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BACKGROUND: The aim of this study was to evaluate markers of inflammation, oxidative stress and endothelial function in a disease-related malnutrition (DRM) outpatient population. METHODS: For this cross-sectional study, a total of 83 subjects were included and clustered in 3 groups: 34 with normonutrition (NN), 21 with DRM without inflammation (DRM-I) and 28 with DRM and inflammation (DRM + I). Nutritional diagnosis was conducted for all subjects according to ASPEN. Biochemical parameters, proinflammatory cytokines, reactive oxygen species production, glutathione, mitochondrial membrane potential, oxygen consumption, adhesion molecules and leukocyte-endothelium interactions were evaluated. RESULTS: DRM + I patients showed lower albumin, prealbumin, transferrin, and retinol-binding protein levels with respect to the NN group (p < 0.05), differences that were less noticeable in the DRM-I group. DRM + I was associated with a significant increase in hsCRP and IL6 vs the NN and DRM-I groups, and TNFα was increased in both DRM vs NN. DRM was characterised by increased oxidative stress, which was marked by a significant increase in ROS levels and a decrease in mitochondrial membrane potential in the DRM + I group. An evident reduction in mitochondrial oxygen consumption and glutathione concentration was observed in both DRM groups, and was accompanied by increased leukocyte adhesion and adhesion molecules and decreased rolling velocity in the DRM + I group. Furthermore, percentage of weight loss was negatively correlated with albumin, prealbumin, transferrin, O2 consumption, glutathione and leukocyte rolling velocity, and positively correlated with hsCRP, IL6, TNFα, ROS, leukocyte adhesion, and VCAM-1. CONCLUSIONS: Our results show that DRM is associated with oxidative stress and an inflammatory state, with a deterioration of endothelial dysfunction in the DRM + I population.

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Cellular pathways such as inflammation or oxidative stress are the cause and triggers of disease-related malnutrition (DRM), but the influence of these markers on endoplasmic reticulum (ER) stress is unknown. The objective of this study was to analyze the relationship between mitochondrial function and ER stress parameters in a DRM population. The study population was composed of 82 outpatient subjects, of whom 45 were diagnosed with DRM and 37 were confirmed to be normonourished according to the American Society for Parenteral and Enteral Nutrition ASPEN criteria. We evaluated anthropometrical and biochemical parameters, pro-inflammatory cytokines in serum. Oxidative and ER stress markers were analyzed in leukocytes. DRM patients showed significant reductions in albumin and transferrin concerning the normonourished group, and also displayed higher levels of hsCRP, IL6, and TNFα, and the soluble adhesion molecules VCAM-1 and ICAM-1. Besides, oxygen consumption and mitochondrial membrane potential were reduced and Radical Oxygen Species ROS production was enhanced in DRM patients. In the case of ER markers, protein and mRNA expression revealed that CHOP, ATF6, and the P-eIF2α signal were enhanced in malnourished patients compared to control subjects. Correlation studies supported a relationship between weight loss and increased inflammation, mitochondrial dysfunction, and compromised function of the ER. Our results demonstrate that ER stress signaling pathways are influenced by inflammation and mitochondrial function in the leukocytes of a DRM population.

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INTRODUCTION: nutritional screenings are used to detect nutritional risk, allow early intervention and influence the prognosis. The Malnutrition Screening Tool (MST) is only validated in hospitalized patients and oncology outpatients. OBJECTIVES: to analyze the nutritional screening MST, Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment-Short Form (MNA-sf) compared to the nutritional assessment gold standard according to socio-sanitary areas and age groups; and to assess the utility of the MST in those areas where it has not been validated. MATERIAL AND METHODS: a total of 815 outpatient, hospitalized and institutionalized subjects were included in this study. MUST and MST screenings, and nutritional assessment were performed in all subjects. MNA-sf was also performed in subjects ≥ 65 years of age. Nutritional diagnosis was performed according to the SENPE-SEDOM consensus. RESULTS: in the outpatient cohort, three screenings have a validity (AUC ROC) greater than 0.8 compared to nutritional assessment. In the institutionalized, the MNA-sf generates false positives and the MUST is more valid than MST (AUC ROC = 0.815 and 0.763, respectively). In hospitalized patients, there are excellent results with MUST and MST. In all socio-sanitary areas the MST obtains a better positive predictive value. By age groups, MUST and MST are valid tools. CONCLUSIONS: in our study, the MST correctly diagnoses more than 80% of the patients (S = 69.4%, E = 94.2%), and has a good reliability and validity with respect to nutritional assessment not only in hospitalized patients and oncology outpatients, where it has already been validated. In our population, the MST was found to be valid in outpatient, institutionalized and hospitalized subjects.

