Nurhayat Tuğra Özer

Background There is no universally accepted definition of sarcopenic obesity (SO), and its prevalence is ambiguous. This study aimed to investigate the prevalence of SO in older adults based on different definitions and determine which predicts all‐cause mortality. Methods This prospective longitudinal follow‐up study included outpatients aged ≥60 years. SO was defined by sarcopenia definition based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria plus obesity. Three different methods were used to define obesity. Body mass index (BMI) ≥ 30 kg/m2, waist circumference (WC) ≥ 102 cm for men and ≥88.0 cm for women, and body fat percentage (BF%) ≥ 37.3% for men and ≥51.1% for women. Different definitions of SO and their mortality predictions were compared. Results The median age of the 584 patients in the study was 70.0 (interquartile range, 66.0 …

Introduction and aimCoronavirus Disease-2019 (Covid-19) is a globally pandemic and causes severe acute respiratory syndrome. It is commonly associated with gastrointestinal manifestations. Intestinal fatty acid binding protein (IFABp) and citrulline are thought to be potential biomarkers of intestinal function and injury. This study aimed to determine relationship between serum IFABp and citrulline concentrations and mortality in COVID-19 patients.Patients and methodsThis observational study was performed in medical intensive care unit (ICU) and included patients diagnosed by PCR-confirmed COVID-19 infection. Serum citrulline and IFABp concentrations were measured using ELISA method within first 24 h after ICU admission. The reference range of serum IFABp and serum citrulline concentrations were 19.89–23.30 ng/mL and 15.03–17.41 nmol/mL, respectively.ResultsA total of 85 critically ill patients …

Introduction and aimThiamine (vitamin B1) is a vitamin that plays a cofactor role in energy metabolism which provide energy from macronutrients in the human body. Plasma thiamine values indicate recent intake while erythrocyte thiamine pyrophosphate (eTPP) level shows actual thiamine status. To determine thiamine level, while the analysis of plasma thiamine is affected by inflammation, eTPP is not. This study aimed to determine effect of nutrition and inflammation on plasma thiamine and eTPP in acute phase of critical illness.Patients and methodsThis prospective observational study performed in medical intensive care unit (ICU). Acute phase determined first 7 days after ICU admission. The study period consisted of two study time points that first is within 24 h in ICU and second is discharge day in participants with ICU stay <7 days or on the 7th ICU day in participants with ICU stay>7 days. Plasma …

Introduction and aimThiamine plays a crucial role on energy metabolism. In critically ill patients, the provision of adequate nutritional support may lead thiamine deficiency. Thiamine deficiency may prevent to use of energy in metabolism in critical illness. This condition may create vicious circle, lead to severe thiamine depletion. Therefore, the determine of thiamine status is important. The analysis of plasma thiamine analysis to determine thiamine level is affected by inflammation related to critical illness. Erythrocyte thiamine pyrophosphate (eTPP) concentration, which is another method for assessing thiamine status, is not affected by inflammation. However, it is a relatively more difficult technical method. The aim of study was to determine the effect of inflammation on plasma thiamine level by accepting the eTPP level as the gold standard in critically ill patients.Patients and methodsThis study performed …

Introduction and aimNutrition plays a major role in the treatment of patients hospitalized in the intensive care unit (ICU). Micronutrients have important functions in carbohydrate, protein, and lipid metabolism, which are necessary for energy production (1). In critically ill patients, micronutrient deficiencies occur as a result of inadequate intake, inadequate absorption, increased requirement, or increased catabolism. There is a risk of micronutrient loss in critically ill patients receiving burns, trauma, or continuous renal replacement therapy (2). Early detection and prevention of micronutrient deficiencies is important for the life expectancy of patients (3). The aim of our study is to evaluate the changes in vitamin B1, B6, B9 and E levels on consecutive days in critically ill patients hospitalized in the intensive care unit.Patients and methodsThirty patients aged 18 years and older and hospitalized in the ICU for 48 h or more …

