Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-31T14:57:55.691Z Has data issue: false hasContentIssue false
  • English
  • Français

Physiological functions should be considered as true end points of nutritional intervention studies

Published online by Cambridge University Press:  07 March 2007

L. Genton ,
W.van Gemert ,
C. Pichard  and
P. Soeters
L. Genton
Affiliation:
Department of Surgery, University Hospital, P. Debyelaan, 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands Department of Clinical Nutrition, University Hospital, Geneva, Switzerland
W.van Gemert
Affiliation:
Department of Surgery, University Hospital, P. Debyelaan, 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
C. Pichard
Affiliation:
Department of Clinical Nutrition, University Hospital, Geneva, Switzerland
P. Soeters*
Affiliation:
Department of Surgery, University Hospital, P. Debyelaan, 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
*
*Corresponding author: Professor Dr P. B. Soeters, fax +31 43 3875473, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

With the beginning of this millennium it has become fashionable to only follow ‘evidence-based’ practices. This generally-accepted approach cruelly negates experience or intelligent interpretation of pathophysiology. Another problem is that the great ‘meta-analysts’ of the present era only accept end points that they consider ‘hard’. In the metabolic and nutritional field these end points are infection-related morbidity and mortality, and all other end points are considered ‘surrogate’. The aim of this presentation is to prove that this claim greatly negates the contribution of more-fundamentally-oriented research, the fact that mortality has multifactorial causes, and that infection is a crude measure of immune function. The following problems should be considered: many populations undergoing intervention have low mortality, requiring studies with thousands of patients to demonstrate effects of intervention on mortality; nutrition is only in rare cases primary treatment, and in many populations is a prerequisite for survival rather than a therapeutic modality; once the effect of nutritional support is achieved, the extra benefit of modulation of the nutritional support regimen can only be modest; cost–benefit is not a valid end point, because the better it is done the more it will cost; morbidity and mortality are crude end points for the effect of nutritional intervention, and are influenced by many factors. In fact, it is a yes or no factor. In the literature the most important contributions include new insights into the pathogenesis of disease, the diminution of disease-related adverse events and/or functional improvement after therapy. In nutrition research the negligence of these end points has precluded the development and validation of functional end points, such as muscle, immune and cognitive functions. Disability, quality of life, morbidity and mortality are directly related to these functional variables. It is, therefore, of paramount importance to validate functional end points and to consider them as primary rather than surrogate end points.

Keywords

Clinical end pointsMuscle functionImmune functionCognitive functionEvidence-based medicine
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 64 , Issue 3 , August 2005 , pp. 285 - 296
Copyright
Copyright © The Nutrition Society 2005

References

Allen, KL, Miskulin, D, Yan, G, Dwyer, JT, Frydrych, A, Leung, J & Poole, D (2002) Association of nutritional markers with physical and mental health status in prevalent hemodialysis patients from the HEMO study. Journal of Renal Nutrition 12, 160–169 CrossRefGoogle ScholarPubMed
Al Snih, S, Markides, KS, Ray, GV & Ostir, GV, Goodwin, JS (2002) Handgrip strength and mortality in older Mexican Americans. Journal of the American Geriatrics Society 50, 1250–1256 CrossRefGoogle ScholarPubMed
