I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
,
p
p
.
1
89
5
~
1
90
2
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/ijp
h
s
.
v
1
3
i
4
.
2
4
1
7
5
1895
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
G
lo
ba
l Lea
dershi
p Initiativ
e on
Ma
lnutrit
io
n c
riter
i
a
f
o
r
predicti
ng
surg
ic
a
l site
in
fect
io
n
in
elect
iv
e
lapa
ro
tom
y
patients
P
a
uli
ne
O
ct
a
v
ia
ni
1
,
Yo
ha
nn
ess
a
Wula
n
da
ri
1
,
F
ebia
ns
y
a
h Ib
ra
him
2
,
Diy
a
h E
k
a
Anda
y
a
ni
1
1
D
e
p
a
r
t
me
n
t
o
f
N
u
t
r
i
t
i
o
n
,
F
a
c
u
l
t
y
o
f
M
e
d
i
c
i
n
e
U
n
i
v
e
r
si
t
a
s I
n
d
o
n
e
s
i
a
,
D
r
.
C
i
p
t
o
M
a
n
g
u
n
k
u
s
u
m
o
H
o
sp
i
t
a
l
,
Ja
k
a
r
t
a
,
I
n
d
o
n
e
s
i
a
2
D
e
p
a
r
t
me
n
t
o
f
S
u
r
g
e
r
y
,
F
a
c
u
l
t
y
o
f
M
e
d
i
c
i
n
e
U
n
i
v
e
r
si
t
a
s I
n
d
o
n
e
s
i
a
,
D
r
.
C
i
p
t
o
M
a
n
g
u
n
k
u
su
m
o
H
o
s
p
i
t
a
l
,
J
a
k
a
r
t
a
,
I
n
d
o
n
e
s
i
a
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
No
v
7
,
2
0
2
3
R
ev
is
ed
J
an
3
0
,
2
0
2
4
Acc
ep
ted
Feb
2
1
,
2
0
2
4
Lap
a
ro
to
m
y
s
u
rg
e
r
y
p
a
ti
e
n
ts
a
re
a
t
risk
fo
r
c
o
m
p
li
c
a
ti
o
n
in
c
l
u
d
i
n
g
su
rg
ica
l
site
in
fe
c
ti
o
n
s
(S
S
I)
wh
ich
a
re
a
ss
o
c
iate
d
with
h
i
g
h
m
o
rb
i
d
it
y
a
n
d
m
o
rtalit
y
.
M
a
ln
u
tr
it
io
n
h
a
s b
e
e
n
id
e
n
ti
fied
a
s
a
risk
fa
c
to
r
f
o
r
th
e
o
c
c
u
rre
n
c
e
o
f
S
S
I
b
u
t
p
re
o
p
e
ra
ti
v
e
m
a
ln
u
tri
ti
o
n
i
d
e
n
ti
fi
c
a
ti
o
n
re
m
a
in
s
lo
w.
Th
e
G
lo
b
a
l
Lea
d
e
rsh
i
p
In
it
iati
v
e
o
n
M
a
l
n
u
tr
it
io
n
(G
LIM
)
h
a
s
p
u
b
l
ish
e
d
a
n
e
w,
p
ra
c
ti
c
a
l,
a
n
d
e
a
sily
a
p
p
li
c
a
b
le
d
e
fi
n
it
i
o
n
o
f
m
a
ln
u
tri
ti
o
n
.
Th
is
stu
d
y
a
ims
to
e
v
a
lu
a
t
e
wh
e
th
e
r
m
a
ln
u
tri
ti
o
n
a
c
c
o
r
d
in
g
t
o
G
LIM
c
rit
e
ria
is
a
p
re
d
ict
o
r
o
f
S
S
I
i
n
e
lec
ti
v
e
lap
a
ro
to
m
y
p
a
ti
e
n
ts.
T
h
is
p
r
o
sp
e
c
ti
v
e
c
o
h
o
rt
st
u
d
y
in
v
o
l
v
e
d
1
2
3
su
b
jec
ts
a
g
e
d
1
8
-
6
5
y
e
a
rs
u
n
d
e
rg
o
in
g
e
le
c
ti
v
e
lap
a
ro
t
o
m
y
,
with
o
u
t
d
iab
e
t
e
s
h
isto
r
y
.
Th
e
i
r
m
a
ln
u
tri
ti
o
n
sta
tu
s wa
s a
ss
e
ss
e
d
u
sin
g
G
LIM
c
rit
e
ria wit
h
b
io
e
lec
tri
c
a
l
imp
e
d
a
n
c
e
a
n
a
ly
sis
(BIA)
to
e
v
a
l
u
a
te
m
u
sc
le
m
a
ss
.
A
to
tal
6
2
su
b
j
e
c
ts
we
re
c
a
teg
o
rize
d
in
t
o
th
e
m
a
ln
u
tri
ti
o
n
g
ro
u
p
a
n
d
t
h
e
re
m
a
in
in
g
in
to
n
o
n
-
m
a
ln
u
tri
ti
o
n
g
r
o
u
p
a
n
d
t
h
e
n
m
o
n
i
to
re
d
f
o
r
th
e
p
re
se
n
c
e
o
f
S
S
I
u
p
t
o
1
0
d
a
y
s
p
o
sto
p
e
ra
ti
v
e
l
y
.
S
S
I
o
c
c
u
rre
d
i
n
1
3
.
8
%
o
f
th
e
su
b
jec
ts.
Th
e
a
n
a
ly
s
is
sh
o
we
d
a
stro
n
g
a
ss
o
c
iatio
n
b
e
twe
e
n
m
a
ln
u
tri
ti
o
n
a
n
d
S
S
I
in
e
lec
ti
v
e
p
o
st
lap
a
ro
to
m
y
(RR
4
.
6
;
9
5
%
CI
1
.
4
-
15
.
1
;
p
=
0
.
0
0
5
).
M
a
l
n
u
tr
it
io
n
a
c
c
o
rd
in
g
t
o
G
LIM
c
rit
e
ria
is
a
sig
n
ifi
c
a
n
t
p
r
e
d
icto
r
o
f
S
S
I
in
e
lec
ti
v
e
p
o
st
la
p
a
ro
to
m
y
p
a
ti
e
n
ts.
K
ey
w
o
r
d
s
:
B
io
elec
tr
ical
im
p
ed
an
ce
an
aly
s
is
Glo
b
al
L
ea
d
er
s
h
ip
I
n
itiativ
e
o
n
Ma
ln
u
tr
itio
n
L
ap
ar
o
to
m
y
Ma
ln
u
tr
itio
n
Su
r
g
ical
s
ite
in
f
ec
tio
n
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Pau
lin
e
Octa
v
ian
i
Dep
ar
tm
en
t o
f
Nu
tr
itio
n
,
Facu
lty
o
f
Me
d
icin
e
,
Un
iv
er
s
itas
I
n
d
o
n
esia
Salem
b
a
R
ay
a
No
.
6
,
Sen
e
n
,
C
en
tr
al
J
ak
ar
ta
-
1
0
4
3
0
,
I
n
d
o
n
e
s
ia
E
m
ail: p
au
lin
eo
ctav
ian
i@
g
m
a
il.c
o
m
1.
I
NT
RO
D
UCT
I
O
N
L
ap
ar
o
to
m
y
is
o
n
e
o
f
th
e
in
v
a
s
iv
e
m
an
ag
em
e
n
ts
th
at
ca
r
r
ies
a
r
is
k
o
f
co
m
p
licatio
n
s
in
p
at
ien
ts
.
T
h
e
in
cid
en
ce
o
f
p
o
s
t
-
o
p
e
r
ativ
e
co
m
p
licatio
n
s
in
s
o
m
e
c
o
u
n
tr
ies
ar
e
r
ep
o
r
ted
to
b
e
1
2
.
5
%
-
1
3
.
2
%
[
1
]
,
[
2
]
.
Su
r
g
ical
s
ite
in
f
ec
tio
n
(
SS
I
)
is
o
n
e
o
f
t
h
e
c
o
m
p
licatio
n
s
o
f
lap
ar
o
t
o
m
y
with
an
in
cid
e
n
c
e
o
f
1
5
%
-
2
5
%
in
g
astro
in
test
in
al
s
u
r
g
er
y
a
n
d
9
.
8
%
in
o
b
s
tetr
ics
an
d
g
y
n
ec
o
lo
g
y
s
u
r
g
er
y
,
d
ep
e
n
d
in
g
o
n
th
e
lev
el
o
f
s
u
r
g
ical
co
n
tam
in
atio
n
[
3
]
.
SS
I
h
as
b
e
en
s
h
o
wn
to
b
e
ass
o
ciate
d
wit
h
h
ig
h
m
o
r
b
id
ity
,
m
o
r
tality
,
h
ea
lth
ca
r
e
co
s
ts
,
an
d
p
r
o
lo
n
g
ed
h
o
s
p
ital stay
s
[
4
]
,
[
5
]
.
O
n
e
o
f
t
h
e
f
a
c
t
o
r
s
t
h
a
t
c
a
n
i
m
p
a
i
r
t
h
e
s
y
s
t
e
m
i
c
h
o
s
t
d
e
f
e
n
s
e
a
n
d
a
l
s
o
d
e
l
a
y
w
o
u
n
d
h
e
a
l
i
n
g
is
m
a
l
n
u
t
r
i
t
i
o
n
.