Introduction and aimTo determine the association between whole blood thiamine pyrophosphate (TPP) concentrations in critically ill patients and plasma metabolites and linked metabolic pathways using high resolution metabolomics.Patients and methodsThis cross-sectional study was performed at Erciyes University Hospital, Medical Intensive Care Unit (ICU), Kayseri, Turkiye and Emory University Department of Medicine Clinical Biomarkers Laboratory, Atlanta, GA, USA. Participants were enrolled as follows;≥18 years of age, with an expected length of ICU stay longer than 48 h and receiving furosemide therapy for at least 6 months or longer before ICU admission.ResultsBlood for TPP and metabolomics was obtained on the first day of ICU admission. Whole blood TPP concentrations were measured using high-performance liquid chromatography (HPLC). Liquid chromatography/mass spectrometry for high …

Introduction and aimOne of the most common causes of trauma is traffic accidents. Although the death rate is decreasing day by day as a result of trauma-related injuries, the incidence of injury is still very high (1). Morbidity is decreasing due to the development of pre-hospital emergency interventions and the increase of authorized personnel. Likewise, intensive care support is of great importance (2). The aim of the study is to sequentially determine serum adipokine levels in critically ill adult patients followed in the intensive care unit due to trauma.Patients and methodsThe study was carried out in Erciyes University Medical Faculty Hospital Internal Diseases Intensive Care Unit. Thirty patients aged 18 years and older and 30 healthy volunteers were included in the study. The patients consisted of patients who were admitted to the intensive care unit due to trauma, stayed for at least 7 days, and did not have any …

Methods: This prospective observational study was performed in 15 adult medical ICUs in Turkey. Serial plasma thiamine concentrations were measured by high-performance liquid chromatography (HPLC).Results: A total of 221 participants were included. The median age of was 71 years and 49% were male. The mean (SD) APACHE II score on ICU admission was 17.7±7.4. Reasons for ICU admissions included respiratory failure (54%) and metabolic diseases (31%). Heart failure and chronic obstructive pulmonary disease were the most frequent underlying diseases requiring chronic diuretics. Median plasma thiamine levels ranged from 42.1 to 46.5 μg/L from baseline to day 10 after admission (normal range= 28–85 μg/L). A total of 18% of participants were thiamine deficient upon admission to the ICU, while 26% of participants were deficient at some point during the 10-day study period. At baseline, 47% of …

Asprosin, a new adipokine, is secreted by subcutaneous white adipose tissue and causes rapid glucose release. The skeletal muscle mass gradually diminishes with aging. The combination of decreased skeletal muscle mass and critical illness may cause poor clinical outcomes in critically ill older adults. To determine the relationship between the serum asprosin level, fat-free mass, and nutritional status of critically ill older adult patients, critically ill patients over the age of 65 receiving enteral nutrition via feeding tube were included in the study. The patients’ cross-sectional area of the rectus femoris (RF) of the lower extremity quadriceps muscle was evaluated by serial measurements. The mean age of the patients was 72 ± 6 years. The median (IQR) serum asprosin level was 31.8 (27.4–38.1) ng/mL on the first study day and 26.1 (23.4–32.3) ng/mL on the fourth study day. Serum asprosin level was high in 96% of the patients on the first day, and it was high in 74% on the fourth day after initiation of enteral feeding. The patients achieved 65.9 ± 34.1% of the daily energy requirement for four study days. A significant moderate correlation between delta serum asprosin level and delta RF was found (Rho = −0.369, p = 0.013). In critically ill older adult patients, a significant negative correlation was determined between serum asprosin level with energy adequacy and lean muscle mass.

Methods: Severity of disease was identified according to the Truelove and Witts score for ulcerative colitis (UC) and Crohn's Disease Activity Index (CDAI) for Crohn’s. Nutritional status was determined by the Subjective Global Assessment (SGA). Risk of RH was assessed using National Institute for Health and Care Excellence (NICE) criteria. Serum phosphate concentration was recorded for 7 days after hospitalization, and less than 0.65 mmol/l was defined as RH.Results: Fifty individuals (33 patients with UC and 17 patients with Crohn’s, mean age: 43.4±14.9 years) were recruited. RH had experienced 23 participants (46.0%). The most common presence of RH was observed on day 5 (n= 7 patients, 14.0%). The sharpest declines in serum phosphate level were determined on the 4 th day (0.74±0.18 mmol/l) and the 5 th day (0.74±0.28 mmol/l). Malnourished patients had higher RH ratio than other groups (p= 0 …

