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JPEN J Parenter Enteral Nutr

Title:		The breath print represents a novel biomarker of malnutrition in pulmonary arterial hypertension: A proof of concept study
Author(s):		Mey JT; Rath MC; McLaughlin K; Galang M; Lynch K; DiMattio J; Nason H; Yang S; Melillo CA; Grove DE; Tonelli AR; Heresi GA; Kirwan JP; Dweik RA;
Address:		"Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA. Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA. Nutrition Department, Case Western Reserve University, Cleveland, Ohio, USA. Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA. Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA"
Journal Title:		JPEN J Parenter Enteral Nutr
Year:		2021
Volume:		20211112
Issue:		8
Page Number:		1645 - 1652
DOI:		10.1002/jpen.2277
ISSN/ISBN:		1941-2444 (Electronic) 0148-6071 (Print) 0148-6071 (Linking)
Abstract:		"BACKGROUND: The breath print is a quantitative measurement of molecules in exhaled breath and represents a new frontier for biomarker identification. It is unknown whether this state-of-the-art, noninvasive method can detect malnutrition. We hypothesize that individuals with malnutrition will present with a distinguishable breath print. METHODS: We conducted a retrospective chart review on patients with previously analyzed breath samples to identify malnutrition. Breath was analyzed by selected-ion flow-tube mass spectrometry. Registered dietitians conducted a retrospective chart review to collect malnutrition diagnoses and nutrition status indicators. Patients were categorized into one of four groups: pulmonary arterial hypertension (PAH), PAH with malnutrition (PAH-Mal), control, and control with malnutrition (Control-Mal), based on the malnutrition diagnosis present in the patient's chart. Principle component analysis was conducted to characterize the breath print. A logistic regression model with forward selection was used to detect the best breath predictor combination of malnutrition. RESULTS: A total of 74 patients met inclusion criteria (PAH: 52; PAH-Mal: 10; control: 10; Control-Mal: 2). Levels of 1-octene (PAH-Mal, 5.1 +/- 1.2; PAH, 12.5 +/- 11.2; P = 0.005) and ammonia (PAH-Mal, 14.6 +/- 15.8; PAH, 56.2 +/- 64.2; P = 0.013) were reduced in PAH-Mal compared with PAH. The combination of 1-octene (P = 0.010) and 3-methylhexane (P = 0.045) distinguished malnutrition in PAH (receiver operating characteristic area under the curve: 0.8549). CONCLUSIONS: This proof of concept study provides the first evidence that the breath print is altered in malnutrition. Larger prospective studies are needed to validate these results and establish whether breath analysis may be a useful tool to screen for malnutrition in the clinical setting"
Keywords:		Biomarkers/analysis Breath Tests/methods Humans *Malnutrition/diagnosis/etiology Proof of Concept Study *Pulmonary Arterial Hypertension Retrospective Studies biomarker breath analysis malnutrition screening volatile organic compound;
Notes:		"MedlineMey, Jacob T Rath, Mary C McLaughlin, Kathleen Galang, Marianne Lynch, Kathryn DiMattio, Jaime Nason, Hillary Yang, Shengping Melillo, Celia A Grove, David E Tonelli, Adriano R Heresi, Gustavo A Kirwan, John P Dweik, Raed A eng R01 HL130209/HL/NHLBI NIH HHS/ T32 AT004094/AT/NCCIH NIH HHS/ U54 GM104940/GM/NIGMS NIH HHS/ Morrison's-Cleveland Clinic Nutrition Research Collaborative grant/ Research Support, N.I.H., Extramural 2021/10/12 JPEN J Parenter Enteral Nutr. 2021 Nov; 45(8):1645-1652. doi: 10.1002/jpen.2277. Epub 2021 Nov 12"