, with a percentage weight loss history of 11.7% ± 2.2% (4.6-19.0). Risk was found to be more pronounced during the warmer season, with NRS-2002 scores of 5.3 ± 0.7 versus 4.8 ± 1.1 (P = 0.136) and greater loss of weight of 13.0% ± 3.2% versus 10.6% ± 3% (P = 0.005), respectively. Increased nutritional risk correlated significantly with creatinine concentrations (rho = 0.359; P = 0.034 versus 0.584; P = 0.001, respectively). Significant discordance in correlations was found between NRS-2002 and the decrease in left ventricle systolic function (rho correlation coefficient [rho-cc] = -0.428; P = 0.009), the increase in glucose concentrations (cc = 0.600; P < 0.001), and the decrease in erythrocyte counts (cc = -0.520; P = 0.001) during the colder season.
Conclusion: Increased nutritional risk was found to be frequently expressed in the course of rehabilitation after heart surgery. Although seasonal climate effects influenced the weight loss dynamics, the impact on reproducibility of NRS-2002 was clinically less important. Further studies on the connection of nutritional risk with composited end points might offer improvements in overall quality of treatment.
Alberti KG, Eckel RH, Grundy SM, et al. 2009. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640-5.nAnker SD, Negassa A, Coats AJ, et al. 2003. Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet 361:1077-83.nDiMaria-Ghalili RA. 2002. Changes in nutritional status and postoperative outcomes in elderly CABG patients. Biol Res Nurs 4:73-84.nGallagher-Allred CR, Voss AC, Finn SC, McCamish MA. 1996. Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc 96:361-366, 369; quiz 367-8.nGu Y, Cheng LT, Chen HM, et al. 2008. Strong association between nutritional markers and arterial stiffness in continuous ambulatory peritoneal dialysis patients. Blood Purif 26:340-6.nHanon EA, Lincoln GA, Fustin JM, et al. Ancestral TSH mechanism signals summer in a photoperiodic mammal. Curr Biol 18:1147-52.nJayarajan S, Daly JM. 2011. The relationships of nutrients, routes of delivery, and immunocompetence. Surg Clin North Am 91:737-753, vii.nKastorini CM, Panagiotakos DB. 2012. The obesity paradox: methodological considerations based on epidemiological and clinical evidence-new insights. Maturitas 72:220-4.nKondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. 2003. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321-36.nKotseva K, Wood D, De Backer G, et al. 2009. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 16:121-37.nKyle UG, Kossovsky MP, Karsegard VL, Pichard C. 2006. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin Nutr 25:409-17.nLaviano A, Muscaritoli M, Cascino A, et al. 2005. Branched-chain amino acids: the best compromise to achieve anabolism? Curr Opin Clin Nutr Metab Care 8:408-14.nMechanick JI. 2004. Practical aspects of nutritional support for wound-healing patients. Am J Surg 188:52-6.nMcGillivray G, Skull SA, Davie G, et al. 2007. High prevalence of asymptomatic vitamin D and iron deficiency in East African immigrant children and adolescents living in a temperate climate. Arch Dis Child 92:1088-93.nMiyake K, Miyake N, Kondo S, Tabe Y, Ohsaka A, Miida T. Seasonal variation in liver function tests: a time-series analysis of outpatient data. Ann Clin Biochem 46:377-84.nOgawa M, Tanaka F, Onoda T, et al. 2007. A community based epidemiological and clinical study of hospitalization of patients with congestive heart failure in Northern Iwate, Japan. Circ J 71:455-9.nPirlich M, Schutz T, Norman K, et al. 2006. The German hospital malnutrition study. Clin Nutr 25:563-72.nSanchez JA, Sanchez LL, Dudrick SJ. 2011. Nutritional considerations in adult cardiothoracic surgical patients. Surg Clin North Am 91:857-75, ix.nShahar DR, Froom P, Harari G, Yerushalmi N, Lubin F, Kristal-Boneh E. 1999. Changes in dietary intake account for seasonal changes in cardiovascular disease risk factors. Eur J Clin Nutr 53:395-400.nShinchuk LM, Holick MF. 2007. Vitamin D and rehabilitation: improving functional outcomes. Nutr Clin Pract 22:297-304.nSorensen HT, Horvath-Puho E, Sogaard KK, et al. 2009. Arterial cardiovascular events, statins, low-dose aspirin and subsequent risk of venous thromboembolism: a population-based case-control study. J Thromb Haemost 7:521-8.nvan Venrooij LM, de Vos R, Zijlstra E, Borgmeijer-Hoelen MM, van Leeuwen PA, de Mol BA. 2011. The impact of low preoperative fat-free body mass on infections and length of stay after cardiac surgery: a prospective cohort study. J Thorac Cardiovasc Surg 142:1263-9.nVrazic H, Sikic J, Lucijanic T, et al. 2012. The prevalence of overweight and obesity among Croatian hospitalized coronary heart disease patients. Coll Antropol 36 (Suppl 1):211-6.nWedick NM, Barrett-Connor E, Knoke JD, Wingard DL. 2002. The relationship between weight loss and all-cause mortality in older men and women with and without diabetes mellitus: the Rancho Bernardo study. J Am Geriatr Soc 50:1810-5.nWirth R, Smoliner C, Sieber CC, Volkert D. 2011. Cognitive function is associated with body composition and nutritional risk of geriatric patients. J Nutr Health Aging 15:706-10.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).