J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 7, July 2019, pages 472-479

Association Between Risk Factors and Intensive Nutritional Intervention Outcomes in Elderly Individuals

**Table 1.** Characteristics of the Participants
	Successful group (n = 140)	Non-successful group (n = 90)	P value
Data are expressed as median (25th - 75th percentile) or percentage (n). The differences between the two groups were analyzed using the Fisher’s exact test, Chi-square test, and Mann-Whitney U test. BMI: body mass index; CCI: Charlson Comorbidity Index; SGA: subjective global assessment; %TEE: the energy fill rate to total energy expenditure; NST: nutrition support team.
Age (years)	85.0	(79.0 - 89.0)	84.0	(78.8 - 89.0)	0.426
Sex (men)	35.0%	(49)	51.1%	(46)	0.020
BMI (kg/m²)	18.7	(16.4 - 21.0)	18.4	(16.1 - 21.5)	0.863
Lack of data		(3)		(5)
CCI (points)
Low, 0	17.9%	(25)	15.6%	(14)	0.464
Medium, 1 - 2	46.4%	(65)	42.2%	(38)
High, 3 - 4	20.7%	(29)	18.9%	(17)
Very high, ≥ 5	15.0%	(21)	23.3%	(21)
SGA score (points)
Normal, 0	11.4%	(15)	5.8%	(5)	0.102
Light, 1 - 2	34.1%	(45)	24.4%	(21)
Moderate, 3 - 4	34.1%	(45)	48.8%	(42)
Severe, 5 - 10	20.5%	(27)	20.9%	(18)
Lack of data		(8)		(4)
Presence of dysphagia	48.9%	(68)	58.9%	(53)	0.175
Lack of data		(1)		(0)
Presence of bedsore	11.4%	(15)	17.4%	(15)	0.230
Lack of data		(8)		(4)
%TEE (%)	66.0	(44.8 - 82.1)	56.3	(36.2 - 73.2)	0.004
Duration of NST intervention (days)	36.0	(22.0 - 50.0)	22.0	(14.0 - 43.0)	< 0.001

Table 1. Characteristics of the Participants

Successful group (n = 140)

Non-successful group (n = 90)

P value

Data are expressed as median (25th - 75th percentile) or percentage (n). The differences between the two groups were analyzed using the Fisher’s exact test, Chi-square test, and Mann-Whitney U test. BMI: body mass index; CCI: Charlson Comorbidity Index; SGA: subjective global assessment; %TEE: the energy fill rate to total energy expenditure; NST: nutrition support team.

Age (years)

85.0

(79.0 - 89.0)

84.0

(78.8 - 89.0)

0.426

Sex (men)

35.0%

(49)

51.1%

(46)

0.020

BMI (kg/m²)

18.7

(16.4 - 21.0)

18.4

(16.1 - 21.5)

0.863

Lack of data

(3)

(5)

CCI (points)

Low, 0

17.9%

(25)

15.6%

(14)

0.464

Medium, 1 - 2

46.4%

(65)

42.2%

(38)

High, 3 - 4

20.7%

(29)

18.9%

(17)

Very high, ≥ 5

15.0%

(21)

23.3%

(21)

SGA score (points)

Normal, 0

11.4%

(15)

5.8%

(5)

0.102

Light, 1 - 2

34.1%

(45)

24.4%

(21)

Moderate, 3 - 4

34.1%

(45)

48.8%

(42)

Severe, 5 - 10

20.5%

(27)

20.9%

(18)

Lack of data

(8)

(4)

Presence of dysphagia

48.9%

(68)

58.9%

(53)

0.175

Lack of data

(1)

(0)

Presence of bedsore

11.4%

(15)

17.4%

(15)

0.230

Lack of data

(8)

(4)

%TEE (%)

66.0

(44.8 - 82.1)

56.3

(36.2 - 73.2)

0.004

Duration of NST intervention (days)

36.0

(22.0 - 50.0)

22.0

(14.0 - 43.0)

