title: Clinical and seasonal variations of nutritional risk screening in patients scheduled for rehabilitation after heart surgery.
abstract: BACKGROUND
  Current knowledge on the pervasiveness of increased nutritional risk in cardiovascular diseases is limited. Our aim was to analyze the characteristics of nutritional risk screening in patients scheduled for rehabilitation after heart surgery. Prevalence and extent of nutritional risk were studied in connection with patients' characteristics and seasonal climate effects on weight loss dynamics.
  
  
  METHODS
  The cohort included 65 consecutive patients with an age range of 25-84 years, 2-6 months after surgical treatment for ischemic or valvular heart disease. Nutritional risk screening was appraised using a standardized NRS-2002 questionnaire. Groups were analyzed according to a timeline of rehabilitation according to the "cold" and "warm" seasons of the moderate Mediterranean climate in Opatija, Croatia.
  
  
  RESULTS
  Increased nutritional risk scores (NRS-2002) of >3 were found in 96% of studied patients. Mean NRS-2002 of patients was 5.0 ± 1.0, with a percentage weight loss history of 11.7% ± 2.2% (4.6-19.0). Risk was found to be more pronounced during the warmer season, with NRS-2002 scores of 5.3 ± 0.7 versus 4.8 ± 1.1 (P = 0.136) and greater loss of weight of 13.0% ± 3.2% versus 10.6% ± 3% (P = 0.005), respectively. Increased nutritional risk correlated significantly with creatinine concentrations (rho = 0.359; P = 0.034 versus 0.584; P = 0.001, respectively). Significant discordance in correlations was found between NRS-2002 and the decrease in left ventricle systolic function (rho correlation coefficient [rho-cc] = -0.428; P = 0.009), the increase in glucose concentrations (cc = 0.600; P < 0.001), and the decrease in erythrocyte counts (cc = -0.520; P = 0.001) during the colder season.
  
  
  CONCLUSIONS
  Increased nutritional risk was found to be frequently expressed in the course of rehabilitation after heart surgery. Although seasonal climate effects influenced the weight loss dynamics, the impact on reproducibility of NRS-2002 was clinically less important. Further studies on the connection of nutritional risk with composited end points might offer improvements in overall quality of treatment.
authors.affiliation: Department of Cardiology, University Hospital Thalassotherapia Opatija, Medical School University of Rijeka, Opatija, Croatia.
authors.forename: Marko
authors.initials: M
authors.lastname: Boban
authors.affiliation: Department of Cardiology, University Hospital Thalassotherapia Opatija, Medical School University of Rijeka, Opatija, Croatia.
authors.forename: Viktor
authors.initials: V
authors.lastname: Persic
authors.affiliation: Department of Pharmacology, Medical School University of Osijek, Osijek, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Jovanovic
authors.affiliation: Department of Cardiology, University Hospital Thalassotherapia Opatija, Medical School University of Rijeka, Opatija, Croatia.
authors.forename: Niksa
authors.initials: N
authors.lastname: Drinkovic
authors.affiliation: Department of Environmental and Occupational Health, Andrija Stampar School of Public Health, University of Zagreb, Zagreb, Croatia.
authors.forename: Milan
authors.initials: M
authors.lastname: Milosevic
authors.affiliation: Department of Clinical Medicine, University La Sapienza, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Laviano
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000534:rehabilitation* / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D017523:Croatia / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology*; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015596:Nutrition Assessment; D011183:Postoperative Complications / Q000453:epidemiology* / Q000534:rehabilitation*; D018570:Risk Assessment / Q000379:methods; D012621:Seasons; D017678:Sex Distribution