Bannerman, E, Pendlebury, J, Phillips, F & Ghosh, S (2000) A cross-sectional and longitudinal study of health-related quality of life after percutaneous gastrostomy. European Journal of Gastroenterology and Hepatology 12, 1101–1109 CrossRefGoogle ScholarPubMed
Barbieri, M, Ferrucci, L, Ragno, E, Corsi, A, Bandinelli, S, Bonafè, M, Oliveri, F, Giovagnetti, S, Franceschi, C, Guralnik, JM & Paolisso, G (2003) Chronic inflammation and the effect of IGF-1 on muscle strength and power in older persons. American Journal of Physiology 284, E481–E487 Google Scholar
Beier-Holgersen, R & Brandstrup, B (1999) Influence of early postoperative enteral nutrition versus placebo on cell-mediated immunity, as measured with the Multitest CMI. Scandinavian Journal of Gastroenterology 34, 98–102 Google Scholar
Bellelli, G, Frisoni, GB, Bianchetti, A & Trabucchi, M (1997) The Bedford Alzheimer Nursing Severity scale for the severely demented: validation study. Alzheimer Disease and Associated Disorders 11, 71–77 Google Scholar
Bourdel-Marchasson, I, Joseph, PA, Dehail, P, Biran, M, Faux, P, Rainfray, M, Emeriau, JP, Canioni, P & Thiaudiere, E (2001) Functional and metabolic early changes in calf muscle occurring during nutritional repletion in malnourished elderly patients. American Journal of Clinical Nutrition 73, 832–838 Google Scholar
Bozzetti, F, Cozzaglio, L, Villa, ML, Ferrario, E & Trabattoni, D (1995) Restorative effect of total parenteral nutrition on natural killer cell activity in malnourished cancer patients. European Journal of Cancer 31, 2023–2027 Google Scholar
Bunker, VW, Stansfield, MF, Deacon-Smith, R, Marzil, RA, Hounslow, A & Clayton, BE (1994) Dietary supplementation and immunocompetence in housebound elderly subjects. British Journal of Biomedical Sciences 51, 128–135 Google Scholar
Bunout, B, Barrera, G, de la Maza, P, Avendano, M, Gattas, V, Petermann, M & Hirsh, S (2004) Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow. Journal of Nutrition, Health and Aging 8, 68–75 Google ScholarPubMed
Cabioglu, N, Bilgic, S, Deniz, G, Aktas, E, Seyhun, Y, Turna, A, Gunay, K & Esen, F (2002) Decreased cytokine expression in peripheral blood leukocytes of patients with severe sepsis. Archives of Surgery 137, 1037–1043 Google Scholar
Calder, PC & Kew, S (2002) The immune system: a target for functional foods? British Journal of Nutrition 88, Suppl. 2, S165–S177.Google Scholar
Canning, CG, Ada, L, Adams, R & O'Dwyer, NJ (2004) Loss of strength contributes more to physical disability after stroke than loss of dexterity. Clinical Rehabilitation 18, 300–308 Google Scholar
Cappola, AR, Xue, QL, Ferrucci, L, Guralnik, JM, Volpato, S & Fried, LP (2003) Insulin-like growth factor I and interleukin-6 contribute synergistically to disability and mortality in older women. Journal of Clinical Endocrinology and Metabolism 88, 2019–2025 Google Scholar
Carli, F, Webster, J, Ramachandra, V, Pearson, M, Read, M, Ford, GC, McArthur, S, Preedy, VR & Halliday, D (1990) Aspects of protein metabolism after elective surgery in patients receiving constant nutritional support. Clinical Science 78, 621–628 Google Scholar
Chandra, RK (2002) Nutrition and the immune system from birth to old age. European Journal of Clinical Nutrition 56, Suppl. 3, S73–S76.CrossRefGoogle ScholarPubMed
Chin, A, Paw, MJ, de Jong, N, Pallast, EG & Kloek, GC, Schouten, EG, Kok, FJ (2000) Immunity and frail elderly: a randomized controlled trial of exercise and enriched foods. Medicine and Science in Sports and Exercise 32, 2005–2011 Google Scholar
Christie, PM & Hill, GL (1990) Effect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease. Gastroenterology 99, 730–736 CrossRefGoogle ScholarPubMed
Christou, NV, Meakins, JL, Gordon, J, Yee, J, Hassan-Zahraee, M, Nohr, CW, Shizgal, HM & MacLean, LD (1995) The delayed hypersensitivity response and host resistance in surgical patients. 20 years later. Annals of Surgery 222, 534–546 Google Scholar