< 0.001

**Table 2.** Laboratory Examination Results
	Successful group (n = 140)	Non-successful group (n = 90)	P value
Data are expressed as median (25th - 75th percentile). The differences between the two groups were analyzed using the Mann-Whitney U test. Alb: albumin; TLC: total lymphocyte count; T-Cho: total cholesterol; CRP: C-reactive protein; TTR: transthyretin; Hb: hemoglobin; TG: triglyceride; CONUT: controlling nutritional status; PNI: Onodera’s prognostic nutritional index; GNRI: geriatric nutritional risk index.
Alb level (g/dL)	140	2.4	(2.0 - 2.7)	90	2.2	(1.8 - 2.6)	0.004
TLC level (/µL)	136	1,160	(825 - 1575)	86	1,100	(760 - 1605)	0.710
T-Cho level (mg/dL)	122	137	(106 - 160)	76	133	(102 - 161)	0.771
CRP level (mg/dL)	139	2.16	(0.83 - 4.80)	90	4.25	(1.39 - 9.08)	0.001
TTR level (mg/dL)	113	10.4	(7.5 - 14.0)	68	8.3	(5.2 - 10.8)	0.002
Hb level (g/dL)	139	9.2	(8.4 - 10.5)	90	9.2	(8.3 - 10.6)	0.930
TG level (mg/dL)	122	90	(63 - 111)	69	89	(66 - 116)	0.607
CONUT score	122	8.0	(6.0 - 10.0)	76	8.5	(7.0 - 10.0)	0.304
PNI score	136	29.6	(25.8 - 34.5)	86	27.2	(23.3 - 32.5)	0.017
GNRI score	137	72.0	(64.3 - 78.2)	85	67.8	(61.0 - 73.4)	0.003

Table 2. Laboratory Examination Results

Successful group (n = 140)

Non-successful group (n = 90)

P value

Data are expressed as median (25th - 75th percentile). The differences between the two groups were analyzed using the Mann-Whitney U test. Alb: albumin; TLC: total lymphocyte count; T-Cho: total cholesterol; CRP: C-reactive protein; TTR: transthyretin; Hb: hemoglobin; TG: triglyceride; CONUT: controlling nutritional status; PNI: Onodera’s prognostic nutritional index; GNRI: geriatric nutritional risk index.

Alb level (g/dL)

140

2.4

(2.0 - 2.7)

2.2

(1.8 - 2.6)

0.004

TLC level (/µL)

136

1,160

(825 - 1575)

1,100

(760 - 1605)

0.710

T-Cho level (mg/dL)

122

137

(106 - 160)

133

(102 - 161)

0.771

CRP level (mg/dL)

139

2.16

(0.83 - 4.80)

4.25

(1.39 - 9.08)

0.001

TTR level (mg/dL)

113

10.4

(7.5 - 14.0)

8.3

(5.2 - 10.8)

0.002

Hb level (g/dL)

139

9.2

(8.4 - 10.5)

9.2

(8.3 - 10.6)

0.930

TG level (mg/dL)

122

(63 - 111)

(66 - 116)

0.607

CONUT score

122

8.0

(6.0 - 10.0)

8.5

(7.0 - 10.0)

0.304

PNI score

136

29.6

(25.8 - 34.5)

27.2

(23.3 - 32.5)

0.017

GNRI score

137

72.0

(64.3 - 78.2)

67.8

(61.0 - 73.4)

0.003

**Table 3.** Methods Used to Supply Nutrients at the Time of NST Enrollment
	Successful group (n = 140)	Non-successful group (n = 90)	P value
Data are expressed as percentage (n). The differences between the two groups were analyzed using the Fisher’s exact test. PEG: percutaneous endoscopic gastrostomy.
Total parenteral nutrition	16.4%	(23)	24.4%	(22)	0.173
Peripheral parenteral nutrition	32.1%	(45)	47.8%	(43)	0.019
Nasal tube feeding	6.4%	(9)	4.4%	(4)	0.771
Gastric fistula (PEG)	6.4%	(9)	2.2%	(2)	0.209
Regular texture diet (including therapeutic diet)	50.7%	(71)	46.7%	(42)	0.590
Oral supplementation (including enteral nutrient)	60.0%	(84)	63.3%	(57)	0.678
Dysphagia diet	35.7%	(50)	41.1%	(37)	0.486

Table 3. Methods Used to Supply Nutrients at the Time of NST Enrollment

Successful group (n = 140)

Non-successful group (n = 90)

P value

Data are expressed as percentage (n). The differences between the two groups were analyzed using the Fisher’s exact test. PEG: percutaneous endoscopic gastrostomy.

