Preoperative nutritional screening by the specialist instead of the nutritional risk score might prevent excess nutrition: a multivariate analysis of nutritional risk factors.

BACKGROUND: The aim of the current study was to assess whether widely used nutritional parameters are correlated with the nutritional risk score (NRS-2002) to identify postoperative morbidity and to evaluate the role of nutritionists in nutritional assessment. METHODS: A randomized trial on preoperative nutritional interventions (NCT00512213) provided the study cohort of 152 patients at nutritional risk (NRS-2002 ≥3) with a comprehensive phenotyping including diverse nutritional parameters (n=17), elaborated by nutritional specialists, and potential demographic and surgical (n=5) confounders. Risk factors for overall, severe (Dindo-Clavien 3-5) and infectious complications were identified by univariate analysis; parameters with P<0.20 were then entered in a multiple logistic regression model. RESULTS: Final analysis included 140 patients with complete datasets. Of these, 61 patients (43.6%) were overweight, and 72 patients (51.4%) experienced at least one complication of any degree of severity. Univariate analysis identified a correlation between few (≤3) active co-morbidities (OR=4.94; 95% CI: 1.47-16.56, p=0.01) and overall complications. Patients screened as being malnourished by nutritional specialists presented less overall complications compared to the not malnourished (OR=0.47; 95% CI: 0.22-0.97, p=0.043). Severe postoperative complications occurred more often in patients with low lean body mass (OR=1.06; 95% CI: 1-1.12, p=0.028). Few (≤3) active co-morbidities (OR=8.8; 95% CI: 1.12-68.99, p=0.008) were related with postoperative infections. Patients screened as being malnourished by nutritional specialists presented less infectious complications (OR=0.28; 95% CI: 0.1-0.78), p=0.014) as compared to the not malnourished. Multivariate analysis identified few co-morbidities (OR=6.33; 95% CI: 1.75-22.84, p=0.005), low weight loss (OR=1.08; 95% CI: 1.02-1.14, p=0.006) and low hemoglobin concentration (OR=2.84; 95% CI: 1.22-6.59, p=0.021) as independent risk factors for overall postoperative complications. Compliance with nutritional supplements (OR=0.37; 95% CI: 0.14-0.97, p=0.041) and supplementation of malnourished patients as assessed by nutritional specialists (OR=0.24; 95% CI: 0.08-0.69, p=0.009) were independently associated with decreased infectious complications. CONCLUSIONS: Nutritional support based upon NRS-2002 screening might result in overnutrition, with potentially deleterious clinical consequences. We emphasize the importance of detailed assessment of the nutritional status by a dedicated specialist before deciding on early nutritional intervention for patients with an initial NRS-2002 score of ≥3.

7/7/20, [gare d'Orsay], arrivée du roi d'Espagne à Paris [avec la reine Victoria et l'infant don Jaime, et à droite M. Raux, préfet de police] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59946

Nutrition Campaign

McDonald's wished to promote the nutritional value of its menu items.

The physiology of inscription : Foucault's genealogy as curative science

In ''Nietzsche, Genealogy, History," Foucault suggests that genealogy is a sort of "curative science." The genealogist must be a physiologist and a pathologist as well as an historian, for his task is to decipher the marks that power relations and historical events leave on the subjugated body; "he must be able to diagnose the illnesses of the body, its conditions of weakness and strength, its breakdowns and resistances, to be in a position to judge philosophical discourse." But this claim seems to be incongruent with another major task of genealogy. After all, genealogy is supposed to show us that the things we take to be absolute are in fact discontinuous and historically situated: "Nothing in man-not even his body-is sufficiently stable to serve as the basis for self-recognition or for understanding other men." If this is true, then the subjugated body can never be restored to a healthy state because it has no essential or original nature. There are no universal standards by which we can even distinguish between healthy and unhealthy bodies. So in what sense is genealogy to be a "curative science"? In my thesis, I try to elucidate the complex relationship between genealogy and the body. I argue that genealogy can be a curative science even while it "multiplies our body and sets it against itself." Ifwe place a special emphasis on the role that transgression plays in Foucault's genealogical works, then the healthy body is precisely the body that resists universal standards and classifications. If genealogy is to be a curative science, then it must restore to the subjugated body an "identity" that transgresses its own limits and that constitutes itself, paradoxically, in the very effacement of identity. In the first chapter of my thesis, I examine the body's role as "surface of the inscription of events." Power relations inscribe on and around the body an identity or subjectivity that appears to be unified and universal, but which is in fact disparate and historically situated. The "subjected" body is the sick and pathologically weak body. In Chapters 2 and 3, I describe how it is possible for the unhealthy body to become healthy by resisting the subjectivity that has been inscribed upon it. Chapter 4 explains how Foucault's later works fit into this characterization of genealogy