Correa Leite, ML, Nicolosi, A, Cristina, S, Hauser, WA & Nappi, G (2001) Nutrition and cognitive deficit in the elderly: a population study. European Journal of Clinical Nutrition 55, 1053–1058 Google Scholar
Corti, MC, Guralnik, JM, Salive, ME & Sorkin, JD (1994) Serum albumin level and physical disability as predictors of mortality in older persons. Journal of the American Medical Association 272, 1036–1042 Google Scholar
Cupisti, A, Licitra, R, Chisari, C, Stampacchia, G, D'Alessandro, C, Galetta, F, Rossi, B & Barsotti, G (2004) Skeletal muscle and nutritional assessment in chronic renal failure patients on a protein-restricted diet. Journal of Internal Medicine 255, 115–124 Google Scholar
Daly, JM, Lieberman, MD, Goldfine, J, Shou, J, Weintraub, F, Rosato, EF & Lavin, P (1992) Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome. Surgery 112, 56–57 Google ScholarPubMed
De Andino, RM, Guillermo Conde-Santiago, J & Mendoza, MM (1995) Functional disability and mental impairment as predictors of mortality in community-dwelling elderly Puerto Ricans. Puerto Rico Health Sciences Journal 14, 285–287 Google Scholar
Deschamps, V, Astier, X, Ferry, M, Rainfray, M, Emeriau, JP & Barberger-Gateau, P (2002) Nutritional status of healthy elderly persons living in Dordogne, France, and relation with mortality and cognitive or functional decline. European Journal of Clinical Nutrition 56, 305–312 CrossRefGoogle ScholarPubMed
Dewey, ME & Saz, P (2001) Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature. International Journal of Geriatric Psychiatry 16, 751–761 CrossRefGoogle ScholarPubMed
Dietz, DW, Laureti, S, Strong, SA, Hull, TL, Church, J, Remzi, FH, Lavery, IC & Fazio, VW (2001) Safety and long term efficacy of stricturoplasty in 314 patients with obstructing small bowel Crohn's disease. Journal of the American College of Surgery 192, 330–337 Google Scholar
Fan, ST, Lo, CM, Lai, EC, Chu, KM, Liu, CL & Wong, J (1994) Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. New England Journal of Medicine 269, 30808–30811 Google Scholar
Faxen-Irving, G, Andren-Olsson, B, af Geijerstam, A, Basun, H & Cederholm, T (2002) The effect of nutritional intervention in elderly subjects residing in group-living for the demented. European Journal of Clinical Nutrition 56, 221–227 CrossRefGoogle ScholarPubMed
Ferreira, IM, Brooks, D, Lacasse, Y & Goldstein, RS (2000) Nutritional support for individuals with COPD: a meta-analysis. Chest 117, 672–678 CrossRefGoogle ScholarPubMed
Fiaccadori, E, Lombardi, M, Leonardi, S, Rotelli, CF, Tortorella, G & Borghetti, A (1999) Prevalence and clinical outcome associated with preexisting malnutrition in acute renal failure: a prospective cohort study. Journal of the American Society of Nephrology 10, 581–593 CrossRefGoogle ScholarPubMed
Fiatarone, MA, O'Neill, EF, Ryan, ND, Clements, KM, Solares, GR, Nelson, ME, Roberts, SB, Kehayias, JJ, Lipsitz, LA & Evans, WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 330, 1769–1775 Google Scholar
Fujita, Y, Nakamura, Y, Hiraoka, J, Kobayashi, K, Sakata, K, Nagai, M & Yanagawa, H (1995) Physical-strength tests and mortality among visitors to health-promotion centers in Japan. Journal of Clinical Epidemiology 48, 1349–1359 Google Scholar
Gale, CR, Martyn, CN & Cooper, C (1996) Cognitive impairment and mortality in a cohort of elderly people. British Medical Journal 312, 608–611 Google Scholar
Genton, L & Kudsk, KA (2003) Interactions between the enteric nervous system and the immune system: role of neuropeptides and nutrition. American Journal of Surgery 186, 253–258 CrossRefGoogle ScholarPubMed
Georgiannos, SN, Renaut, AJ & Goode, AW (1997) Short-term restorative nutrition in malnourished patients: pro's and con's of intravenous and enteral alimentation using compositionally matched nutrients. International Surgery 82, 301–306 Google Scholar
Giampaoli, S, Ferrucci, L, Cecchi, F, Lo Noce, C, Poce, A, Dima, F, Santaquilani, A, Vescio, MF & Menotti, A (1999) Hand-grip strength predicts incident disability in non-disabled older men. Age and Ageing 28, 283–288 CrossRefGoogle ScholarPubMed