T
h
e
p
r
e
v
a
l
e
n
c
e
o
f
p
e
r
i
o
p
e
r
a
t
i
v
e
m
a
l
n
u
t
r
i
ti
o
n
is
e
s
t
i
m
a
t
e
d
t
o
b
e
a
r
o
u
n
d
4
0
%
-
6
5
%
[
6
]
.
P
a
t
i
e
n
t
s
w
it
h
m
a
l
n
u
t
r
i
t
i
o
n
u
n
d
e
r
g
o
i
n
g
s
u
r
g
e
r
y
e
s
p
e
c
i
a
ll
y
c
a
n
c
e
r
s
u
r
g
e
r
y
e
x
p
e
r
i
e
n
c
e
e
a
r
l
y
h
i
g
h
e
r
p
o
s
t
-
o
p
e
r
a
t
i
v
e
m
o
r
t
a
l
i
ty
r
a
t
e
s
,
i
n
c
r
e
a
s
e
d
h
o
s
p
i
t
al
c
o
s
t
s
,
h
i
g
h
e
r
r
e
a
d
m
i
s
s
i
o
n
r
a
t
es
,
a
n
d
p
r
o
l
o
n
g
e
d
h
o
s
p
i
t
a
l
s
t
a
y
s
[
7
]
,
[
8
]
.
E
v
e
n
t
h
o
u
g
h
t
h
e
r
e
l
a
t
i
o
n
s
h
i
p
b
e
t
w
e
e
n
m
a
l
n
u
t
r
i
ti
o
n
a
n
d
p
o
o
r
s
u
r
g
i
c
a
l
o
u
t
c
o
m
e
s
i
s
k
n
o
w
n
,
t
h
e
i
d
e
n
ti
f
i
c
a
ti
o
n
o
f
s
u
r
g
i
c
a
l
p
a
t
i
e
n
ts
w
i
t
h
m
a
l
n
u
t
r
i
ti
o
n
o
r
a
t
r
i
s
k
o
f
m
a
l
n
u
t
r
i
t
i
o
n
r
e
m
a
i
n
s
v
e
r
y
l
o
w
.
A
s
u
r
v
e
y
s
t
u
d
y
s
h
o
w
e
d
t
h
a
t
o
n
l
y
1
2
.
1
%
o
f
d
i
g
e
s
t
i
v
e
s
u
r
g
e
o
n
s
a
n
s
w
e
r
e
d
co
r
r
e
c
t
l
y
r
e
g
a
r
d
i
n
g
t
h
e
p
a
r
a
m
e
t
e
r
s
f
o
r
d
i
a
g
n
o
s
i
n
g
m
a
l
n
u
t
r
i
t
i
o
n
i
n
c
a
n
c
e
r
p
a
t
i
e
n
t
s
[
9
]
.
T
h
e
r
e
f
o
r
e
,
t
h
e
r
e
i
s
a
n
e
e
d
f
o
r
a
c
c
u
r
a
t
e
d
i
a
g
n
o
s
is
o
f
m
a
l
n
u
tr
i
t
i
o
n
w
h
i
c
h
is
p
r
a
c
ti
c
a
l
t
o
b
e
u
s
e
d
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J
Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
8
9
5
-
1
9
0
2
1896
I
n
2
0
1
9
,
Glo
b
al
L
ea
d
er
s
h
ip
I
n
itiativ
e
o
n
Ma
ln
u
tr
itio
n
(
G
L
I
M)
p
u
b
lis
h
ed
th
e
latest
d
e
f
in
itio
n
o
f
m
aln
u
tr
itio
n
f
o
r
ad
u
lt
p
atien
ts
,
wh
ich
in
clu
d
es
p
h
e
n
o
ty
p
ic
cr
iter
ia
s
u
ch
as
weig
h
t
lo
s
s
,
lo
w
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
,
d
ec
r
ea
s
ed
m
u
s
cle
m
ass
,
an
d
etio
lo
g
ic
cr
iter
ia
s
u
ch
as
r
e
d
u
ce
d
f
o
o
d
in
tak
e
o
r
ass
im
ilatio
n
an
d
in
f
lam
m
atio
n
[
1
0
]
.
Ma
ln
u
tr
iti
o
n
cr
iter
ia
ac
co
r
d
in
g
to
GL
I
M
r
ep
r
esen
t
th
e
latest
an
d
p
r
ac
tical
cr
iter
ia
f
o
r
d
iag
n
o
s
is
m
aln
u
tr
itio
n
.
I
t
is
e
asier
to
ap
p
ly
co
m
p
a
r
ed
to
p
r
ev
io
u
s
m
aln
u
tr
itio
n
c
r
iter
ia,
s
o
GL
I
M
cr
iter
ia
is
b
ein
g
ex
ten
s
iv
ely
r
esear
c
h
ed
to
ass
es
s
th
eir
v
alid
ity
an
d
r
elev
an
ce
in
clin
ical
p
r
ac
tice,
in
clu
d
in
g
in
p
er
io
p
er
ativ
e
co
n
d
itio
n
s
[
1
1
]
.
On
e
r
etr
o
s
p
ec
tiv
e
co
h
o
r
t
s
tu
d
y
[
1
2
]
d
e
m
o
n
s
tr
ates
th
at
ca
n
ce
r
p
atien
ts
with
m
aln
u
tr
itio
n
b
ased
o
n
GL
I
M
cr
iter
ia
ar
e
at
1
.
8
2
tim
e
s
h
ig
h
er
r
is
k
o
f
ex
p
er
ien
ci
n
g
p
o
s
t
ab
d
o
m
in
al
s
u
r
g
er
y
-
r
elate
d
lu
n
g
co
m
p
lic
atio
n
s
an
d
a
n
o
th
er
s
tu
d
y
[
1
3
]
also
r
e
v
ea
led
th
at
p
atien
t
with
m
aln
u
tr
itio
n
ac
co
r
d
in
g
t
o
GL
I
M
cr
iter
ia
ar
e
at
r
is
k
1
.
3
tim
es
h
ig
h
er
r
is
k
o
f
ex
p
e
r
ien
cin
g
s
ev
er
e
s
u
r
g
ical
co
m
p
licatio
n
s
b
ased
o
n
th
e
r
ev
is
ed
ac
co
r
d
io
n
class
if
icatio
n
s
y
s
tem
.
Stu
d
ies
o
n
m
aln
u
tr
itio
n
as
a
p
r
ed
icto
r
o
f
c
o
m
p
licatio
n
s
in
lap
ar
o
to
m
y
s
u
r
g
e
r
y
,
esp
ec
iall
y
SS
I
,
ar
e
s
till
lim
ited
.
T
h
e
o
cc
u
r
r
en
ce
o
f
SS
I
h
as
b
ee
n
s
ig
n
if
ican
tly
s
h
o
wn
to
b
e
m
o
r
e
f
r
e
q
u
en
t
in
p
atien
ts
at
r
is
k
o
f
m
aln
u
tr
itio
n
b
ased
o
n
t
h
e
n
u
tr
itio
n
al
r
is
k
s
cr
ee
n
in
g
(
NR
S)
-
2
0
0
2
s
co
r
in
g
an
d
Am
er
ican
So
ciety
f
o
r
Par
en
ter
al
an
d
E
n
ter
al
Nu
tr
itio
n
(
ASPE
N)
m
aln
u
tr
itio
n
cr
iter
ia
wh
en
co
m
p
ar
ed
t
o
n
o
n
-
m
aln
o
u
r
is
h
e
d
p
atien
ts
.
As
f
ar
as
th
e
au
th
o
r
’
s
k
n
o
wled
g
e,
th
e
r
e
h
av
en
’
t
b
ee
n
an
y
s
tu
d
ies
th
at
h
av
e
e
x
am
in
ed
t
h
e
r
e
latio
n
s
h
ip
b
etwe
en
m
aln
u
tr
itio
n
b
ased
o
n
GL
I
M
c
r
iter
ia
an
d
th
e
o
cc
u
r
r
en
ce
o
f
S
SI
af
ter
s
u
r
g
e
r
y
.
T
h
e
o
b
jectiv
e
o
f
th
is
r
esear
ch
is
to
d
eter
m
in
e
wh
eth
er
m
aln
u
tr
i
tio
n
as
d
ef
in
e
d
b
y
GL
I
M
cr
ite
r
ia,
is
a
p
r
ed
ict
o
r
f
ac
to
r
f
o
r
th
e
o
cc
u
r
r
e
n
ce
o
f
SS
I
in
p
atien
ts
u
n
d
e
r
g
o
in
g
elec
tiv
e
lap
ar
o
to
m
y
at
Dr
.
C
ip
to
Ma
n
g
u
n
k
u
s
u
m
o
h
o
s
p
ital.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n,
pa
rt
icipa
nt
s
,
a
nd
et
hica
l a
pp
ro
v
a
l
T
h
is
r
esear
ch
is
a
p
r
o
s
p
ec
tiv
e
co
h
o
r
t
s
tu
d
y
c
o
n
d
u
cted
at
D
r
.
C
ip
to
Ma
n
g
u
n
k
u
s
u
m
o
h
o
s
p
ita
l,
J
ak
ar
ta
f
r
o
m
Ma
r
ch
to
J
u
n
e
2
0
2
3
.
T
h
e
s
tu
d
y
s
u
b
jects
ar
e
p
atien
ts
u
n
d
er
g
o
in
g
elec
tiv
e
lap
ar
o
to
m
y
s
u
r
g
er
y
wh
o
m
ee
t
th
e
s
tu
d
y
cr
iter
ia
an
d
h
av
e
s
ig
n
ed
co
n
s
en
t f
o
r
m
.