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Introducción: los cribados son empleados para detectar el riesgo nutricional y permiten intervenir precozmente e influir en el pronóstico. La herramienta Malnutrition Screening Tool (MST) está validada en paciente hospitalizado y oncológico ambulatorio. Objetivo: analizar por ámbitos sociosanitarios y grupos etarios los cribados MST, Malnutrition Universal Screening Tool (MUST) y Mini Nutritional Assessment-Short Form (MNA-sf) respecto a la valoración nutricional completa (VNC) como patrón de referencia, y evaluar la utilidad del MST en aquellos ámbitos donde no está validado. Material y métodos: se han incluido 815 sujetos ambulatorios, hospitalizados e institucionalizados. Se les realizó el cribado MUST, MST y una VNC; con los ≥ 65 años también se llevó a cabo el MNA-sf. Se empleó el Consenso SENPE-SEDOM para el diagnóstico. Resultados: en ambulatorios, los tres cribados presentan una validez AUC ROC > 0,8 respecto a la VNC. En los institucionalizados, el MNA-sf genera falsos positivos y el MUST presenta mayor validez que el MST (AUC ROC = 0,815 y 0,763 respectivamente). En hospitalizados, hay excelentes resultados con el MUST y el MST. En los tres ámbitos el MST obtiene mejor valor predictivo positivo. Por rango de edad, tanto el MUST como el MST son herramientas válidas. Conclusiones: en nuestro estudio, el MST diagnostica correctamente a más del 80% de los pacientes (S = 69,4%, E = 94,2%), y posee buena concordancia y validez respecto a la VNC no solo en paciente hospitalizado y oncológico ambulatorio, donde ya había sido validado. En nuestra población, el MST es válido para ser aplicado en pacientes ambulatorios, institucionalizados y hospitalizados

Introduction: nutritional screenings are used to detect nutritional risk, allow early intervention and influence the prognosis. The Malnutrition Screening Tool (MST) is only validated in hospitalized patients and oncology outpatients. Objectives: to analyze the nutritional screening MST, Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment-Short Form (MNA-sf) compared to the nutritional assessment gold standard according to socio-sanitary areas and age groups; and to assess the utility of the MST in those areas where it has not been validated. Material and methods: a total of 815 outpatient, hospitalized and institutionalized subjects were included in this study. MUST and MST screenings, and nutritional assessment were performed in all subjects. MNA-sf was also performed in subjects ≥ 65 years of age. Nutritional diagnosis was performed according to the SENPE-SEDOM consensus. Results: in the outpatient cohort, three screenings have a validity (AUC ROC) greater than 0.8 compared to nutritional assessment. In the institutionalized, the MNA-sf generates false positives and the MUST is more valid than MST (AUC ROC = 0.815 and 0.763, respectively). In hospitalized patients, there are excellent results with MUST and MST. In all socio-sanitary areas the MST obtains a better positive predictive value. By age groups, MUST and MST are valid tools. Conclusions: in our study, the MST correctly diagnoses more than 80% of the patients (S = 69.4%, E = 94.2%), and has a good reliability and validity with respect to nutritional assessment not only in hospitalized patients and oncology outpatients, where it has already been validated. In our population, the MST was found to be valid in outpatient, institutionalized and hospitalized subjects

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Introducción y objetivo: Los cribados nutricionales permiten detectar el riesgo nutricional, deben estar validados y su utilidad contrastada con un patrón de referencia. El objetivo de este trabajo es conocer la validez, el comportamiento y la concordancia de 3 herramientas de cribado nutricional respecto a la valoración nutricional completa. Material y métodos: Subanálisis de un estudio transversal y descriptivo sobre prevalencia de desnutrición relacionada con la enfermedad. La muestra fue seleccionada de pacientes ambulatorios, hospitalizados e institucionalizados. Se realizaron los cribados MUST, MNAsf y MST, una valoración nutricional completa a todos los pacientes y se empleó el consenso SENPE-SEDOM para el diagnóstico. Resultados: En los pacientes ambulatorios tanto el MUST como el MNAsf presentan una validez similar respecto a la valoración nutricional completa (AUC 0,871 y 0,883, respectivamente). En los institucionalizados la herramienta MUST es la de mayor validez (AUC 0,815) y en los hospitalizados, tanto el MUST como el MST (AUC 0,868 y 0,853, respectivamente). Conclusiones: Es imprescindible la utilización de cribados nutricionales para detectar la desnutrición relacionada con la enfermedad e invertir bien los recursos disponibles. Según nuestros resultados, el cribado MUST es el más apropiado en centros hospitalarios y de tercera edad (AU)

