The Prevalence of Malnutrition and Sarcopenia in Swiss Rehabilitation Settings

Study Overview
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Brief Summary
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The aim of the study is to identify the prevalence of malnutrition and sarcopenia in patients admitted in Swiss rehabilitation centers. Furthermore, the aim is to investigate the changes of selected malnutrition and sarcopenia parameters over the length of the rehabilitation stay.

Detailed Description
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The project aims to investigate the prevalence of malnutrition and sarcopenia in the rehabilitation setting. A cross-sectional national multicenter study will be conducted in five rehabilitation centers in Switzerland, including 80 - 130 participants per center for the primary objective (prevalence study). Patients will be screened for malnutrition and sarcopenia with established screening tools and if an elevated risk is observed, diagnosis will be confirmed and severity investigated according to international guidelines. Furthermore, the evolution of selected malnutrition and sarcopenia parameters over the rehabilitation stay should be assessed.

Official Title
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The Prevalence of Malnutrition and Sarcopenia in Swiss Rehabilitation Settings

Conditions
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Malnutrition, Sarcopenia

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients treated in the following groups of rehabilitations will be included: Geriatric rehabilitation Pulmonal rehabilitation Cardiovascular rehabilitation Neurological rehabilitation Musculoskeletal rehabilitation Internistic rehabilitation and oncological rehabilitation Exclusion criteria: Inability to give informed consent Inability to follow study procedures (e.g., due to delirium or language barriers) Expected life expectancy < 3 months and/or palliative care Isolation for example due to Covid-19 infection or tuberculosis Severe dehydration/ volume overload Medical conditions that prevent conducting a Bioelectrical Impedance Analysis (BIA) measurement (e.g. non-removable plasters or bandages at feet or hands) or defibrillator

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of malnutrition - Risk for malnutrition | The risk for malnutrition will be screened by the Nutritional Risk Screening (NRS-2002, in points). NRS has a scale from 0 to 7 points; higher points indicate a higher risk for malnutrition. | Within 7 days after admission | 
| Body weight | (in kg) | Within 7 days after admission | 
| Height | (in cm) | Within 7 days after admission | 
| Body Mass Index | (calculated by weight and height in kg/m2) | Within 7 days after admission | 
| Weight loss | Weight loss (in percent in six categories - <5 percent within the last 6 months, 5-10 percent within the last 6 months, >10 percent within the last 6 months; <10 percent in more than 6 months, 10 -20 percent in more than 6 months, >20 percent in more than 6 months) | Within 7 days after admission | 
| Reduced energy intake | Reduced energy intake (in percent of intake versus requirement in three categories: less than 50 percent of energy requirement covered for more than 1 week, any reduced energy intake versus requirement for >2 weeks, no reduced energy intake) | Within 7 days after admission | 
| Muscle mass by Bioelectrical Impedance Analysis (BIA) - Part 1 | Resistance (in Ohm) and Reactance (in Ohm) | Within 7 days after admission | 
| Muscle mass by Bioelectrical Impedance Analysis (BIA) - Part 2 | Resistance (in Ohm) and Reactance (in Ohm) measured with BIA are combined with further information on weight, height, sex and age to calculate the appendicular skeletal muscle mass index (in kg/m2) | Within 7 days after admission | 
| Prevalence of malnutrition - Confirmed diagnosis and severity of malnutrition | In case of positive screening, diagnosis of malnutrition will be confirmed and severity assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria using the following measures described above: weight (in kg); height (in cm); Body Mass Index (calculated by weight and height in kg/m2); weight loss (in percent in six categories - <5 percent within the last 6 months, 5-10 percent within the last 6 months, >10 percent within the last 6 months; <10 percent in more than 6 months, 10 -20 percent in more than 6 months, >20 percent in more than 6 months); reduced energy intake (in percent of intake versus requirement in three categories: less than 50 percent of energy requirement covered for more than 1 week, any reduced energy intake versus requirement for >2 weeks, no reduced energy intake); Bioelectrical impedance analysis for muscle mass: resistance (in Ohm), reactance (in Ohm), Appendicular skeletal muscle mass index (in kg/m2) | Within 7 days after admission | 
| Prevalence of malnutrition - overall | Overall prevalence of malnutrition will be reported in percent | Calculated through study completion after five months recruitment duration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of sarcopenia - Risk for sarcopenia by SARC-F | according to European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Screening will be performed by the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire (in points). SARC-F has a scale from 0 - 10 with higher score indicating higher risk for sarcopenia. | Within 7 days after admission | 
| Prevalence of sarcopenia - Risk for sarcopenia by handgrip strength | according to European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Screening will be performed by handgrip strength (in kPa) | Within 7 days after admission | 
| Prevalence of sarcopenia - Risk for sarcopenia | according to European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Screening will be performed by Chair Stand Test (in seconds) | Within 7 days after admission | 
| Prevalence of sarcopenia - Diagnosis of sarcopenia | In case of positive screening, muscle mass will be measured by BIA via resistance (in Ohm), reactance (in Ohm). Resistance (in Ohm) and Reactance (in Ohm) measured by BIA is combined with further information on weight, height, sex and age to calculate the appendicular skeletal muscle mass index in kg/m2. Diagnosis is confirmed if the appendicular skeletal muscle mass index is below a threshold (<7.0 kg/m2 for male and < 5.5. kg/m2 for female). | Within 7 days after admission | 
| Prevalence of sarcopenia - Severity of sarcopenia | In case of positive screening, severity of sarcopenia will be analysed by Timed Up and Go Test (in seconds). | Within 7 days after admission | 
| Prevalence of sarcopenia - Overall | Overall prevalence of sarcopenia will be reported in percent | Calculated through study completion after five months recruitment duration | 
| Changes of handgrip strength between admission and discharge of rehabilitation | Handgrip strength (in kPa) | At admission and 21 days after admission (or, if admission occurs before 21 days and the length of stay was at least 14 days than within 3 days before discharge) | 
| Changes of body weight between admission and discharge of rehabilitation | body weight (in kg) | At admission and 21 days after admission (or, if admission occurs before 21 days and the length of stay was at least 14 days than within 3 days before discharge) | 
| Changes of BMI between admission and discharge of rehabilitation | BMI (calculated in kg/m2) | At admission and 21 days after admission (or, if admission occurs before 21 days and the length of stay was at least 14 days than within 3 days before discharge) | 
| Changes of Functional Independence Measure between admission and discharge of rehabilitation | Functional Independence Measure (FIM) (in points). FIM has a scale from 18 to 126 points. Higher points indicate a higher independence for activities of daily living. | At admission and 21 days after admission (or, if admission occurs before 21 days and the length of stay was at least 14 days than within 3 days before discharge) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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malnutrition, sarcopenia, rehabilitation, prevalence, Nutritional Risk Screening, handgrip strength