Patien
ts
s
ch
ed
u
led
f
o
r
lap
a
r
o
to
m
y
s
u
r
g
er
y
,
ag
ed
1
8
-
6
5
y
ea
r
s
,
an
d
ab
le
to
s
tan
d
ar
e
in
clu
d
ed
.
Patien
ts
wi
th
d
iab
etes
m
ell
itu
s
an
d
ca
n
n
o
t
u
n
d
er
g
o
b
io
el
ec
tr
ical
im
p
ed
an
ce
an
aly
s
is
ex
am
in
atio
n
(
d
u
e
to
ed
em
a,
elec
tr
o
n
ic
im
p
lan
ts
,
m
etal
im
p
lan
ts
,
p
r
eg
n
an
cy
,
o
r
ex
ten
s
iv
e
s
k
in
wo
u
n
d
s
)
ar
e
e
x
clu
d
ed
.
T
h
e
d
r
o
p
-
o
u
t
cr
iter
ia
u
s
ed
in
clu
d
e
p
atien
ts
wh
o
p
ass
ed
awa
y
an
d
ca
n
n
o
t
b
e
c
o
n
tacte
d
d
u
r
in
g
th
e
1
0
-
d
ay
p
o
s
t
-
o
p
er
a
tiv
e
m
o
n
ito
r
in
g
p
er
i
o
d
,
o
r
r
e
f
u
s
e
to
c
o
n
tin
u
e
p
a
r
ticip
atin
g
in
th
e
s
tu
d
y
.
T
h
is
r
esear
ch
was
ap
p
r
o
v
ed
b
y
th
e
E
th
ics
C
o
m
m
ittee
o
f
th
e
F
ac
u
lty
o
f
Me
d
icin
e,
Un
iv
e
r
s
itas
o
f
I
n
d
o
n
esia
-
Dr
.
C
ip
to
Ma
n
g
u
n
k
u
s
u
m
o
H
o
s
p
ital w
ith
eth
ical
clea
r
an
ce
n
o
.
K
E
T
-
1
1
2
/UN2
.
F1
/ET
I
K/PP
M.
0
0
.
0
2
/2
0
2
3
.
2
.
2
.
Da
t
a
c
o
llect
io
n a
nd
ins
t
rum
ent
A
to
tal
o
f
1
3
0
p
ar
ticip
an
ts
wer
e
in
clu
d
ed
in
t
h
is
s
tu
d
y
,
th
at
ca
lcu
lated
wh
ile
co
n
s
id
er
in
g
9
5
%
co
n
f
id
en
ce
le
v
el
an
d
2
0
%
d
r
o
p
o
u
t
r
ate.
T
h
e
p
ar
ticip
an
ts
s
elec
ted
u
s
in
g
th
e
co
n
s
ec
u
tiv
e
s
am
p
lin
g
m
eth
o
d
.
Data
co
llectio
n
p
r
o
ce
d
u
r
es
in
clu
d
ed
in
ter
v
iews
to
g
ath
er
i
n
f
o
r
m
atio
n
o
n
ch
ar
a
cter
is
tics
(
ag
e
an
d
g
en
d
er
)
,
h
is
to
r
y
o
f
d
ec
r
ea
s
ed
f
o
o
d
i
n
tak
e
in
last
two
wee
k
s
,
weig
h
t
l
o
s
s
h
is
to
r
y
in
last
s
ix
m
o
n
th
s
,
an
d
g
astro
in
test
in
al
co
m
p
lain
ts
(
n
au
s
ea
,
v
o
m
itin
g
,
d
if
f
icu
lty
ea
tin
g
,
d
iar
r
h
ea
,
c
o
n
s
tip
atio
n
,
o
r
ab
d
o
m
in
al
p
ai
n
ac
co
m
p
an
ied
b
y
d
escr
ip
tio
n
o
f
in
ten
s
ity
,
f
r
eq
u
en
cy
,
an
d
d
u
r
atio
n
r
elate
d
t
o
th
e
s
y
m
p
to
m
s
)
,
a
n
th
r
o
p
o
m
etr
ic
m
ea
s
u
r
em
en
ts
(
b
o
d
y
weig
h
t,
h
eig
h
t,
a
n
d
waist
cir
cu
m
f
er
en
ce
)
,
a
n
d
b
o
d
y
c
o
m
p
o
s
itio
n
a
n
aly
s
is
u
s
in
g
Se
ca
m
B
C
A
-
5
2
5
to
o
b
tain
ap
p
en
d
ic
u
lar
s
k
eleta
l
m
ass
in
d
ex
(
ASMI
)
a
n
d
f
at
f
r
ee
m
ass
in
d
ex
(
FF
MI
)
v
alu
es.
Me
d
ical
r
ec
o
r
d
d
ata
wer
e
also
co
llected
to
o
b
tain
i
n
f
o
r
m
atio
n
o
n
m
ed
ical
d
iag
n
o
s
es,
p
r
o
ce
d
u
r
es,
co
n
tam
in
atio
n
s
u
r
g
e
r
y
ty
p
e,
an
d
th
e
len
g
th
o
f
p
o
s
t
-
o
p
er
ativ
e
h
o
s
p
ital stay
s
.
2
.
3
.
Da
t
a
a
na
ly
s
is
T
h
e
d
ata
co
llected
wer
e
an
al
y
ze
d
u
s
in
g
s
tatis
tical
p
r
o
g
r
a
m
f
o
r
s
o
cial
s
cien
ce
(
SP
SS
)
v
er
s
io
n
2
9
.
Un
iv
ar
iate
an
aly
s
is
was
co
n
d
u
cted
o
n
n
u
m
er
ical
s
ca
le
d
ata
with
th
e
Ko
lm
o
g
o
r
o
v
-
Sm
ir
n
o
f
n
o
r
m
ality
test
.
Data
with
n
o
r
m
al
d
is
tr
ib
u
tio
n
wer
e
p
r
esen
ted
as
m
ea
n
an
d
s
tan
d
ar
d
d
ev
iatio
n
wh
ile
o
th
er
s
wer
e
p
r
esen
ted
as
m
ed
ian
an
d
r
a
n
g
e
(
m
in
im
u
m
-
m
ax
im
u
m
)
.
C
ateg
o
r
ical
s
ca
l
e
d
ata
wer
e
p
r
esen
ted
as
p
r
o
p
o
r
tio
n
s
(
f
r
eq
u
en
cy
d
is
tr
ib
u
tio
n
)
.
Dif
f
er
e
n
ce
s
b
et
wee
n
th
e
two
g
r
o
u
p
s
wer
e
an
aly
ze
d
u
s
in
g
th
e
t
-
test
o
r
Ma
n
n
-
W
h
itn
ey
test
(
d
ep
en
d
in
g
o
n
th
e
r
esu
lts
o
f
t
h
e
n
o
r
m
ality
test
)
f
o
r
n
u
m
er
i
ca
l
an
d
t
h
e
C
hi
-
s
q
u
ar
e
test
f
o
r
ca
teg
o
r
ical
d
ata.
B
iv
ar
iate
an
aly
s
is
to
ass
es
s
th
e
r
elatio
n
s
h
ip
b
etwe
en
m
aln
u
tr
itio
n
d
iag
n
o
s
is
b
ased
o
n
GL
I
M
c
r
iter
ia
an
d
th
e
o
cc
u
r
r
en
ce
o
f
SS
I
p
o
s
to
p
er
ativ
ely
was
p
e
r
f
o
r
m
ed
u
s
in
g
th
e
C
hi
-
s
q
u
ar
e
test
with
a
9
5
%
c
o
n
f
id
e
n
ce
in
ter
v
al.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Glo
b
a
l Lea
d
ers
h
ip
I
n
itia
tive
o
n
Ma
ln
u
tr
itio
n
crit
eria
fo
r
p
r
ed
ictin
g
s
u
r
g
ica
l
…
(
P
a
u
lin
e
O
cta
via
n
i
)
1897
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
A
to
tal
1
3
0
p
atien
ts
wh
o
m
et
th
e
s
tu
d
y
cr
iter
ia
an
d
a
g
r
ee
d
to
p
ar
ticip
ate
in
th
e
r
esear
ch
we
r
e
in
itially
en
r
o
lled
.
At
th
e
en
d
o
f
th
e
s
tu
d
y
,
th
er
e
wer
e
s
ev
e
n
d
r
o
p
o
u
t s
u
b
jects (
5
.
4
%).
T
h
e
s
u
b
ject
s
elec
tio
n
f
lo
wch
ar
t is
s
h
o
wed
in
Fig
u
r
e
1
.
I
n
th
is
s
tu
d
y
,
th
e
m
e
d
ian
ag
e
o
f
th
e
s
u
b
jects
was
4
4
y
ea
r
s
,
with
a
r
a
n
g
e
o
f
1
9
-
6
5
y
ea
r
s
.
T
h
e
m
ajo
r
ity
o
f
th
em
wer
e
f
e
m
ale.
T
h
e
m
ed
ian
B
MI
o
f
th
e
s
u
b
jects
with
in
n
o
r
m
o
-
weig
h
t
n
u
tr
itio
n
al
s
tatu
s
.
Mo
s
t
s
u
b
jects
wer
e
d
iag
n
o
s
ed
with
m
alig
n
an
cy
o
r
s
u
s
p
ec
ted
m
alig
n
an
cy
.
B
ased
o
n
th
e
co
n
tam
in
atio
n
s
u
r
g
er
y
ty
p
e,
th
e
m
ajo
r
ity
o
f
s
u
b
jects
u
n
d
e
r
wen
t
clea
n
-
co
n
tam
in
ated
s
u
r
g
er
y
.