Introduction and objective: Nutritional screening allows for the detection of nutritional risk. Validated tools should be implemented, and their usefulness should be contrasted with a gold standard. The aim of this study is to discover the validity, efficacy and reliability of 3 nutritional screening tools in relation to complete nutritional assessment. Material and methodology: A sub-analysis of a cross-sectional and descriptive study on the prevalence of disease-related malnutrition. The sample was selected from outpatients, hospitalized and institutionalized patients. MUST, MNAsf and MST screening were employed. A nutritional assessment of all the patients was undertaken. The SENPE-SEDOM consensus was used for the diagnosis. Results: In the outpatients, both MUST and MNAsf have a similar validity in relation to the nutritional assessment (AUC 0.871 and 0.883, respectively). In the institutionalized patients, the MUST screening method is the one that shows the greatest validity (AUC 0.815), whereas in the hospitalized patients, the most valid methods are both MUST and MST (AUC 0.868 and 0.853, respectively). Conclusions: It is essential to use nutritional screening to invest the available resources wisely. Based on our results, MUST is the most suitable screening method in hospitalized and institutionalized patients (AU)

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INTRODUCTION AND OBJECTIVE: Nutritional screening allows for the detection of nutritional risk. Validated tools should be implemented, and their usefulness should be contrasted with a gold standard. The aim of this study is to discover the validity, efficacy and reliability of 3 nutritional screening tools in relation to complete nutritional assessment. MATERIAL AND METHODOLOGY: A sub-analysis of a cross-sectional and descriptive study on the prevalence of disease-related malnutrition. The sample was selected from outpatients, hospitalized and institutionalized patients. MUST, MNAsf and MST screening were employed. A nutritional assessment of all the patients was undertaken. The SENPE-SEDOM consensus was used for the diagnosis. RESULTS: In the outpatients, both MUST and MNAsf have a similar validity in relation to the nutritional assessment (AUC 0.871 and 0.883, respectively). In the institutionalized patients, the MUST screening method is the one that shows the greatest validity (AUC 0.815), whereas in the hospitalized patients, the most valid methods are both MUST and MST (AUC 0.868 and 0.853, respectively). CONCLUSIONS: It is essential to use nutritional screening to invest the available resources wisely. Based on our results, MUST is the most suitable screening method in hospitalized and institutionalized patients.

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INTRODUCTION: The prevalence of disease-related malnutrition depends on the population studied and the methods used for screening, for nutritional assessment and the diagnostic criteria employed. OBJECTIVES: To determine the prevalence of nutritional risk and malnutrition, and the type and degree of malnutrition in outpatient, hospitalized and institutionalized populations in a health department. MATERIAL AND METHODS: Cross-sectional and descriptive study with a randomly selected sample. Malnutrition Universal Screening Tool (MUST) was performed as a screening test to assess nutritional risk, and a complete nutritional assessment was carried out according to the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria. The type and degree of malnutrition was determined according to the SENPE-SEDOM consensus criteria. RESULTS: MUST revealed a prevalence of nutritional risk of 28% (215) (outpatients n = 106: 15.1% [16]; institutionalized patients n = 375: 31.2% [117]; hospitalized patients n = 285: 28.8% [82]). The overall prevalence of disease-related malnutrition was 26.4% (202) (outpatients n = 106: 2.8% [3]; institutionalized patients n = 375: 30.13% [113]; hospitalized patients n = 285: 30.2% [86]). Prevalence was highest amongst patients older than 75 years (74.3%). Malnutrition of a caloric type and a mild degree was the most common in the whole sample (18% and 12.9%, respectively). CONCLUSIONS: One in four patients in the analyzed sample is malnourished. Disease-related malnutrition is especially prevalent in inpatients and in the elderly, affecting one in three patients. In light of this prevalence, it is essential to put in place nutritional screening procedures associated with therapeutic action plans.

