title: Emerging Impact of Malnutrition on Surgical Patients: Literature Review and Potential Implications for Cystectomy in Bladder Cancer.
abstract: Malnutrition is emerging as a significant factor in patient outcomes. A contemporary review of malnutrition has not been performed for the urologist. We review the available literature and current standards of care for malnutrition screening, assessment and intervention, focusing on patients with bladder cancer treated with cystectomy.
  
  
  
  Our multidisciplinary team searched PubMed® for available literature on malnutrition, focusing on definition and significance, importance to urologists, screening, assessment, diagnosis, immunological and economic impacts, and interventions.
  
  
  
  The prevalence of malnutrition in hospitalized patients is estimated to range from 15% to 60%, reaching upward of 71% in those with cancer. Malnutrition has been shown to increase inflammatory markers, further intensifying catabolism and weight loss. Bladder cancer is catabolic and patients undergoing cystectomy have increased resting energy expenditure postoperatively. Data are emerging on the impact of malnutrition in the cystectomy population. Recent studies have identified poor nutritional status based on low albumin or sarcopenia (loss of muscle) as having an adverse impact on length of hospitalization, complications and survival. The current standard of care malnutrition assessment tool, the 2012 consensus statement of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition, has not been evaluated in the urological literature. Perioperative immunonutrition in patients undergoing colorectal surgery has been associated with significant decreases in postoperative complications, and recent pilot work has identified the potential for immunonutrition to positively impact the cystectomy population.
  
  
  
  Malnutrition has a significant impact on surgical patients, including those with bladder cancer. There are emerging data in the urological literature regarding how best to identify and improve the nutritional status of patients undergoing cystectomy. Additional research is needed to identify malnutrition in these patients and interventions to improve surgical outcomes.
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Conrad M
authors.initials: CM
authors.lastname: Tobert
authors.affiliation: University of Kansas, Kansas City, Kansas.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Hamilton-Reeves
authors.affiliation: University of Alabama-Birmingham, Birmingham, Alabama.
authors.forename: Lyse A
authors.initials: LA
authors.lastname: Norian
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Chermaine
authors.initials: C
authors.lastname: Hung
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Brooks
authors.affiliation: University of Kansas, Kansas City, Kansas.
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Holzbeierlein
authors.affiliation: University of Wisconsin, Madison, Wisconsin.
authors.forename: Tracy M
authors.initials: TM
authors.lastname: Downs
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Robertson
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Ruth
authors.initials: R
authors.lastname: Grossman
authors.affiliation: University of Iowa, Iowa City, Iowa. Electronic address: kenneth-nepple@uiowa.edu.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Nepple
mesh_terms: D015653:Cystectomy / Q000009:adverse effects*; D006801:Humans; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis; D011183:Postoperative Complications / Q000453:epidemiology*; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000601:surgery*
keywords: cystectomy; malnutrition; patient outcome assessment; urinary bladder neoplasms