Gil, Gregorio, P, Ramirez, Diaz, SP & Ribera, Casado JM (2003) Dementia and nutrition. Intervention study in institutionalized patients with Alzheimer disease. Journal of Nutrition, Health and Aging 7, 304–308 Google Scholar
Gogos, CA, Ginopoulos, P, Salsa, B, Apostolidou, E, Zoumbos, NC & Kalfarentzos, F (1998) Dietary omega-3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with generalized malignancy: a randomized control trial. Cancer 82, 395–402 Google Scholar
Gosker, HR, Kubat, B, Schaart, G, van der Vusse, GJ, Wouters, EF & Schols, AM (2003) Myopathological features in skeletal muscle of patients with chronic obstructive pulmonary disease. European Respiratory Journal 22, 280–285 Google Scholar
Gramlich, L, Kichian, K, Pinilla, J, Rodych, NJ, Dhaliwal, R & Heyland, DK (2004) Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 20, 843–848 Google Scholar
Griffiths, RD, Jones, C & Palmer, TE (1997) Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition 13, 295–302 Google Scholar
Groeneveld, AB, Tacx, AN, Bossink, AW, van Mierlo, GJ & Hack, CE (2003) Circulating inflammatory mediators predict shock and mortality in febrile patients with microbial infection. Clinical Immunology 106, 106–115 Google Scholar
Harbour, R & Miller, J (2001) A new system for grading recommendations in evidence based guidelines. British Medical Journal 323, 334–336 Google Scholar
Hasselmann, M, Schlossmacher, P & Kummerlen, C (2001) Nutrition et immunite (Nutrition and immunity). In Traite de Nutrition Clinique de l'Adulte (Clinical Assessment of Nutrition of the Adult), pp. 82 – 88 [Basdevant, A, Laville, M and Lerebours, E, editors]. Paris: Flammarion.Google Scholar
Henriksen, MG, Hessov, I, Dela, F, Hansen, HV, Haraldsted, V & Rodt, SA (2003) Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta Anaesthesiologica Scandinavia 47, 191–199 Google Scholar
Hiroshige, K, Iwamoto, M, Kabashima, N, Mutoh, Y, Yuu, K & Ohtani, A (1998) Prolonged use of intradialysis parenteral nutrition in elderly malnourished chronic haemodialysis patients Nephrology, Dialysis, Transplantation 13, 2081–2087 Google Scholar
Hu, SS, Fontaine, F, Kelly, B & Bradford, DS (1998) Nutritional depletion in staged spinal reconstructive surgery. The effect of total parenteral nutrition. Spine 23, 1401–1405 CrossRefGoogle ScholarPubMed
Huijbregts, PP, Feskens, EJ, Rasanen, L, Fidanza, F, Alberti-Fidanza, A, Nissinen, A, Giampaoli, S & Kromhout, D (1998) Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands. European Journal of Clinical Nutrition 52, 826–831 Google Scholar
Humphreys, J, de la Maza, P, Hirsch, S, Barrera, G, Gattas, V & Bunout, D (2002) Muscle strength as a predictor of loss of functional status in hospitalized patients. Nutrition 18, 616–620 Google Scholar
Hurley, BF (1995) Age, gender, and muscular strength. Journal of Gerontology 50, 41–44 Special issueGoogle ScholarPubMed
Irving, GF, Olsson, BA & Cederholm, T (1999) Nutritional and cognitive status in elderly subjects living in service flats, and the effect of nutrition education on personnel. Gerontology 45, 187–194 Google Scholar
Janicki, MP, Dalton, AJ, Henderson, CM & Davidson, PW (1999) Mortality and morbidity among older adults with intellectual disability: health services considerations. Disability and Rehabilitation 21, 284–294 CrossRefGoogle ScholarPubMed
Kattainen, A, Reunanen, A, Koskinen, S, Martelin, T, Knekt, P & Aromaa, A (2004) Disability predicted mortality in men but not women with coronary heart disease. Journal of Clinical Epidemiology 57, 513–521 Google Scholar
Keating, JL & Matyas, TA (1996) The influence of subject and test design on dynamometric measurements of extremity muscles. Physical Therapy 76, 866–889 Google Scholar
Keusch, GT (2003) The history of nutrition: malnutrition, infection and immunity. Journal of Nutrition 133, 336S–340S Google Scholar