T
h
e
m
ed
ian
len
g
th
o
f
p
o
s
t
-
o
p
er
ativ
e
s
tay
was
f
o
u
r
d
ay
s
,
with
a
r
an
g
e
o
f
2
-
3
0
d
ay
s
.
T
h
e
m
ea
n
ASMI
o
f
th
e
s
u
b
j
ec
ts
was
lo
w
b
ased
o
n
th
e
Asi
an
W
o
r
k
in
g
Gr
o
u
p
f
o
r
Sar
c
o
p
en
ia
(
AW
GS)
cu
t
-
o
f
f
wh
ile
th
e
m
ea
n
FF
MI
was
f
o
u
n
d
n
o
r
m
al
i
n
f
em
ale
s
u
b
jects a
n
d
lo
w
in
m
a
le
s
u
b
jects.
T
ab
le
1
s
h
o
ws ch
a
r
ac
ter
is
tics
o
f
s
u
b
jects.
F
i
g
u
r
e
1
.
F
l
o
wc
h
a
r
t
o
f
s
t
u
d
y
s
u
b
j
e
c
t
s
e
l
e
c
ti
o
n
T
a
b
l
e
1
.
S
u
b
j
e
ct
c
h
a
r
a
c
t
e
r
i
s
t
i
cs
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
A
l
l
s
u
b
j
e
c
t
s
n
=
1
2
3
G
e
n
d
e
r
,
n
(
%)
M
a
l
e
2
4
(
1
9
.
5)
F
e
mal
e
9
9
(
8
0
,
5
)
A
g
e
,
y
e
a
r
4
4
(
1
9
-
6
5
)
†
M
e
d
i
c
a
l
d
i
a
g
n
o
s
i
s,
n
(
%)
M
a
l
i
g
n
a
n
c
y
/
S
u
sp
e
c
t
m
a
l
i
g
n
a
n
c
y
7
4
(
6
0
,
2
)
N
o
t
m
a
l
i
g
n
a
n
c
y
4
9
(
3
9
,
8
)
C
o
n
t
a
mi
n
a
t
i
o
n
s
u
r
g
e
r
y
t
y
p
e
(
n
,
%)
C
l
e
a
n
3
0
(
2
4
.
4)
C
l
e
a
n
-
c
o
n
t
a
m
i
n
a
t
e
d
7
9
(
6
4
.
2)
C
o
n
t
a
mi
n
a
t
e
d
1
4
(
1
1
.
4)
Le
n
g
t
h
o
f
p
o
st
-
o
p
e
r
a
t
i
v
e
s
t
a
y
,
d
a
y
4
(
2
-
3
0
)
†
B
M
I
(
k
g
/
m
2
)
22
.
9
(
1
2
.
5
-
46
.
4)
†
U
n
d
e
r
w
e
i
g
h
t
(
n
,
%)
2
1
(
1
7
.
1)
N
o
r
mo
w
e
i
g
h
t
(
n
,
%)
4
4
(
3
5
.
8)
O
v
e
r
w
e
i
g
h
t
(
n
,
%)
1
9
(
1
5
.
4)
O
b
e
si
t
y
g
r
a
d
e
I
(
n
,
%)
2
6
(
2
1
.
1)
O
b
e
si
t
y
g
r
a
d
e
I
I
(
n
,
%)
1
3
(
1
0
.
6)
A
S
M
I
(
k
g
/
m
2
)
4
.
0
0
.
8
*
M
a
l
e
4
.
3
0
.
8
*
F
e
mal
e
4
.
0
0
.
8
*
F
F
M
I
(
k
g
/
m
2
)
16
.
4
2
.
3
*
M
a
l
e
16
.
7
1
.
8
*
F
e
mal
e
16
.
3
2
.
4
*
*
M
e
a
n
s
t
a
n
d
a
r
d
d
e
v
i
a
t
i
o
n
;
†
m
e
d
i
a
n
(
m
i
n
i
mu
m
-
ma
x
i
m
u
m)
;
b
o
d
y
m
a
ss
i
n
d
e
x
(
B
M
I
)
;
a
p
p
e
n
d
i
c
u
l
a
r
s
k
e
l
e
t
a
l
mass
i
n
d
e
x
(
A
S
M
I
)
;
f
a
t
f
r
e
e
mas
s i
n
d
e
x
(
F
F
M
I
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J
Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
8
9
5
-
1
9
0
2
1898
T
h
er
e
was
a
s
ig
n
if
ican
t
d
if
f
er
en
ce
in
all
ch
ar
ac
ter
is
tic
v
ar
iab
les
b
etwe
en
th
e
m
aln
u
tr
itio
n
an
d
non
-
m
al
n
u
tr
itio
n
g
r
o
u
p
s
b
ase
d
o
n
GL
I
M
cr
iter
ia.
I
n
th
e
m
aln
u
tr
itio
n
g
r
o
u
p
b
ased
o
n
G
L
I
M
cr
iter
ia,
it
was
f
o
u
n
d
th
at
th
e
m
e
d
ian
ag
e
an
d
len
g
th
o
f
p
o
s
t
-
o
p
er
ativ
e
s
ta
y
wer
e
s
ig
n
if
ican
tly
h
ig
h
er
,
a
n
d
th
e
m
ea
n
B
MI
,
ASMI
,
an
d
FF
MI
wer
e
lo
wer
th
an
n
o
n
-
m
aln
u
t
r
itio
n
g
r
o
u
p
as
s
h
o
wn
in
T
ab
le
2
.
Me
a
n
wh
ile,
r
eg
a
r
d
in
g
th
e
o
cc
u
r
r
e
n
ce
o
f
SS
I
,
s
tu
d
ies
in
d
icate
th
at
th
er
e
is
n
o
s
ig
n
if
ica
n
t
co
r
r
elatio
n
b
etwe
en
g
e
n
d
er
an
d
th
e
r
is
k
o
f
SS
I
af
ter
ab
d
o
m
in
al
s
u
r
g
e
r
y
,
a
f
ter
elim
in
atin
g
r
elev
an
t c
o
n
f
o
u
n
d
in
g
f
ac
to
r
s
[
1
4
]
.
T
ab
le
2
.
Su
b
ject
c
h
ar
ac
ter
is
tics
b
ased
o
n
m
aln
u
tr
itio
n
g
r
o
u
p
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
M
a
l
n
u
t
r
i
t
i
o
n
a
c
c
o
r
d
i
n
g
t
o
G
LI
M
c
r
i
t
e
r
i
a
n
=
6
2
N
o
M
a
l
n
u
t
r
i
t
i
o
n
a
c
c
o
r
d
i
n
g
t
o
G
LI
M
c
r
i
t
e
r
i
a
n
=
6
2
p
G
e
n
d
e
r
,
n
(
%)
0
.
0
0
7
M
a
l
e
1
8
(
2
9
)
6
(
9
.
8
)
F
e
mal
e
4
4
(
7
1
)
5
5
(
9
0
.
2
)
A
g
e
,
y
e
a
r
4
8
(
2
0
-
6
5
)
†
4
2
(
1
9
-
6
5
)
†
0
.
0
2
6
M
e
d
i
c
a
l
d
i
a
g
n
o
s
i
s,
n
(
%)
0
.
0
3
6
M
a
l
i
g
n
a
n
c
y
/
S
u
sp
e
c
t
m
a
l
i
g
n
a
n
c
y
4
3
(
6
9
.
4
)
3
1
(
5
0
.
8
)
N
o
t
m
a
l
i
g
n
a
n
c
y
1
9
(
3
0
.
6
)
3
0
(
4
9
.
2
)
C
o
n
t
a
mi
n
a
t
i
o
n
s
u
r
g
e
r
y
t
y
p
e
(
n
,
%)
0
.
0
1
C
l
e
a
n
1
1
(
1
7
.
7
)
1
9
(
3
1
.
1
)
C
l
e
a
n
-
c
o
n
t
a
m
i
n
a
t
e
d
3
9
(
6
2
.
9
)
4
0
(
6
5
.
6
)
C
o
n
t
a
mi
n
a
t
e
d
1
2
(
1
9
.
4
)
2
(
3
.
3
)
Le
n
g
t
h
o
f
p
o
st
-
o
p
e
r
a
t
i
v
e
s
t
a
y
,
d
a
y
5
.
5
(
2
-
3
0
)
†
3
(
2
-
8)
†
<
0
.
0
0
1
B
M
I
(
k
g
/
m
2
)
1
9
.
9
(
1
2
.
5
-
3
0
.
9
)
†
24
.
9
(
1
8
.
6
-
4
6
.
4
)
†
<
0
.
0
0
1
U
n
d
e
r
w
e
i
g
h
t
(
n
,
%)
2
1
(
3
3
.
9
)
0
(
0
)
N
o
r
mo
w
e
i
g
h
t
(
n
,
%)
2
6
(
4
1
.
9
)
1
8
(
2
9
.
5
)
O
v
e
r
w
e
i
g
h
t
(
n
,
%)
5
(
8
.
1
)
1
4
(
2
3
)
O
b
e
si
t
y
g
r
a
d
e
I
(
n
,
%)
7
(
1
1
.
3
)
1
9
(
3
1
.
1
)
O
b
e
si
t
y
g
r
a
d
e
I
I
(
n
,
%)
3
(
4
.
8
)
1
0
(
1
6
.
4
)
A
S
M
I
(
k
g
/
m
2
)
3
.
8
0
.
8
*
4
.
3
0
.
6
*
0
.
