- Email: [email protected]
Malnutrition: The kiss of Grim Reaper
Accepted Manuscript Malnutrition: the kiss of Grim Reaper Gozde Sengul Aycicek, MD, Gunes Arik, MD, Zekeriya Ulger, Ph D, Assoc.Prof PII:
S0261-5614(16)30095-4
DOI:
10.1016/j.clnu.2016.04.031
Reference:
YCLNU 2824
To appear in:
Clinical Nutrition
Received Date: 16 February 2016 Accepted Date: 28 April 2016
Please cite this article as: Sengul Aycicek G, Arik G, Ulger Z, Malnutrition: the kiss of Grim Reaper, Clinical Nutrition (2016), doi: 10.1016/j.clnu.2016.04.031. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT 1
Malnutrition: the kiss of Grim Reaper
2 Sengul Aycicek G, Arik G, Ulger Z
4
Corresponding Author: Gozde Sengul Aycicek
5
E-mail adress: [email protected]
6 7
Contact address: Gazi University, Faculty of Internal Medicine, Division of Geriatrics, Ankara, Turkey
8
+903122025070
9
Gozde Sengul Aycicek, MD
RI PT
3
Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
11
Gunes Arik, MD
12
Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
13
Zekeriya Ulger, Ph D, Assoc.Prof.
14
Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
15 16
Key Words: Elderly, high protein beta-hydroxy- beta-methylbutyrate, malnutrition, oral nutritional supplement, mortality
M AN U
SC
10
20 21 22 23 24 25 26 27 28 29 30 31 32 33
EP
19
Conflict of interests: The authors state that they have no conflicts of interest
AC C
18
TE D
17
ACCEPTED MANUSCRIPT 34
Dear Editor,
35 It is spectacular that Deutz N.E.P et al (1) highlighted once again the importance of malnutrition in the
37
elderly with the NOURISH study . It is reported that a specialized oral nutritional supplement, rich in
38
protein and beta- hydroxy- beta-methylbutyrate improved the nutritional outcomes and decreased
39
mortality in hospitalized older adults. However, there are some points that should be addressed about
40
the methodology of the study.
RI PT
36
41
Although Subjective Global Assessment (SGA) is a widely used tool to assess malnutrition in
43
hospitalized patients, it mainly depends on the medical history and physical examination, therefore
44
objective aspect of the assessment remains weak. In addition, the authors mentioned that patients
45
were SGA B or C, but we couldn’t find any information if there was any difference between the
46
objective nutritional parameters in the study and placebo group like albumin, prealbumin etc.
SC
42
M AN U
47
It is a well known fact that physical inactivity or decreased physical activity leads to loss of muscle
49
mass and strength resulting in sarcopenia. Protein supplementation in combination with exercise is
50
considered optimal for maintaining muscle function (2). Physical exercise should be recommended for
51
all older people, with a frequency of at least 3 days per week, even in the presence of chronic illnesses
52
(3). But in the current study, we couldn’t find any information about the exercise levels of the patients.
53
And when this issue is taken account, if there is any difference between study and control group in
54
their activity levels, we think that, it is impossible to launch the results solely related to protein and
55
HMB supplementation.
56
TE D
48
References
58 59 60
1) Deutz N.E.P, et al. NOURISH Study Group. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016; 35(1): 18-26.
61 62
2) Deutz N.E.P, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group.Clin Nutr. 2014; 33(6): 929-36.