Total parenteral nutrition

16.4%

(23)

24.4%

(22)

0.173

Peripheral parenteral nutrition

32.1%

(45)

47.8%

(43)

0.019

Nasal tube feeding

6.4%

(9)

4.4%

(4)

0.771

Gastric fistula (PEG)

6.4%

(9)

2.2%

(2)

0.209

Regular texture diet (including therapeutic diet)

50.7%

(71)

46.7%

(42)

0.590

Oral supplementation (including enteral nutrient)

60.0%

(84)

63.3%

(57)

0.678

Dysphagia diet

35.7%

(50)

41.1%

(37)

0.486

**Table 4.** Results of the Univariate and Multivariate Cox Proportional Hazard Analyses of the NST Intervention Outcomes
	Successful group	Non-successful group	P value^a	Univariate analysis	P value	Multivariate analysis^b	P value
^aFisher’s exact test. ^bModel included age, sex, CCI score, SGA score, %TEE, TLC, CRP, GNRI score, and PPN. HR: hazard ratio; CI: confidence interval; BMI: body mass index; CCI: Charlson Comorbidity Index; SGA: subjective global assessment; %TEE: the energy fill rate to total energy expenditure; Alb: albumin; TLC: total lymphocyte count; CRP: C-reactive protein; TTR: transthyretin; CONUT: controlling nutritional status; PNI: Onodera’s prognostic nutritional index; GNRI: geriatric nutritional risk index; PPN: peripheral parental nutrition.
Age (years)
< 85	49.3% (69)	53.3% (48)	0.590	1	0.285	1	0.368
≥ 85	50.7% (71)	46.7% (42)		0.80 (0.52 - 1.21)		0.81 (0.51 - 1.29)
Sex
Women	65.0% (91)	48.9% (44)	0.020	1	0.173	1	0.812
Men	35.0% (49)	51.1% (46)		1.34 (0.88 - 2.03)		1.06 (0.66 - 1.71)
BMI (kg/m²)
≥ 18.5	51.8% (71)	49.4% (42)	0.783	1	0.332
< 18.5	48.2% (66)	50.6% (43)		1.24 (0.81 - 1.90)
CCI (points)
< 2	26.4% (37)	22.2% (20)	0.533	1	0.627	1	0.937
≥ 2	73.6% (103)	77.8% (70)		1.13 (0.69 - 1.86)		1.02 (0.59 - 1.77)
SGA score (points)
< 3	43.9% (58)	29.1% (25)	0.032	1	0.062	1	0.259
≥ 3	56.1% (74)	70.9% (61)		1.56 (0.98 - 2.49)		1.34 (0.81 - 2.20)
%TEE (%)
≥ 66.0	50.0% (70)	32.2% (29)	0.010	1	0.009	1	0.061
< 66.0	50.0% (70)	67.8% (61)		1.82 (1.16 - 2.83)		1.61 (0.98 - 2.66)
Alb level (g/dL)
≥ 2.4	57.9% (81)	37.8% (34)	0.004	1	0.015
< 2.4	42.1% (59)	62.2% (56)		1.70 (1.11 - 2.61)
TLC level (/µL)
≥ 1,195	45.6% (62)	44.2% (38)	0.890	1	0.513	1	0.642
< 1,195	54.4% (74)	55.8% (48)		1.15 (0.75 - 1.77)		0.89 (0.55 - 1.45)
CRP level (mg/dL)
< 2.00	46.8% (65)	28.9% (26)	0.009	1	0.013	1	0.103
≥ 2.00	53.2% (74)	71.1% (64)		1.79 (1.13 - 2.83)		1.55 (0.92 - 2.62)
TTR level (mg/dL)
≥ 8.5	69.9% (79)	48.5% (33)	0.005	1	0.006
< 8.5	30.1% (34)	51.5% (35)		1.97 (1.22 - 3.19)
CONUT score
≤ 7	41.8% (51)	36.8% (28)	0.551	1	0.414
≥ 8	58.2% (71)	63.2% (48)		1.22 (0.76 - 1.94)
PNI score
≥ 33.0	32.4% (44)	23.3% (20)	0.172	1	0.063
< 33.0	67.6% (92)	76.7% (66)		1.61 (0.98 - 2.67)
GNRI score
≥ 70.0	57.0% (77)	38.8% (33)	0.012	1	0.009	1	0.099
< 70.0	43.0% (58)	61.2% (52)		1.80 (1.16 - 2.79)		1.54 (0.92 - 2.56)
PPN
Absence	67.9% (95)	52.2% (47)	0.019	1	0.004	1	0.014
Presence	32.1% (45)	47.8% (43)		1.86 (1.22 - 2.84)		1.80 (1.13 - 2.88)