INTRODUCCIÓN: la prevalencia de desnutrición relacionada con la enfermedad (DRE) varía según la población estudiada y los métodos empleados para el cribado, para la valoración nutricional y los criterios diagnósticos. OBJETIVOS: determinar la prevalencia de riesgo nutricional y de desnutrición establecida, tipo y grado de la misma en población ambulatoria, hospitalizada e institucionalizada, en un departamento de salud. Material y métodos: estudio transversal y descriptivo con selección aleatoria de la muestra. A la población reclutada se le realizó el Malnutrition Universal Screening Tool (MUST) como cribado para evaluar el riesgo nutricional y una valoración nutricional completa según los criterios de la American Society for Parenteral and Enteral Nutrition (ASPEN). El tipo y grado de desnutrición se estableció interpretando los criterios del consenso SENPE-SEDOM. RESULTADOS: la prevalencia de riesgo nutricional encontrada con el MUST es del 28% (215) (ambulatorios n = 106: 15,1% [16]; institucionalizados n = 375: 31,2% [117]; hospitalizados n = 285: 28,8% [82]). La prevalencia global de DRE encontrada es del 26,4% (202) (ambulatorios n = 106: 2,8% [3]; institucionalizados n = 375: 30,13% [113]; hospitalizados n = 285: 30,2% [86]). La mayor prevalencia de DRE se da en pacientes mayores de 75 años (74,3%). La desnutrición de tipo calórico y grado leve es la más frecuente en nuestra muestra (18% y 12,9%, respectivamente). CONCLUSIONES: uno de cada cuatro pacientes de la muestra estudiada está desnutrido. La DRE es especialmente prevalente en el medio hospitalario y en los ancianos afecta a uno de cada tres pacientes. Dada la prevalencia de desnutrición encontrada, es imprescindible la implementación sistemática de cribados nutricionales asociados a planes de acción terapéuticos.

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Introducción: la prevalencia de desnutrición relacionada con la enfermedad (DRE) varía según la población estudiada y los métodos empleados para el cribado, para la valoración nutricional y los criterios diagnósticos. Objetivos: determinar la prevalencia de riesgo nutricional y de desnutrición establecida, tipo y grado de la misma en población ambulatoria, hospitalizada e institucionalizada, en un departamento de salud. Material y métodos: estudio transversal y descriptivo con selección aleatoria de la muestra. A la población reclutada se le realizó el Malnutrition Universal Screening Tool (MUST) como cribado para evaluar el riesgo nutricional y una valoración nutricional completa según los criterios de la American Society for Parenteral and Enteral Nutrition (ASPEN). El tipo y grado de desnutrición se estableció interpretando los criterios del consenso SENPE-SEDOM. Resultados: la prevalencia de riesgo nutricional encontrada con el MUST es del 28% (215) (ambulatorios n = 106: 15,1% [16]; institucionalizados n = 375: 31,2% [117]; hospitalizados n = 285: 28,8% [82]). La prevalencia global de DRE encontrada es del 26,4% (202) (ambulatorios n = 106: 2,8% [3]; institucionalizados n = 375: 30,13% [113]; hospitalizados n = 285: 30,2% [86]). La mayor prevalencia de DRE se da en pacientes mayores de 75 años (74,3%). La desnutrición de tipo calórico y grado leve es la más frecuente en nuestra muestra (18% y 12,9%, respectivamente). Conclusiones: uno de cada cuatro pacientes de la muestra estudiada está desnutrido. La DRE es especialmente prevalente en el medio hospitalario y en los ancianos afecta a uno de cada tres pacientes. Dada la prevalencia de desnutrición encontrada, es imprescindible la implementación sistemática de cribados nutricionales asociados a planes de acción terapéuticos (AU)

Introduction: The prevalence of disease-related malnutrition depends on the population studied and the methods used for screening, for nutritional assessment and the diagnostic criteria employed. Objectives: To determine the prevalence of nutritional risk and malnutrition, and the type and degree of malnutrition in outpatient, hospitalized and institutionalized populations in a health department. Material and methods: Cross-sectional and descriptive study with a randomly selected sample. Malnutrition Universal Screening Tool (MUST) was performed as a screening test to assess nutritional risk, and a complete nutritional assessment was carried out according to the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria. The type and degree of malnutrition was determined according to the SENPE-SEDOM consensus criteria. Results: MUST revealed a prevalence of nutritional risk of 28% (215) (outpatients n = 106: 15.1% [16]; institutionalized patients n = 375: 31.2% [117]; hospitalized patients n = 285: 28.8% [82]). The overall prevalence of disease-related malnutrition was 26.4% (202) (outpatients n = 106: 2.8% [3]; institutionalized patients n = 375: 30.13% [113]; hospitalized patients n = 285: 30.2% [86]). Prevalence was highest amongst patients older than 75 years (74.3%). Malnutrition of a caloric type and a mild degree was the most common in the whole sample (18% and 12.9%, respectively). Conclusions: One in four patients in the analyzed sample is malnourished. Disease-related malnutrition is especially prevalent in inpatients and in the elderly, affecting one in three patients. In light of this prevalence, it is essential to put in place nutritional screening procedures associated with therapeutic action plans (AU)

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