Background Gastrointestinal (GI) dysfunction is common in the intensive care unit (ICU), although there is no consensus on biomarkers of GI dysfunction. We aimed to evaluate ultrasound‐based gastric antrum measurements and serum intestinal fatty acid–binding protein (IFABP) and citrulline levels in relation to GI dysfunction in critically ill patients. Methods Adult critically ill patients receiving enteral nutrition and stayed for in the ICU for ≥48 h was included. GI dysfunction was described using Gastrointestinal Dysfunction Score (GIDS). Gastric antrum measurements, including craniocaudal (CC) diameter, anteroposterior diameter, and antral–cross sectional area (CSA), as well as serum levels for IFABP and citrulline, were prospectively recorded at baseline and on day 3 and day 5 of enteral nutrition. The receiver operating characteristic (ROC) analysis was performed to evaluate gastric ultrasound parameters …

Methods: This cross-sectional study was performed in the Erciyes University Hospital Medical Intensive Care Unit, Kayseri, Turkey, with plasma HRM measured at the Emory University Clinical Biomarkers Laboratory, Atlanta, GA, USA. Participants were 18 years of age or older with expected length of ICU stay greater than 48 hours. HRM was performed with liquid chromatography/mass spectrometry analysis of plasma obtained on the first day of ICU admission, with mNUTRIC score calculated on the same day. Participants at high risk of malnutrition (mNUTRIC score 5-9) were compared to those with low risk (mNUTRIC score 0-4).Results: Of the 77 participants enrolled, 33 (43%) had a mNUTRIC score> 4 and thus were classified as high malnutrition risk. Pathway analysis of significant (p< 0.05) differentially expressed metabolites between the high and low malnutrition risk patients showed significant differences in …

Background/ObjectivesThiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations.Subjects/MethodsThis observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission.ResultsA total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with …

Methods: This study prospectively conducted in Gastroenterology Clinics and included patients who aged≥ 18 years, with liver cirrhosis and expected to hospital stay> 48 hours. Severity of disease was defined by Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) score. Malnutrition was identified by Subjective Global Assessment (SGA). Serum phosphate levels was followed-up for 14 days after hospitalization. Serum phosphate levels< 2.0 mg/dl (0.65 mmol/L) defined as hypophosphatemia.Results: Our study included 50 participants aged with 64.0 (55.5-70.0) years. Of patients, the median CTP score was 6.0 (4.0-7.3) and the median MELD score was 10.5 (9.0-14.0). A total of 24% of our sample had RH during first 14 days period after admission. The most common RH was determined in 4 subjects (8%) in day 4. The serum phosphate concentrations of RH group and non-RH group were …

Objective: Genistein has an anti-inflammatory effect that may be beneficial in many inflammatory diseases. The aim of this study was to determine the effects of supplementation of oral/enteral nutrition (EN) with genistein on the level of inflammatory cytokines in septic patients.Materials and Methods: This prospective, randomized controlled study included critically ill adult patients with sepsis receiving EN or oral/EN. The patients were randomly divided into a genistein or a control group. Genistein (60 mg/day) was administered as a supplement to EN in the genistein group and the control group received only EN or oral/EN. Serum interleukin 1 beta (IL-1β), interleukin 6 (IL-6), high mobility group box 1 protein (HMGB-1), tumor necrosis factor alfa (TNF-α), procalcitonin (PCT), and C-reactive protein (CRP) concentrations were serially measured at the baseline, 24th hour, and 72nd hour after admission.Results: Thirty-two participants (genistein group: 16 patients, control group: 16 patients) were included. The mean age was 56±17 years. The serum IL-1β concentration in the genistein group was significantly higher than that of the control group in follow-up (p= 0.001). The control group had a significantly lower serum IL-6 value at the 72nd hour compared with the baseline and 24th-hour values (p= 0.001). The TNF-α concentration was significantly greater (p< 0.001, both groups), while the PCT values were lower in follow-up measurements (genistein group: p= 0.031; control group: p= 0.004). The CRP level was higher in the genistein group than in the control group at the baseline (p= 0.019) and significantly lower in follow-up measurements (p= 0.028 …