0
1
8
M
a
l
e
4
.
2
0
.
9
*
4
.
5
0
.
4
*
F
e
mal
e
3
.
6
0
.
9
*
4
.
3
0
.
7
*
F
F
M
I
(
k
g
/
m
2
)
1
5
.
7
2
.
5
*
1
7
.
1
2
.
0
*
0
.
0
2
7
M
a
l
e
1
6
.
3
1
.
9
*
1
7
.
8
1
.
2
*
F
e
mal
e
1
5
.
5
2
.
6
*
1
7
.
0
2
.
0
*
S
S
I
(
n
,
%)
S
u
p
e
r
f
i
c
i
a
l
9
(
6
4
.
3
)
3
(
1
0
0
)
D
e
e
p
5
(
3
5
.
7
)
0
(
0
)
*
M
e
a
n
s
t
a
n
d
a
r
d
d
e
v
i
a
t
i
o
n
;
†
m
e
d
i
a
n
(
mi
n
i
mu
m
-
ma
x
i
m
u
m)
;
b
o
d
y
mass
i
n
d
e
x
(
B
M
I
)
;
a
p
p
e
n
d
i
c
u
l
a
r
sk
e
l
e
t
a
l
ma
ss
i
n
d
e
x
(
A
S
M
I
)
;
f
a
t
f
r
e
e
mass
i
n
d
e
x
(
F
F
M
I
)
;
su
r
g
i
c
a
l
s
i
t
e
i
n
f
e
c
t
i
o
n
(
SSI
)
T
h
is
s
tu
d
y
s
h
o
wed
th
at
m
aln
u
tr
itio
n
ac
co
r
d
in
g
to
GL
I
M
cr
iter
ia
in
cr
ea
s
es
th
e
r
is
k
o
f
ex
p
er
ien
cin
g
s
u
r
g
ical
s
ite
in
f
ec
tio
n
s
b
y
4
.
6
tim
es,
f
o
llo
win
g
elec
tiv
e
lap
ar
o
to
m
y
co
m
p
ar
ed
to
n
o
n
-
m
a
ln
u
tr
itio
n
g
r
o
u
p
as
s
h
o
wn
in
T
ab
le
3
.
T
h
e
r
elativ
e
r
is
k
in
th
is
s
tu
d
y
was
h
ig
h
e
r
co
m
p
ar
ed
to
o
th
er
s
im
ilar
s
tu
d
ies.
A
s
tu
d
y
b
y
T
an
et
a
l.
[
1
5
]
wh
ich
ex
am
i
n
ed
1
,
1
1
5
s
u
b
jects
f
o
u
n
d
th
a
t
m
aln
o
u
r
is
h
ed
ca
n
ce
r
p
atie
n
ts
b
ased
o
n
GL
I
M
cr
iter
ia
wer
e
s
ig
n
if
ica
n
tly
at
h
ig
h
er
r
is
k
o
f
wo
u
n
d
h
ea
lin
g
-
r
elate
d
co
m
p
licatio
n
s
(
OR
2
.
5
4
;
9
5
%
C
I
:
1
.
3
8
-
4
.
7
1
)
a
n
d
in
f
ec
tio
n
-
r
elate
d
co
m
p
licatio
n
s
in
clu
d
in
g
SS
I
,
lu
n
g
in
f
ec
tio
n
s
,
u
r
i
n
ar
y
tr
ac
t
in
f
ec
tio
n
s
,
an
d
s
ep
s
is
(
OR
2
.
1
9
;
9
5
%
C
I
:
1
.
6
7
-
3
.
2
1
)
p
o
s
t
-
s
u
r
g
er
y
d
u
e
to
g
astro
in
test
in
al
m
alig
n
an
cies.
An
o
b
s
er
v
atio
n
al
s
tu
d
y
b
y
Mu
r
esan
et
a
l.
also
in
d
icate
d
n
o
s
o
co
m
ial
in
f
ec
tio
n
ev
en
ts
wer
e
m
o
r
e
f
r
e
q
u
en
t
in
h
o
s
p
italized
ca
n
ce
r
p
atien
ts
with
m
aln
u
tr
itio
n
b
ased
o
n
G
L
I
M
cr
iter
ia
co
m
p
ar
e
d
to
p
ati
en
ts
with
o
u
t
m
aln
u
tr
itio
n
[
1
6
]
.
An
o
th
er
s
tu
d
y
b
y
Po
r
tu
o
n
d
o
et
a
l.
[
1
2
]
s
h
o
wed
a
h
ig
h
er
r
is
k
o
f
SS
I
(
OR
2
.
6
5
;
9
5
%
C
I
:
1
.
1
2
-
6
.
2
2
)
i
n
s
u
r
g
er
y
p
atien
ts
with
m
aln
u
tr
itio
n
b
ased
o
n
ASPE
N
cr
iter
ia,
in
v
o
lv
in
g
4
5
6
s
u
b
j
ec
ts
.
T
h
e
o
cc
u
r
r
e
n
ce
o
f
SS
I
w
as
also
s
ig
n
if
ican
tly
r
ep
o
r
ted
in
p
atien
ts
at
r
is
k
o
f
m
aln
u
tr
itio
n
.
Sk
eie
et
a
l.
[
1
7
]
d
em
o
n
s
tr
ated
th
at
th
e
in
cid
en
ce
o
f
SS
I
was
s
ig
n
if
ican
tly
ass
o
ciate
d
with
t
h
e
p
r
ev
alen
ce
o
f
m
aln
u
t
r
itio
n
r
is
k
b
ased
o
n
NR
S
2
0
0
2
cr
iter
ia
in
1
,
1
9
4
s
u
r
g
ical
p
atien
ts
(
OR
1
.
8
1
;
9
5
%
C
I
:
1
.
0
4
-
3
.
1
6
)
.
Alth
o
u
g
h
th
e
r
ela
tiv
e
r
is
k
in
t
h
is
s
tu
d
y
is
h
i
g
h
er
an
d
s
tatis
tically
s
ig
n
if
ican
t,
th
e
wid
e
r
an
g
e
o
f
co
n
f
id
en
ce
in
te
r
v
al
co
m
p
a
r
ed
to
o
th
er
s
tu
d
y
s
h
o
u
ld
b
e
n
o
te
d
.
T
h
is
wid
e
r
an
g
e
m
ay
b
e
attr
ib
u
ted
to
th
e
s
m
all
s
am
p
le
s
ize
an
d
s
ig
n
if
ican
t
d
ata
v
ar
iatio
n
,
lead
in
g
to
lar
g
er
s
tan
d
ar
d
er
r
o
r
s
in
th
is
s
tu
d
y
.
T
h
is
s
tu
d
y
also
s
h
o
wed
h
ig
h
p
r
ev
alen
ce
o
f
SS
I
(
1
3
.
8
%)
p
o
s
t
-
o
p
er
ativ
ely
i
n
s
u
b
jects,
w
h
ich
alig
n
e
d
with
s
ev
er
al
s
tu
d
ies
in
d
icatin
g
th
at
p
r
ev
alen
ce
o
f
SS
I
g
en
er
ally
r
an
g
es
f
r
o
m
2
%
to
1
7
.
8
%.
[
1
8
]
A
s
tu
d
y
at
ter
tiar
y
ca
r
e
ce
n
ter
in
I
n
d
ia
a
ls
o
f
o
u
n
d
SS
I
in
cid
en
ce
o
f
1
4
.
3
%
in
p
atien
ts
u
n
d
er
g
o
in
g
elec
tiv
e
lap
ar
o
to
m
y
[
1
9
]
.
B
ir
h
a
n
u
’
s
s
tu
d
y
i
n
E
th
io
p
ia
s
h
o
wed
a
h
ig
h
er
p
r
ev
alen
c
e
o
f
SS
I
at
1
9
.
3
%
in
p
atien
ts
u
n
d
er
g
o
in
g
g
en
er
a
l
s
u
r
g
er
y
wh
ich
b
lo
o
d
tr
an
s
f
u
s
io
n
,
h
em
o
g
l
o
b
in
lev
els,
p
r
e
s
en
ce
o
f
s
h
o
ck
,
p
r
ev
io
u
s
s
u
r
g
er
y
h
is
to
r
y
,
an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Glo
b
a
l Lea
d
ers
h
ip
I
n
itia
tive
o
n
Ma
ln
u
tr
itio
n
crit
eria
fo
r
p
r
ed
ictin
g
s
u
r
g
ica
l
…
(
P
a
u
lin
e
O
cta
via
n
i
)
1899
p
r
o
lo
n
g
ed
h
o
s
p
ital
s
tay
s
wer
e
s
ig
n
if
ican
tly
ass
o
ciate
d
with
SS
I
[
2
0
]
.
B
ased
o
n
th
e
s
u
r
g
ical
co
n
tam
in
atio
n
ca
teg
o
r
ies,
th
e
in
cid
en
ce
o
f
S
SI
is
h
ig
h
er
in
th
e
co
n
tam
in
a
ted
an
d
d
ir
t
y
ca
teg
o
r
ies
co
m
p
ar
ed
t
o
clea
n
an
d
clea
n
-
co
n
tam
in
ate
d
ca
teg
o
r
ie
s
.
I
n
a
s
tu
d
y
in
v
o
lv
in
g
1
,
8
7
8
p
atie
n
ts
u
n
d
er
g
o
in
g
a
clea
n
-
co
n
tam
in
ate
d
g
astro
in
test
in
al
s
u
r
g
er
y
,
it
was
f
o
u
n
d
th
at
1
1
.