Kudsk, KA, Tolley, EA, DeWitt, RC, Janu, PG, Blackwell, AP, Yeary, S & King, BK (2003) Preoperative albumin and surgical site identify surgical risk for major postoperative complications. Journal of Parenteral and Enteral Nutrition 27, 1–9 Google Scholar
Lauretani, F, Russo, CR, Bandinelli, S, Bartali, B, Cavazzini, C, Di Iorio, A, Corsi, AM, Rantanen, T, Guralnik, JM & Ferrucci, L (2003) Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. Journal of Applied Physiology 95, 1851–1860 Google Scholar
Le Cornu, KA, McKiernan, FJ, Kapadia, SA & Neuberger, JM (2000) A prospective randomized study of preoperative nutritional supplementation in patients awaiting elective orthotopic liver transplantation. Transplantation 69, 1364–1369 Google Scholar
Le Tulzo, Y, Pangault, C, Gacouin, A, Guilloux, V, Tribut, O, Amiot, L, Tattevin, P, Thomas, R & Fauchet, R, Drenou, B (2002) Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome. Shock 18, 487–494 CrossRefGoogle ScholarPubMed
Lin, E, Kotani, JG & Lowry, SF (1998) Nutritional modulation of immunity and the inflammatory response. Nutrition 14, 545–550 Google Scholar
McArdle, W, Katch, F & Katch, V (1996) Exercise Physiology: Energy, Nutrition, and Human Performance MA, Baltimore Williams & WilkinsGoogle Scholar
McCarter, MD, Gentilini, OD, Gomez, ME & Daly, JM (1998) Preoperative oral supplement with immunonutrients in cancer patients. Journal of Parenteral and Enteral Nutrition 22, 206–211 Google Scholar
Magri, F, Borza, A, del Vecchio, S, Chytiris, S, Cuzzoni, G, Busconi, L, Rebesco, A & Ferrari, E (2003) Nutritional assessment of demented patients: a descriptive study. Aging: Clinical and Experimental Research 15, 148–153 Google Scholar
Marik, PE, Zaloga, GP (2004) Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. British Medical Journal 328, 1407 CrossRefGoogle ScholarPubMed
Melchior, JC, Niyongabo, T, Henzel, D, Durack-Bown, I, Henri, SC & Boulier, A (1999) Malnutrition and wasting, immunodepression, and chronic inflammation as independent predictors of survival in HIV-infected patients. Nutrition 15, 865–869 Google Scholar
Mendenhall, CL, Moritz, TE, Roselle, GA, Morgan, TR, Nemchausky, BA, Tamburro, CH, Schiff, ER, McClain, CJ, Marsano, LS & Allen, JI (1995) Protein energy malnutrition in severe alcoholic hepatitis: diagnosis and response to treatment. The VA Cooperative Study Group, #275. Journal of Parenteral and Enteral Nutrition 19, 258–265 Google Scholar
Mokart, D, Capo, C & Blache, JL, Delpero, JR, Houvenaeghel, G, Martin, C, Mege, JL (2002) Early postoperative compensatory anti-inflammatory response syndrome is associated with septic complications after major surgical trauma in patients with cancer. British Journal of Surgery 89, 1450–1456 CrossRefGoogle ScholarPubMed
Monneret, G, Debard, AL, Venet, F, Bohe, J & Hequet, O, Bienvenu, J, Lepape, A (2003) Marked elevation of human circulating CD4+CD25+ regulatory T cells in sepsis-induced immunoparalysis. Critical Care Medicine 31, 2068–2071 Google Scholar
Moore, FA, Andrassy, RJ, McArdle, AH, Booth, FV, Morgenstein-Wagner, TB, Kellum, JM, Welling, RE & Moore, EE (1992) Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Annals of Surgery 216, 172–183 CrossRefGoogle ScholarPubMed
Neisser, U (1967) Cognitive Psychology. Englewood Cliffs NJ: Prentice-Hall.Google Scholar
Noale, M, Maggi, S, Minicuci, N, Marzari, C, Destro, C, Farchi, G, Scafato, E, Baldereschi, M, Di Carlo, A & Crepaldi, G (2003) Dementia and disability: impact on mortality. The Italian Longitudinal Study on Aging. Dementia and Geriatric Cognitive Disorders 16, 7–14 Google Scholar
Ortega, RM, Requejo, AM, Andres, P, Lopez-Sobaler, AM, Quintas, ME, Redondo, MR, Navia, B & Rivas, T (1997) Dietary intake and cognitive function in a group of elderly people. American Journal of Clinical Nutrition 66, 803–809 Google Scholar