63
3) Montero-Fernandez N, et al. Eur J Phys Rehabil Med 2013; 49: 131-43
64
AC C
EP
57
ACCEPTED MANUSCRIPT Conflict of Interest Statement Gunes Arik, MD Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
AC C
EP
TE D
M AN U
SC
RI PT
Conflict of interests: The authors state that they have no conflicts of interest
ACCEPTED MANUSCRIPT Conflict of Interest Statement Gozde Sengul Aycicek, MD Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
AC C
EP
TE D
M AN U
SC
RI PT
Conflict of interests: The authors state that they have no conflicts of interest
ACCEPTED MANUSCRIPT Conflict of Interest Statement Zekeriya Ulger, Ph D, Assoc.Prof. Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
AC C
EP
TE D
M AN U
SC
RI PT
Conflict of interests: The authors state that they have no conflicts of interest
S0261-5614(16)30095-4
DOI:
10.1016/j.clnu.2016.04.031
Reference:
YCLNU 2824
To appear in:
Clinical Nutrition
Received Date: 16 February 2016 Accepted Date: 28 April 2016
Please cite this article as: Sengul Aycicek G, Arik G, Ulger Z, Malnutrition: the kiss of Grim Reaper, Clinical Nutrition (2016), doi: 10.1016/j.clnu.2016.04.031. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT 1
Malnutrition: the kiss of Grim Reaper
2 Sengul Aycicek G, Arik G, Ulger Z
4
Corresponding Author: Gozde Sengul Aycicek
5
E-mail adress: [email protected]
6 7
Contact address: Gazi University, Faculty of Internal Medicine, Division of Geriatrics, Ankara, Turkey
8
+903122025070
9
Gozde Sengul Aycicek, MD
RI PT
3
Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
11
Gunes Arik, MD
12
Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
13
Zekeriya Ulger, Ph D, Assoc.Prof.
14
Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
15 16
Key Words: Elderly, high protein beta-hydroxy- beta-methylbutyrate, malnutrition, oral nutritional supplement, mortality
M AN U
SC
10
20 21 22 23 24 25 26 27 28 29 30 31 32 33
EP
19
Conflict of interests: The authors state that they have no conflicts of interest
AC C
18
TE D
17
ACCEPTED MANUSCRIPT 34
Dear Editor,
35 It is spectacular that Deutz N.E.P et al (1) highlighted once again the importance of malnutrition in the
37
elderly with the NOURISH study . It is reported that a specialized oral nutritional supplement, rich in
38
protein and beta- hydroxy- beta-methylbutyrate improved the nutritional outcomes and decreased
39
mortality in hospitalized older adults. However, there are some points that should be addressed about
40
the methodology of the study.
RI PT
36
41
Although Subjective Global Assessment (SGA) is a widely used tool to assess malnutrition in
43
hospitalized patients, it mainly depends on the medical history and physical examination, therefore
44
objective aspect of the assessment remains weak. In addition, the authors mentioned that patients
45
were SGA B or C, but we couldn’t find any information if there was any difference between the
46
objective nutritional parameters in the study and placebo group like albumin, prealbumin etc.
SC
42
M AN U
47
It is a well known fact that physical inactivity or decreased physical activity leads to loss of muscle
49
mass and strength resulting in sarcopenia. Protein supplementation in combination with exercise is
50
considered optimal for maintaining muscle function (2). Physical exercise should be recommended for
51
all older people, with a frequency of at least 3 days per week, even in the presence of chronic illnesses
52
(3). But in the current study, we couldn’t find any information about the exercise levels of the patients.
53
And when this issue is taken account, if there is any difference between study and control group in
54
their activity levels, we think that, it is impossible to launch the results solely related to protein and
55
HMB supplementation.
56
TE D
48
References
58 59 60
1) Deutz N.E.P, et al. NOURISH Study Group. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016; 35(1): 18-26.
61 62
2) Deutz N.E.P, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group.Clin Nutr. 2014; 33(6): 929-36.
63
3) Montero-Fernandez N, et al. Eur J Phys Rehabil Med 2013; 49: 131-43
64
AC C
EP
57
ACCEPTED MANUSCRIPT Conflict of Interest Statement Gunes Arik, MD Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
AC C
EP
TE D
M AN U
SC
RI PT
Conflict of interests: The authors state that they have no conflicts of interest
ACCEPTED MANUSCRIPT Conflict of Interest Statement Gozde Sengul Aycicek, MD Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
AC C
EP
TE D
M AN U
SC
RI PT
Conflict of interests: The authors state that they have no conflicts of interest
ACCEPTED MANUSCRIPT Conflict of Interest Statement Zekeriya Ulger, Ph D, Assoc.Prof. Gazi University, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
AC C
EP
TE D
M AN U
SC
RI PT
Conflict of interests: The authors state that they have no conflicts of interest