3
%
o
f
p
atie
n
ts
ex
p
er
ien
ce
d
SS
I
,
ev
en
th
o
u
g
h
6
5
%
o
f
th
em
u
n
d
er
wen
t
la
p
ar
o
s
co
p
y
,
wh
ic
h
s
h
o
u
ld
h
av
e
b
ee
n
a
p
r
o
tecti
v
e
f
ac
to
r
[
2
1
]
.
T
h
e
p
r
ev
ale
n
c
e
o
f
SS
I
in
elec
tiv
e
s
u
r
g
er
ies
with
clea
n
an
d
clea
n
-
co
n
tam
in
ate
d
ca
teg
o
r
ies
is
esti
m
ated
to
b
e
ar
o
u
n
d
6
-
1
5
%,
with
th
e
in
cid
en
ce
o
f
SS
I
in
d
e
v
elo
p
in
g
c
o
u
n
tr
i
es
p
r
o
v
e
n
to
b
e
h
i
g
h
er
[
1
8
]
,
[
2
2
]
.
Similar
to
t
h
is
s
tu
d
y
wh
ich
co
n
d
u
cted
in
I
n
d
o
n
esia
as
a
d
ev
elo
p
in
g
co
u
n
tr
y
an
d
d
o
m
in
ated
b
y
clea
n
-
co
n
tam
in
ate
d
s
u
r
g
er
y
,
th
e
p
r
ev
alen
ce
o
f
SS
I
in
th
is
s
tu
d
y
alig
n
s
with
th
e
esti
m
ates.
T
ab
le
3
.
R
elatio
n
s
h
ip
m
aln
u
tr
i
tio
n
ac
co
r
d
i
n
g
to
GL
I
M
cr
iter
i
a
an
d
s
u
r
g
ical
s
ite
in
f
ec
tio
n
M
a
l
n
u
t
r
i
t
i
o
n
s
t
a
t
u
s
a
c
c
o
r
d
i
n
g
t
o
G
LI
M
c
r
i
t
e
r
i
a
S
u
r
g
i
c
a
l
s
i
t
e
i
n
f
e
c
t
i
o
n
To
t
a
l
p
R
R
(
9
5
%
C
I
)
Y
e
s
n
(
%)
N
o
n
(
%)
M
a
l
n
u
t
r
i
t
i
o
n
1
4
(
2
4
.
2
)
4
8
(
7
5
.
8
)
62
0
.
0
0
5
cs
4
.
6
(
1
.
4
-
1
5
.
1
)
N
o
ma
l
n
u
t
r
i
t
i
o
n
3
(
4
.
9
)
5
8
(
9
5
.
1
)
61
To
t
a
l
17
1
0
6
1
2
3
cs
=
C
hi
-
s
q
u
a
re
I
n
th
is
s
tu
d
y
,
it
was
f
o
u
n
d
th
at
co
n
tam
in
ated
s
u
r
g
ical
p
r
o
ce
d
u
r
es
wer
e
m
o
r
e
co
m
m
o
n
in
th
e
m
aln
u
tr
itio
n
g
r
o
u
p
.
T
h
is
co
u
l
d
b
e
d
u
e
to
th
e
f
ac
t
th
at
p
r
eo
p
er
ativ
e
co
n
d
itio
n
s
in
m
aln
o
u
r
is
h
ed
p
atien
ts
m
ig
h
t
lead
to
ea
r
lier
co
n
tam
in
atio
n
an
d
ac
u
te
in
f
lam
m
atio
n
in
th
e
s
u
r
g
ical
ar
ea
,
ca
teg
o
r
iz
in
g
th
e
s
u
r
g
e
r
y
as
co
n
tam
in
ated
.
T
h
is
s
tu
d
y
in
clu
d
ed
s
u
r
g
er
ies
r
elate
d
to
g
astro
in
test
in
al,
g
y
n
ec
o
lo
g
y
,
an
d
u
r
o
lo
g
y
.
I
n
g
y
n
ec
o
l
o
g
y
s
u
r
g
er
y
,
m
ali
g
n
a
n
cy
an
d
d
ir
ty
co
n
tam
i
n
atio
n
s
u
r
g
er
y
ar
e
s
ig
n
if
ica
n
t
in
d
ep
en
d
en
t
r
is
k
f
ac
to
r
s
ass
o
ciate
d
with
SS
I
af
ter
h
y
s
ter
ec
to
m
y
p
r
o
ce
d
u
r
es
[
2
3
]
.
An
o
th
er
s
tu
d
y
b
y
Atip
o
et
a
l.
[
2
4
]
f
o
u
n
d
a
h
ig
h
in
cid
en
ce
o
f
SS
I
r
ea
ch
in
g
2
2
.
9
6
%
in
u
r
o
lo
g
y
s
u
r
g
e
r
y
,
p
ar
ticu
lar
ly
in
o
ld
er
p
atien
ts
wit
h
co
m
o
r
b
id
f
ac
to
r
s
s
u
ch
as d
iab
etes m
ellitu
s
,
h
y
p
er
ten
s
io
n
,
an
d
r
en
al
f
ailu
r
e.
Su
b
jects
in
th
is
s
tu
d
y
d
iv
id
ed
in
to
two
g
r
o
u
p
s
b
ased
o
n
th
eir
m
aln
u
tr
itio
n
s
tatu
s
u
s
in
g
GL
I
M
cr
iter
ia,
wh
ich
h
av
e
ad
v
an
ta
g
es
o
v
er
o
th
er
n
u
tr
itio
n
al
as
s
ess
m
en
t
to
o
ls
.
GL
I
M
cr
iter
i
a
s
h
o
w
s
atis
f
ac
to
r
y
ac
cu
r
ac
y
,
with
a
s
en
s
itiv
ity
o
f
8
6
.
6
%
an
d
s
p
ec
if
icity
o
f
8
1
.
6
%
f
o
r
ass
ess
in
g
m
aln
u
tr
itio
n
in
h
o
s
p
italized
p
atien
ts
[
2
5
]
.
T
h
e
s
y
s
tem
atic
r
ev
iew
b
y
B
r
o
wn
et
a
l
.
co
n
clu
d
ed
th
at
GL
I
M
c
r
iter
ia
p
r
ed
ict
p
o
o
r
clin
ical
o
u
tco
m
es,
i
n
clu
d
in
g
p
o
s
to
p
er
ativ
e
co
m
p
licatio
n
s
an
d
lo
n
g
er
h
o
s
p
ital
s
tay
s
.
I
t
also
f
o
u
n
d
th
at
alth
o
u
g
h
th
e
p
ar
am
eter
s
f
o
r
p
h
en
o
t
y
p
ic
an
d
etio
lo
g
ic
cr
iter
ia
v
a
r
ied
ac
r
o
s
s
d
if
f
er
en
t
s
tu
d
ies
in
th
e
r
ev
iew,
th
e
r
esu
lts
co
n
s
is
ten
tly
s
h
o
wed
th
at
GL
I
M
cr
iter
ia
wer
e
ass
o
ciate
d
wit
h
p
o
o
r
clin
ical
o
u
tco
m
es
[
2
6
]
.
I
n
th
e
m
aln
u
tr
itio
n
g
r
o
u
p
,
weig
h
t
lo
s
s
o
f
m
o
r
e
th
an
5
%
i
n
th
e
last
s
ix
m
o
n
th
s
i
s
th
e
m
o
s
t
f
r
eq
u
en
tly
f
o
u
n
d
p
h
en
o
ty
p
ic
cr
iter
io
n
.
T
h
is
alig
n
ed
with
s
tu
d
y
b
y
B
r
ito
et
a
l.
th
at
s
h
o
w
6
9
.
2
%
o
f
s
u
b
jects
class
if
ied
as
m
aln
o
u
r
is
h
ed
b
ased
o
n
GL
I
M
cr
iter
ia
h
a
d
ex
p
er
ien
ce
d
weig
h
t
lo
s
s
[
2
5
]
.
W
eig
h
t
lo
s
s
an
d
lo
w
B
MI
c
r
iter
ia
ar
e
m
o
r
e
co
m
m
o
n
ly
u
s
ed
as
p
h
en
o
ty
p
ic
c
r
iter
ia
in
v
ar
i
o
u
s
GL
I
M
-
r
elate
d
s
tu
d
ies.
C
o
m
p
ar
ed
to
lo
w
B
MI
,
s
tu
d
ie
s
h
av
e
s
h
o
wn
t
h
at
u
n
in
ten
tio
n
al
weig
h
t
lo
s
s
is
a
s
tr
o
n
g
p
r
ed
icto
r
o
f
co
m
p
licatio
n
s
b
ec
au
s
e
it
s
ig
n
if
ies
a
lo
s
s
o
f
f
at
an
d
f
at
-
f
r
ee
m
ass
,
wh
ich
lead
s
to
r
e
d
u
ce
d
m
u
s
cle
s
tr
en
g
th
.
W
h
en
s
o
m
eo
n
e
lo
s
es
f
at
m
ass
,
n
o
t
o
n
ly
is
f
at
s
to
r
ag
e
r
e
d
u
ce
d
,
b
u
t
also
n
u
tr
itio
n
al
r
eser
v
es
th
at
im
p
ac
t
im
m
u
n
e
an
d
in
f
lam
m
ato
r
y
r
esp
o
n
s
es,
d
ec
r
ea
s
in
g
a
p
er
s
o
n
’
s
a
b
ilit
y
to
h
an
d
le
s
u
r
g
e
r
y
.