Ostchega, Y, Dillon, CF, Lindle, R, Carroll, M & Hurley, BF (2004) Isokinetic leg muscle strength in older Americans and its relationship to a standardized walk test: data from the National Health and Nutrition Examination Survey 1999–2000. Journal of the American Geriatrics Society 52, 977–982 Google Scholar
Pearson, JM, Schlettwein-Gsell, D, Brzozowska, A & van Staveren, WA, Bjornsbo, K (2001) Life style characteristics associated with nutritional risk in elderly subjects aged 80–85 years. Journal of Nutrition, Health and Aging 5, 278–283 Google Scholar
Persson, MD, Brismar, KE, Katzarski, KS, Nordenstrom, J, Cederholm, TE (2002) Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. Journal of the American Geriatrics Society 50, 1996–2002 CrossRefGoogle ScholarPubMed
Pieters, T, Boland, B, Beguin, C, Veriter, C, Stanescu, D, Frans, A & Lambert, M (2000) Lung function study and diffusion capacity in anorexia nervosa. Journal of Internal Medicine 248, 137–142 Google Scholar
Pifer, TB, McCullough, KP, Port, FK, Goodkin, DA, Maroni, BJ & Held, PJ & Young, EW (2002) Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney International 62, 2238–2245 Google Scholar
Ponzer, S, Tidermark, J, Brismar, K, Soderqvist, A & Cederholm, T (1999) Nutritional status, insulin-like growth factor-1 and quality of life in elderly women with hip fractures. Clinical Nutrition 18, 241–246 Google Scholar
Potter, JM, Roberts, MA, McColl, JH & Reilly, JJ (2001) Protein energy supplements in unwell elderly patients – a randomized controlled trial. Journal of Parenteral and Enteral Nutrition 25, 323–329 Google Scholar
Powell, JJ, Murchison, JT, Fearon, KC, Ross, JA & Siriwardena, AK (2000) Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis. British Journal of Surgery 87, 1375–1381 Google Scholar
Ramirez-Sarmiento, A, Orozco-Levi, M, Barreiro, E, Mendez, R, Ferrer, A, Broquetas, J & Gea, J (2002) Expiratory muscle endurance in chronic obstructive pulmonary disease. Thorax 57, 132–136 Google Scholar
Ranieri, P (2001) One-year mortality in elderly stable patients with COPD. Monaldi Archives of Chest Disease 56, 481–485 Google Scholar
Rantanen, T, Guralnik, JM, Foley, D, Masaki, K, Leveille, S, Curb, JD & White, L (1999) Midlife hand grip strength as a predictor of old age disability. Journal of the American Medical Association 281, 558–560 Google Scholar
Rantanen, T, Harris, T, Leveille, SG, Visser, M, Foley, D, Masaki, K & Guralnik, JM (2000) Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. Journal of Gerontology 55, M168–M173 Google Scholar
Rantanen, T, Volpato, S, Ferrucci, L, Heikkinen, E, Fried, LP & Guralnik, JM (2003) Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. Journal of the American Geriatrics Society 51, 636–641 Google Scholar
Reddan, DN, Klassen, PS, Szczech, LA, Coladonato, JA, O'Shea, S, Owen, WF, Jr, Lowrie EG (2003) White blood cells as a novel mortality predictor in haemodialysis patients Nephrology, Dialysis, Transplantation 18, 1167–1173 Google Scholar
Requejo, AM, Ortega, RM, Robles, F, Navia, B, Faci, M, Aparicio, A (2003) Influence of nutrition on cognitive function in a group of elderly, independently living people. European Journal of Clinical Nutrition 57, S54–S57 Suppl. 1 Google Scholar
Riedel, WJ, Jorissen, BL (1998) Nutrients, age and cognitive function. Current Opinion in Clinical Nutrition and Metabolic Care 1, 579–585 Google Scholar
Romagnoni, F, Zuliani, G, Bollini, C, Leoci, V, Soattin, L, Dotto, S, Rizzotti, P, Valerio, G, Lotto, D, Fellin, R (1999) Disability is associated with malnutrition in institutionalized elderly people. The I.R.A. Study. Istituto di Riposo per Anziani. Aging (Milano) 11, 194–199 Google Scholar
Sacks, GS, Brown, RO, Teague, D, Dickerson, RN, Tolley, EA, Kudsk, KA (1995) Early nutrition support modified immune function in patients sustaining severe head injury. Journal of Parenteral and Enteral Nutrition 19, 387–392 Google Scholar
Santos, AA, Rodrick, ML, Jacobs, DO, Dinarello, CA, Wolff, SM, Mannick, JA, Wilmore, DW (1994) Does the route of feeding modify the inflammatory response. Annals of Surgery 220, 155–163 Google Scholar
