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Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Prado, Carla M.; Ford, Katherine L.; Gonzalez, M. Cristina; Murnane, Lisa C.; Gillis, Chelsia; Wischmeyer, Paul E.; Morrison, Chet A.; Lobo, Dileep N.

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Authors

Carla M. Prado

Katherine L. Ford

M. Cristina Gonzalez

Lisa C. Murnane

Chelsia Gillis

Paul E. Wischmeyer

Chet A. Morrison

DILEEP LOBO dileep.lobo@nottingham.ac.uk
Professor of Gastrointestinal Surgery



Abstract

Preoperative nutrition status is an important determinant of surgical outcomes, yet malnutrition assessment is not integrated into all surgical pathways. Given its importance and the high prevalence of malnutrition in patients undergoing surgical procedures, preoperative nutrition screening, assessment, and intervention are needed to improve postoperative outcomes. This narrative review discusses novel methods to assess malnutrition and frailty in the surgical patient. The Global Leadership Initiative for Malnutrition (GLIM) criteria are increasingly used in surgical settings although further spread and implementation are strongly encouraged to help standardize the diagnosis of malnutrition. The use of body composition (ie, reduced muscle mass) as a phenotypic criterion in GLIM may lead to a greater number of patients identified as having malnutrition, which may otherwise be undetected if screened by other diagnostic tools. Skeletal muscle loss is a defining criterion of malnutrition and frailty. Novel direct and indirect approaches to assess muscle mass in clinical settings may facilitate the identification of patients with or at risk for malnutrition. Selected imaging techniques have the additional advantage of identifying myosteatosis (an independent predictor of morbidity and mortality for surgical patients). Feasible pathways for screening and assessing frailty exist and may determine the cost/benefit of surgery, long‐term independence and productivity, and the value of undertaking targeted interventions. Finally, the evaluation of nutrition risk and status is essential to predict and mitigate surgical outcomes. Nascent to novel approaches are the future of objectively identifying patients at perioperative nutrition risk and guiding therapy toward optimal perioperative standards of care.

Citation

Prado, C. M., Ford, K. L., Gonzalez, M. C., Murnane, L. C., Gillis, C., Wischmeyer, P. E., …Lobo, D. N. (2023). Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient. Journal of Parenteral and Enteral Nutrition, 47(S1), S54-S68. https://doi.org/10.1002/jpen.2420

Journal Article Type Article
Acceptance Date Jun 7, 2022
Online Publication Date Dec 5, 2022
Publication Date Feb 7, 2023
Deposit Date Dec 6, 2022
Publicly Available Date Feb 8, 2023
Journal Journal of Parenteral and Enteral Nutrition
Print ISSN 0148-6071
Electronic ISSN 1941-2444
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 47
Issue S1
Pages S54-S68
DOI https://doi.org/10.1002/jpen.2420
Keywords body composition, frailty, GLIM, imaging, malnutrition, muscle mass, nutritional assessment, nutritional risk, nutritional screening, perioperative nutrition, sarcopenia, surgery
Public URL https://nottingham-repository.worktribe.com/output/14592942
Publisher URL https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2420

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Publisher Licence URL
https://creativecommons.org/licenses/by-nc/4.0/

Copyright Statement
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.





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