Table 4. Results of the Univariate and Multivariate Cox Proportional Hazard Analyses of the NST Intervention Outcomes

Successful group

Non-successful group

P value^a

Univariate analysis

P value

Multivariate analysis^b

P value

% (n)

HR (95% CI)

^aFisher’s exact test. ^bModel included age, sex, CCI score, SGA score, %TEE, TLC, CRP, GNRI score, and PPN. HR: hazard ratio; CI: confidence interval; BMI: body mass index; CCI: Charlson Comorbidity Index; SGA: subjective global assessment; %TEE: the energy fill rate to total energy expenditure; Alb: albumin; TLC: total lymphocyte count; CRP: C-reactive protein; TTR: transthyretin; CONUT: controlling nutritional status; PNI: Onodera’s prognostic nutritional index; GNRI: geriatric nutritional risk index; PPN: peripheral parental nutrition.

Age (years)

< 85

49.3% (69)

53.3% (48)

0.590

0.285

0.368

≥ 85

50.7% (71)

46.7% (42)

0.80 (0.52 - 1.21)

0.81 (0.51 - 1.29)

Sex

Women

65.0% (91)

48.9% (44)

0.020

0.173

0.812

Men

35.0% (49)

51.1% (46)

1.34 (0.88 - 2.03)

1.06 (0.66 - 1.71)

BMI (kg/m²)

≥ 18.5

51.8% (71)

49.4% (42)

0.783

0.332

< 18.5

48.2% (66)

50.6% (43)

1.24 (0.81 - 1.90)

CCI (points)

< 2

26.4% (37)

22.2% (20)

0.533

0.627

0.937

≥ 2

73.6% (103)

77.8% (70)

1.13 (0.69 - 1.86)

1.02 (0.59 - 1.77)

SGA score (points)

< 3

43.9% (58)

29.1% (25)

0.032

0.062

0.259

≥ 3

56.1% (74)

70.9% (61)

1.56 (0.98 - 2.49)

1.34 (0.81 - 2.20)

%TEE (%)

≥ 66.0

50.0% (70)

32.2% (29)

0.010

0.009

0.061

< 66.0

50.0% (70)

67.8% (61)

1.82 (1.16 - 2.83)

1.61 (0.98 - 2.66)

Alb level (g/dL)

≥ 2.4

57.9% (81)

37.8% (34)

0.004

0.015

< 2.4

42.1% (59)

62.2% (56)

1.70 (1.11 - 2.61)

TLC level (/µL)

≥ 1,195

45.6% (62)

44.2% (38)

0.890

0.513

0.642

< 1,195

54.4% (74)

55.8% (48)

1.15 (0.75 - 1.77)

0.89 (0.55 - 1.45)

CRP level (mg/dL)

< 2.00

46.8% (65)

28.9% (26)

0.009

0.013

0.103

≥ 2.00

53.2% (74)

71.1% (64)

1.79 (1.13 - 2.83)

1.55 (0.92 - 2.62)

TTR level (mg/dL)

≥ 8.5

69.9% (79)

48.5% (33)

0.005

0.006

< 8.5

30.1% (34)

51.5% (35)

1.97 (1.22 - 3.19)

CONUT score

≤ 7

41.8% (51)

36.8% (28)

0.551

0.414

≥ 8

58.2% (71)

63.2% (48)

1.22 (0.76 - 1.94)

PNI score

≥ 33.0

32.4% (44)

23.3% (20)

0.172

0.063

< 33.0

67.6% (92)

76.7% (66)

1.61 (0.98 - 2.67)

GNRI score

≥ 70.0

57.0% (77)

38.8% (33)

0.012

0.009

0.099

< 70.0

43.0% (58)

61.2% (52)

1.80 (1.16 - 2.79)

1.54 (0.92 - 2.56)

PPN

Absence

67.9% (95)

52.2% (47)

0.019

0.004

0.014

Presence

32.1% (45)

47.8% (43)

1.86 (1.22 - 2.84)

1.80 (1.13 - 2.88)