Schauder, P, Rohn, U, Schafer, G, Korff, G, Schenk, HD (2002) Impact of fish oil-enriched total parenteral nutrition on DNA synthesis, cytokine release and receptor expression by lymphocytes in the postoperative period. British Journal of Nutrition 87, S103–S110 Google Scholar
Schiel, R, Bocklitz, G, Braun, A, Leppert, K, Stein, G, Muller, UA (2003) Cognitive function and quality of diabetes care in patients with type-2-diabetes mellitus in general practitioner practice. European Journal of Medical Research 8, 419–427 Google Scholar
Scrimshaw, NS (2003) Historical concepts of interactions, synergism and antagonism between nutrition and infection. Journal of Nutrition 133, 316S–321S Google Scholar
Shizgal, HM, Vasilevsky, CA, Gardiner, PF & Wang, WZ, Tuitt, DA, Brabant, GV (1986) Nutritional assessment and skeletal muscle function. American Journal of Clinical Nutrition 44, 761–771 Google Scholar
Steiner, MC, Barton, RL, Singh, SJ, Morgan, MD (2003) Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: a randomised controlled trial. Thorax 58, 745–751 Google Scholar
Stenvinkel, P, Barany, P, Chung, SH, Lindholm, B, Heimburger, O (2002) A comparative analysis of nutritional parameters as predictors of outcome in male and female ESRD patients Nephrology, Dialysis, Transplantation 17, 1266–1274 Google Scholar
Sullivan, DH (1995) The role of nutrition in increased morbidity and mortality. Clinics in Geriatric Medicine 11, 661–674 Google Scholar
Suttmann, U, Ockenga, J, Selberg, O, Hoogestraat, L, Deicher, H, Muller, MJ (1995) Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology 8, 239–246 Google Scholar
Vaccarino, V, Berkman, LF, Mendes, de, Leon, CF, Seeman, TE, Horwitz, RI, Krumholz, HM (1997) Functional disability before myocardial infarction in the elderly as a determinant of infarction severity and postinfarction mortality. Archives of Internal Medicine 157, 2196–2204 Google Scholar
Van Bokhorst-de, van, der, Shuer, von Blomberg-van, der, Flier, BM, Kuik, DJ, Scholten, PE, Siroen, MP, Snow, GB, Quak, JJ, van Leeuwen, PA (2000) Survival of malnourished head and neck cancer patients can be predicted by human leukocyte antigen-DR expression and interleukin- 6/tumor necrosis factor-alpha response of the monocyte. Journal of Parenteral and Enteral Nutrition 24, 329–336 Google Scholar
Vieira, MJ, Gama-Rodrigues, JJ, Habr-Gama, A, Faintuch, J, Waitzberg, DL, Pinotti, HW (1996) Preoperative assessment in cases of adult megacolon suffering from moderate malnutrition. Nutrition 12, 491–495 Google Scholar
Von Strauss, E, Aguëro-Torres, H, Kareholt, I, Winblad, B, Fratiglioni, L (2003) Women are more disabled in basic activities of daily living than men only in very advanced ages: A study on disability, morbidity, and mortality from the Kungsholmen Project. Journal of Clinical Epidemiology 56, 669–677 Google Scholar
Windsor, AC, Kanwar, S, Li, AG, Barnes, E, Guthrie, JA, Spark, JL, Welsh, F, Guillou, PJ, Reynolds, JV (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42, 431–435 Google Scholar
World Health Organization World Health Organization (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Report of the Joint WHO/FAO Expert Consultation. WHO Technical Report Series no.916. –GenevaWHO.Google Scholar
Wouters-Wesseling, W, Van Hooijdonk, C, Wagenaar, L, Bindels, J, de Groot, L, Van Staveren, W (2003) The effect of a liquid nutrition supplement on body composition and physical functioning in elderly people. Clinical Nutrition 22, 371–377 Google Scholar
Ziegler, TR, Young, LS, Benfell, K, Scheltinga, M, Hortos, K, Bye, R et al. . (1992) Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study. Annals of Internal Medicine 116, 821–828 Google Scholar
Zuliani, G, Romagnoni, F, Volpato, S, Soattin, L, Leoci, V, Bollini, MC, Buttarello, M, Lotto, D, Fellin, R (2001) Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes. Journal of Gerontology 56, M212–M216 Google ScholarPubMed