Methods: The study was conducted prospectively and randomly with 50 patients treated with HSCT. The data of the patients were recorded during their follow-up. Univariate logistic regression analysis was applied to examine the effect of all data on RH. Then, backward multivariate logistic regression analysis was performed with the data found to be significant (p< 0.2).Results: RH developed in 78% of patients treated with HSCT. Pre-transplantation PGSGA score, frequency of vomiting, and development of infection were higher in patients with RH (p< 0.05). The patients had a mean weight loss of 2.9% after transplantation. Pre-transplantation 88% of patients were well-nourished (PGSGA 0-3), post-transplantation 70% of patients were moderately undernourished (PGSGA 4-8) and 30% were severely malnourished (PGSGA≥ 9). While total protein and albumin decreased after transplantation, CRP increased (p< 0 …

PurposeIn an effort to better manage critically ill patients hospitalised in the intensive care unit (ICU) after experiencing multiple traumas, the present study aimed to assess whether plasma levels of intestinal epithelial cell barrier proteins, including occludin, claudin-1, junctional adhesion molecule (JAM-1), tricellulin and zonulin, could be used as novel biomarkers. Additional potential markers such as intestinal fatty acid-binding protein (I-FABP), d-lactate, lipopolysaccharide (LPS) and citrulline were also evaluated. We also aimed to determine the possible relationships between the clinical, laboratory, and nutritional status of patients and the measured marker levels.MethodsPlasma samples from 29 patients (first, second, fifth and tenth days in the ICU and on days 7, 30 and 60 after hospital discharge) and 23 controls were subjected to commercial enzyme-linked immunosorbent assay (ELISA) testing.ResultsOn first …

Methods: This study was prospectively conducted in the Medical Oncology Clinics. Serum phosphate levels< 2.5 mg/dl defined as hypophosphatemia [2, 4]. Patients aged 18 and over, expected to stay in the service for 48 hours or more, were included in the study. The patients were followed in the service for 14 days.Results: A total of 100 patients were included the study. The mean age of the patients was 59±9 years and 59% were male. The frequency of RH in any day was 87% in patients. The days when RH is seen with the highest rate are determined as the 3 rd and 12 th days (71% and 33%, respectively). Serum phosphorus levels of the patients by days are shown in table 1. When the patients are grouped as gastrointestinal system (GIS) cancer and non-GIS cancer; the frequency of RH was significantly higher in the GIS cancer group on the 3 rd and 11 th days than in the non-GIS cancer group. The amount of …

Background & Aims: Refeeding hypophosphataemia (RH) is associated with poor clinical outcomes and mortality rates. However, the presence of RH in patients with cirrhosis remains unknown. This study aimed to determine the relationship among the frequency of RH, nutritional status, and disease severity in patients with liver cirrhosis.Methods: This prospective study was conducted at a single-centre gastroenterology clinic. Malnutrition was identified using the Subjective Global Assessment (SGA). Disease severity was defined using the Child-Turcotte-Pugh (CTP) and the Model for End-Stage Liver Disease (MELD) scores. Hypophosphatemia was defined as a serum phosphate level of< 2.0 mg/dL.Results: Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in four patients on day four during the study follow-up. The sharpest decline in serum phosphate levels was observed on day four (median: 2.3 mg/dL). The CTP score and MELD scores did not differ significantly between RH and non-RH groups ((p= 0.478 and p= 0.643), respectively. The rate of malnutrition according to the SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher prevalence of RH than that of patients receiving only oral or enteral tube feeding (p= 0.001). The CTP score strongly and negatively correlated with serum phosphorus levels on days two (p= 0.016 …

Background The Global Leadership Initiative on Malnutrition (GLIM) published malnutrition identification criteria. The Mini Nutritional Assessment (MNA) is malnutrition assessment tool commonly used in older adults. This study aimed to determine prevalence of malnutrition and the relationship between the GLIM and the MNA long form (MNA‐LF) and short form (MNA‐SF) and energy‐protein intake. Methods A total of 252 older adult outpatients (aged 68.0 years, 61% females) were included. Malnutrition was defined according to the GLIM, MNA‐LF, and MNA‐SF. Food intake was assessed using the 24‐h dietary recall. We analyzed the cutoff value on the MNA‐LF score, MNA‐SF score, and energy‐protein intake for GLIM criteria–defined malnutrition severity with receiver operating characteristic analysis. Results Malnutrition was present in 32.2%, 12.7%, and 13.1% of patients according to the GLIM criteria …