Recommendations. We have incorporated these four factors in developing a clinical scoring system to predict an individual elderly patient’s risk for malnutrition. As far as we are aware, this is the first scoring system utilizing clinical factors and parameters providing an individualised malnutrition risk assessment in this unique population of patients. There are however some limitations to our study. The NSI checklist was originally applied in a cohort of non-instituitionalised, white, older persons without a specific diagnosis of cancer [20]. Few studies have validated the NSI checklist and data for its predictive value with regards to mortality remains weak[18,40?2]. Our study population is small and heterogeneous in terms of the tumor types. The patients included in our analysis are outpatients representing a group of fitter patients. The majority of our patients had GI tract cancers with an underrepresentation of other solid tumour types. This reflects selection bias in the conduct of this study the results of which may therefore not be completely extrapolated to the general elderly cancer patient population. GI tract cancer patients may have higher risk of malnutrition due to the site and nature of their buy FPS-ZM1 disease compared to those with other tumor types. Given several reports on varying prevalence of malnutrition based on primary tumour sites[36], future studies should be conducted focusing on specific tumor types. In taking the findings of this study to the next step, we plan to prospectively validate this score in a separate population of elderly Asian cancer patients. In conclusion, a significant number of elderly Asian cancer patients are at nutritional risk. Physicians need to have a strong index of suspicion of under nutrition in the elderly population. Advanced stage of cancer, poor performance status, depression and anaemia are independent predictors of moderate to high nutritional risk.Author ContributionsConceived and designed the experiments: RK DP. Performed the experiments: KNK LLC RK DP. Analyzed the data: TT WSO RK. Contributed reagents/materials/analysis tools: WSO DP RK. Wrote the paper: TT WSO TR KNK LLC DP ARC LK RK.PLOS ONE | DOI:10.1371/journal.pone.0156008 May 27,10 /Nutritional Risk in Elderly Asian Cancer Patients
Asthma is a chronic allergic airways disease (AAD) characterized by airway inflammation and airway hyperresponsiveness (AHR). The incidence of asthma has increased U0126 web dramatically over the past three decades although disease incidence has now plateaued [1]. The reasons for the increased incidence remain controversial, however, alterations in exposure to microbes during the induction and development of the disease have been widely postulated to be involved [2, 3]. This potentially occurs through altered stimulation of the innate immune system. Pathogen associated molecular patterns (PAMPs) are recognized by pattern recognition receptors (PRRs) such as Toll-like receptors (TLRs). TLRs are expressed on antigen presenting cells, such as macrophages and dendritic cells (DCs). TLR engagement leads to nuclear factor (NF)-B and/or interferon regulatory factor (IRF)3/7-induced production of inflammatory mediators including TNF, IL-1, IL-6, IFN/ and monocyte chemotactic protein (MCP)-1, which attempt to control infection, as well as anti-inflammatory molecules such as IL-10 [4, 5]. TLR2 and TLR4 are two of the major TLRs involved in the recognition of major bacterial components [6]. TLR engagement likely plays.Recommendations. We have incorporated these four factors in developing a clinical scoring system to predict an individual elderly patient’s risk for malnutrition. As far as we are aware, this is the first scoring system utilizing clinical factors and parameters providing an individualised malnutrition risk assessment in this unique population of patients. There are however some limitations to our study. The NSI checklist was originally applied in a cohort of non-instituitionalised, white, older persons without a specific diagnosis of cancer [20]. Few studies have validated the NSI checklist and data for its predictive value with regards to mortality remains weak[18,40?2]. Our study population is small and heterogeneous in terms of the tumor types. The patients included in our analysis are outpatients representing a group of fitter patients. The majority of our patients had GI tract cancers with an underrepresentation of other solid tumour types. This reflects selection bias in the conduct of this study the results of which may therefore not be completely extrapolated to the general elderly cancer patient population. GI tract cancer patients may have higher risk of malnutrition due to the site and nature of their disease compared to those with other tumor types. Given several reports on varying prevalence of malnutrition based on primary tumour sites[36], future studies should be conducted focusing on specific tumor types. In taking the findings of this study to the next step, we plan to prospectively validate this score in a separate population of elderly Asian cancer patients. In conclusion, a significant number of elderly Asian cancer patients are at nutritional risk. Physicians need to have a strong index of suspicion of under nutrition in the elderly population. Advanced stage of cancer, poor performance status, depression and anaemia are independent predictors of moderate to high nutritional risk.Author ContributionsConceived and designed the experiments: RK DP. Performed the experiments: KNK LLC RK DP. Analyzed the data: TT WSO RK. Contributed reagents/materials/analysis tools: WSO DP RK. Wrote the paper: TT WSO TR KNK LLC DP ARC LK RK.PLOS ONE | DOI:10.1371/journal.pone.0156008 May 27,10 /Nutritional Risk in Elderly Asian Cancer Patients
Asthma is a chronic allergic airways disease (AAD) characterized by airway inflammation and airway hyperresponsiveness (AHR). The incidence of asthma has increased dramatically over the past three decades although disease incidence has now plateaued [1]. The reasons for the increased incidence remain controversial, however, alterations in exposure to microbes during the induction and development of the disease have been widely postulated to be involved [2, 3]. This potentially occurs through altered stimulation of the innate immune system. Pathogen associated molecular patterns (PAMPs) are recognized by pattern recognition receptors (PRRs) such as Toll-like receptors (TLRs). TLRs are expressed on antigen presenting cells, such as macrophages and dendritic cells (DCs). TLR engagement leads to nuclear factor (NF)-B and/or interferon regulatory factor (IRF)3/7-induced production of inflammatory mediators including TNF, IL-1, IL-6, IFN/ and monocyte chemotactic protein (MCP)-1, which attempt to control infection, as well as anti-inflammatory molecules such as IL-10 [4, 5]. TLR2 and TLR4 are two of the major TLRs involved in the recognition of major bacterial components [6]. TLR engagement likely plays.