Ad
d
itio
n
ally
,
lo
w
in
tak
e
o
r
d
ep
letio
n
o
f
n
u
tr
itio
n
al
r
eser
v
es
in
s
k
eleta
l
m
u
s
cle
ca
n
also
d
elay
wo
u
n
d
h
ea
lin
g
.
T
h
is
ex
p
lain
s
h
o
w
m
aln
u
tr
itio
n
ca
n
lead
to
SS
I
[
1
3
]
.
A
t
o
t
a
l
6
9
.
4
%
o
f
s
u
b
j
e
c
t
s
i
n
t
h
e
G
L
I
M
m
a
l
n
u
t
r
i
t
i
o
n
g
r
o
u
p
h
a
d
a
d
i
a
g
n
o
s
i
s
m
a
l
i
g
n
a
n
c
y
o
r
s
u
s
p
e
c
t
e
d
m
a
l
i
g
n
a
n
c
y
.
M
e
t
a
b
o
li
c
c
h
a
n
g
es
i
n
c
a
n
c
e
r
p
at
i
e
n
ts
,
p
a
r
ti
c
u
l
a
r
ly
c
h
a
n
g
e
s
i
n
t
h
e
u
ti
l
iz
a
t
i
o
n
o
f
n
u
t
r
i
e
n
t
s
ca
u
s
e
d
b
y
t
h
e
t
u
m
o
r
o
r
c
a
n
c
e
r
t
h
e
r
a
p
y
,
r
e
s
u
l
t
i
n
c
h
r
o
n
i
c
i
n
f
l
a
m
m
a
t
i
o
n
an
d
e
x
c
e
s
s
i
v
e
c
a
t
a
b
o
li
s
m
.
C
h
r
o
n
i
c
i
n
f
l
a
m
m
a
t
i
o
n
i
n
m
a
l
i
g
n
a
n
c
y
f
u
l
f
i
ll
s
t
h
e
et
i
o
l
o
g
ic
a
l
c
r
it
e
r
i
a
i
n
t
h
e
G
L
I
M
m
a
l
n
u
t
r
i
t
i
o
n
.
T
h
e
m
e
c
h
a
n
is
m
v
i
a
m
a
ln
u
t
r
i
t
i
o
n
a
f
f
e
ct
s
t
h
e
c
l
i
n
i
c
al
o
u
t
c
o
m
es
o
f
c
a
n
c
e
r
p
a
t
i
e
n
ts
i
n
cl
u
d
e
r
e
d
u
c
e
d
n
u
t
r
ie
n
t
i
n
t
a
k
e
d
u
e
t
o
t
h
e
e
f
f
e
c
ts
o
f
a
l
te
r
e
d
n
u
t
r
i
e
n
t
m
e
t
a
b
o
l
is
m
a
n
d
r
e
s
t
i
n
g
e
n
e
r
g
y
e
x
p
e
n
d
i
t
u
r
e
o
r
i
g
i
n
a
t
i
n
g
f
r
o
m
th
e
t
u
m
o
r
s
y
s
te
m
i
c
al
l
y
.
M
al
n
u
tr
i
t
i
o
n
a
ls
o
w
e
a
k
e
n
s
t
h
e
i
m
m
u
n
e
r
e
s
p
o
n
s
e
a
n
d
r
e
d
u
c
e
s
t
o
le
r
a
n
c
e
t
o
c
h
e
m
o
t
h
e
r
a
p
y
o
r
i
m
m
u
n
o
t
h
e
r
a
p
y
[
2
7
]
.
L
ap
ar
o
to
m
y
is
a
tr
a
u
m
a
th
at
c
an
ca
u
s
e
v
a
r
io
u
s
d
e
g
r
ee
s
o
f
in
f
lam
m
atio
n
a
n
d
in
c
r
ea
s
ed
g
ly
co
g
en
,
f
at,
an
d
p
r
o
tein
ca
tab
o
lis
m
,
lead
in
g
to
a
lo
s
s
o
f
b
o
d
y
ce
ll
m
ass
.
W
h
en
th
er
e
is
a
d
ec
r
ea
s
e
in
p
er
io
p
er
ativ
e
m
u
s
cle
tis
s
u
e,
th
e
r
ec
o
v
er
y
f
u
n
ctio
n
is
h
i
n
d
er
ed
.
I
n
p
atien
ts
with
in
a
d
eq
u
ate
n
u
tr
itio
n
a
l
r
eser
v
es,
v
ar
io
u
s
co
m
p
licatio
n
s
ca
n
o
cc
u
r
wh
en
th
e
b
o
d
y
ca
n
n
o
t
o
v
er
c
o
m
e
in
f
lam
m
atio
n
an
d
tis
s
u
e
h
ea
lin
g
[
2
8
]
.
B
ased
o
n
t
h
e
s
ite
o
f
in
f
ec
tio
n
,
s
u
b
jects
in
th
e
m
aln
u
tr
itio
n
g
r
o
u
p
ex
p
e
r
i
en
ce
d
b
o
t
h
s
u
p
er
f
icial
an
d
d
ee
p
SS
I
,
wh
ile
th
e
non
-
m
al
n
u
tr
itio
n
g
r
o
u
p
o
n
l
y
ex
p
er
ien
ce
d
s
u
p
e
r
f
icial
SS
I
.
T
h
e
s
e
r
e
s
u
lts
in
d
icate
th
at
s
u
b
jects
wi
th
m
aln
u
tr
itio
n
ex
p
er
ien
ce
m
o
r
e
s
ev
er
e
ty
p
es
o
f
SS
I
co
m
p
ar
ed
to
th
o
s
e
with
o
u
t
m
aln
u
tr
itio
n
.
A
s
tu
d
y
b
y
Go
in
s
et
a
l.
[
2
9
]
s
h
o
wed
th
at
g
y
n
ec
o
l
o
g
ical
ca
n
ce
r
p
atien
ts
with
m
aln
u
tr
itio
n
b
ased
o
n
on
E
u
r
o
p
ea
n
So
ciety
f
o
r
C
lin
ical
Nu
tr
itio
n
an
d
Me
tab
o
lis
m
(
E
SP
E
N)
cr
iter
ia
wer
e
s
ig
n
if
ican
tly
at
h
ig
h
er
r
is
k
f
o
r
m
ajo
r
co
m
p
licatio
n
s
,
in
clu
d
i
n
g
d
ee
p
SS
I
an
d
o
r
g
a
n
co
m
p
licatio
n
s
f
o
r
u
ter
in
e
,
ce
r
v
ical,
a
n
d
o
v
ar
ia
n
m
alig
n
an
cies.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J
Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
8
9
5
-
1
9
0
2
1900
Kn
o
win
g
ev
id
en
ce
o
f
s
ig
n
if
ic
an
tly
in
cr
ea
s
ed
p
o
s
t
-
o
p
er
ativ
e
SS
I
in
p
atien
ts
with
m
aln
u
tr
itio
n
,
it
i
s
im
p
o
r
tan
t
to
im
p
lem
en
t
ea
r
ly
s
cr
ee
n
in
g
,
ass
ess
m
en
t,
a
n
d
n
u
tr
itio
n
al
m
an
a
g
em
en
t
b
ef
o
r
e
u
n
d
er
g
o
in
g
lap
ar
o
to
m
y
.
Z
ewu
d
ie
et
a
l.
r
ec
o
m
m
en
d
p
er
io
p
er
ativ
e
n
u
tr
itio
n
al
m
an
ag
em
e
n
t
in
v
o
lv
in
g
p
r
o
v
is
io
n
o
f
20
-
3
5
k
ca
l/k
g
o
f
e
n
er
g
y
wh
ile
co
n
s
id
er
in
g
elec
tr
o
l
y
te
an
d
m
in
er
al
s
tatu
s
f
o
r
ca
n
ce
r
p
atien
t
s
with
m
aln
u
tr
itio
n
[
3
0
]
.
E
SP
E
N
r
ec
o
m
m
en
d
s
th
e
n
ee
d
f
o
r
s
cr
ee
n
in
g
a
n
d
ass
ess
m
en
t
in
p
atien
ts
u
n
d
er
g
o
i
n
g
s
u
r
g
er
y
.
Sev
er
ely
m
aln
o
u
r
is
h
ed
p
atien
ts
r
e
q
u
ir
i
n
g
n
u
tr
itio
n
al
th
er
ap
y
7
-
1
4
d
ay
s
b
ef
o
r
e
m
ajo
r
s
u
r
g
e
r
y
,
wh
ich
m
ay
n
ec
ess
itate
d
elay
in
g
s
u
r
g
er
y
u
n
til
n
u
tr
itio
n
al
im
p
r
o
v
em
e
n
t
is
ac
h
iev
ed
.
Nu
tr
itio
n
al
th
e
r
ap
y
in
clu
d
es
ed
u
ca
tio
n
a
n
d
co
u
n
s
ellin
g
,
o
r
al
n
u
tr
itio
n
s
u
p
p
o
r
t,
e
n
ter
al
n
u
tr
itio
n
,
a
n
d
p
ar
en
ter
al
n
u
tr
itio
n
(
f
o
r
s
ev
e
r
ely
m
aln
o
u
r
is
h
ed
p
atien
ts
wh
en
en
er
g
y
r
e
q
u
ir
e
m
en
ts
ca
n
n
o
t b
e
m
et
v
ia
o
r
al
o
r
en
ter
al
[
3
1
]
.
T
h
is
s
tu
d
y
was
th
e
f
ir
s
t
in
I
n
d
o
n
esia
to
ass
ess
m
aln
u
tr
itio
n
b
ased
o
n
GL
I
M
c
r
iter
ia
as
a
p
r
ed
icto
r
o
f
p
o
s
t
-
lap
ar
o
to
m
y
SS
I
.
I
t
was
a
p
r
o
s
p
ec
tiv
e
co
h
o
r
t
s
tu
d
y
with
a
lo
w
d
r
o
p
o
u
t
r
ate
o
f
5
.
4
%.
Similar
s
tu
d
ies
th
at
in
v
esti
g
ate
th
e
ass
o
ciatio
n
b
et
wee
n
m
aln
u
tr
itio
n
an
d
SS
I
s
till
u
s
e
ASPEN
cr
iter
ia,
wh
ile
th
is
s
tu
d
y
em
p
l
o
y
s
th
e
latest,
p
r
ac
tical,
an
d
ea
s
ily
ap
p
licab
le
GL
I
M
m
aln
u
tr
itio
n
cr
iter
ia.
T
h
e
s
tu
d
y
also
u
s
es
a
m
u
lti
-
f
r
eq
u
en
cy
s
eg
m
en
tal
B
I
A
ex
am
in
atio
n
with
p
ar
am
eter
s
an
d
c
u
to
f
f
s
th
at
co
n
f
o
r
m
to
r
ec
o
m
m
e
n
d
atio
n
s
an
d
eth
n
ic
co
n
s
id
er
atio
n
s
to
d
eter
m
in
e
l
o
w
m
u
s
cle
m
ass
ac
co
r
d
in
g
to
th
e
p
h
en
o
ty
p
ic
cr
iter
ia
o
f
G
L
I
M.
Ho
wev
er
,
th
e
s
tu
d
y
d
o
es
h
a
v
e
lim
itatio
n
s
.
I
t
d
o
es
n
o
t
an
aly
ze
co
n
f
o
u
n
d
in
g
f
ac
to
r
s
s
u
ch
as
d
u
r
atio
n
o
f
s
u
r
g
er
y
,
am
o
u
n
t
o
f
in
tr
ao
p
er
ativ
e
b
leed
in
g
,
a
n
d
co
m
o
r
b
i
d
f
ac
to
r
s
o
th
e
r
th
an
d
iab
etes
m
ellitu
s
.
Ad
d
itio
n
ally
,
th
is
s
tu
d
y
o
n
ly
d
eter
m
in
es th
e
m
aln
u
tr
itio
n
s
tatu
s
with
o
u
t a
s
s
ess
in
g
th
e
s
ev
er
ity
o
f
m
al
n
u
tr
itio
n
.
4.
CO
NCLU
SI
O
N
Per
io
p
er
ativ
e
m
al
n
u
tr
itio
n
h
as
b
ee
n
s
h
o
wn
t
o
b
e
ass
o
ciate
d
with
p
o
o
r
p
o
s
t
-
o
p
er
ati
v
e
clin
ical
o
u
tco
m
es,
in
clu
d
in
g
s
u
r
g
ical
s
ite
in
f
ec
tio
n
s
.
T
h
e
ea
s
ily
ap
p
licab
le
GL
I
M
m
aln
u
t
r
itio
n
cr
iter
ia
ca
n
b
e
a
v
alu
ab
le
ch
o
ice
as
an
ass
ess
m
en
t
to
o
l
f
o
r
m
al
n
u
tr
itio
n
in
p
atien
ts
u
n
d
er
g
o
in
g
s
u
r
g
e
r
y
.
B
ased
o
n
th
is
s
tu
d
y
,
m
aln
u
tr
itio
n
ac
co
r
d
in
g
to
G
L
I
M
cr
iter
ia
s
ig
n
if
ican
tly
in
cr
ea
s
ed
th
e
r
is
k
o
f
ex
p
er
ie
n
cin
g
SS
I
f
o
llo
win
g
elec
tiv
e
lap
ar
o
to
m
y
c
o
m
p
ar
e
d
to
th
o
s
e
with
o
u
t
m
aln
u
tr
itio
n
(
4
.
6
tim
es
h
ig
h
e
r
)
.
T
h
er
ef
o
r
e,
r
o
u
tin
e
s
cr
ee
n
in
g
,
ass
es
s
m
en
t,
an
d
n
u
tr
itio
n
al
in
ter
v
en
tio
n
s
in
th
e
7
-
1
4
d
a
y
s
lead
in
g
u
p
t
o
s
u
r
g
er
y
f
o
r
p
atien
ts
s
ch
ed
u
led
f
o
r
lap
ar
o
to
m
y
ar
e
r
ec
o
m
m
e
n
d
ed
.
Fu
r
th
er
s
tu
d
ies
ar
e
also
n
ee
d
ed
to
d
eter
m
in
e
co
n
f
o
u
n
d
in
g
f
ac
to
r
s
th
at
m
a
y
h
av
e
an
im
p
ac
t o
n
th
e
o
cc
u
r
r
e
n
ce
o
f
SS
I
af
ter
la
p
ar
o
to
m
y
.
RE
F
E
R
E
NC
E
S
[
1
]
B
.
B
.
B
a
y
i
ssa
,
M
.
M
u
mm
u
d
,
F
.
M
i
r
e
ssa,
a
n
d
G
.
F
e
k
a
d
u
,
“
P
o
s
t
o
p
e
r
a
t
i
v
e
c
o
m
p
l
i
c
a
t
i
o
n
s
a
n
d
a
ss
o
c
i
a
t
e
d
f
a
c
t
o
r
s
a
mo
n
g
su
r
g
i
c
a
l
p
a
t
i
e
n
t
s
t
r
e
a
t
e
d
a
t
a
Te
r
t
i
a
r
y
H
o
sp
i
t
a
l
,
Ea
s
t
e
r
n
Et
h
i
o
p
i
a
:
a
p
r
o
sp
e
c
t
i
v
e
c
o
h
o
r
t
s
t
u
d
y
,
”
O
p
e
n
A
c
c
e
ss
S
u
r
g
e
r
y
,
v
o
l
.
1
4
,
p
p
.
3
7
–
4
6
,
2
0
2
1
,
d
o
i
:
1
0
.
2
1
4
7
/
o
a
s.s
3
2
0
5
0
6
.
[
2
]
E
.
E
.
D
e
n
c
k
e
r
,
A
.
B
o
n
d
e
,
A
.
T
r
o
e
l
s
e
n
,
K
.
M
.
V
a
r
a
d
a
r
a
j
a
n
,
a
n
d
M
.
S
i
l
l
e
s
e
n
,
“
P
o
s
t
o
p
e
r
a
t
i
v
e
c
o
m
p
l
i
c
a
t
i
o
n
s
:
a
n
o
b
s
e
r
v
a
t
i
o
n
a
l
s
t
u
d
y
o
f
t
r
e
n
d
s
i
n
t
h
e
U
n
i
t
e
d
S
t
a
t
e
s
f
r
o
m
2
0
1
2
t
o
2
0
1
8
,
”
B
M
C
S
u
r
g
e
r
y
,
v
o
l
.
2
1
,
n
o
.
1
,
p
p
.
1
–
1
0
,
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
8
9
3
-
0
2
1
-
0
1
3
9
2
-
z.
[
3
]
F
.
C
h
a
i
r
a
n
i
,
I
.
P
u
s
p
i
t
a
s
a
r
i
,
a
n
d
R
.
H
.
A
sd
i
e
,
“
I
n
c
i
d
e
n
c
e
a
n
d
r
i
s
k
f
a
c
t
o
r
s
f
o
r
su
r
g
i
c
a
l
w
o
u
n
d
i
n
f
e
c
t
i
o
n
s
i
n
o
b
s
t
e
t
r
i
c
s
a
n
d
g
y
n
e
c
o
l
o
g
y
su
r
g
e
r
y
i
n
h
o
sp
i
t
a
l
s
(
i
n
I
n
d
o
n
e
s
i
a
n
:
I
n
si
d
e
n
si
d
a
n
f
a
k
t
o
r
r
i
s
i
k
o
i
n
f
e
k
si
l
u
k
a
o
p
e
r
a
si
p
a
d
a
b
e
d
a
h
o
b
st
e
t
r
i
d
a
n
g
i
n
e
k
o
l
o
g
i
d
i
r
u
ma
h
sak
i
t
)
,
”
J
u
r
n
a
l
M
a
n
a
j
e
m
e
n
d
a
n
P
e
l
a
y
a
n
a
n
Fa
rm
a
si
(
J
o
u
rn
a
l
o
f
M
a
n
a
g
e
m
e
n
t
a
n
d
P
h
a
rm
a
c
y
Pr
a
c
t
i
c
e
)
,
v
o
l
.
9
,
n
o
.
4
,
2
0
1
9
,
d
o
i
:
1
0
.
2
2
1
4
6
/
j
mp
f
.
4
8
0
2
4
.
[
4
]
W
H
O
,
G
l
o
b
a
l
g
u
i
d
e
l
i
n
e
s
f
o
r
t
h
e
p
re
v
e
n
t
i
o
n
o
f
su
r
g
i
c
a
l
si
t
e
i
n
f
e
c
t
i
o
n
st
r
o
n
g
g
u
i
d
e
l
i
n
e
re
c
o
m
m
e
n
d
a
t
i
o
n
s
,
2
n
d
e
d
.
G
e
n
e
v
a
:
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
2
0
1
6
.
[
5
]
Z.
L
i
e
t
a
l
.
,
“
P
r
o
s
p
e
c
t
i
v
e
m
u
l
t
i
c
e
n
t
e
r
st
u
d
y
o
n
t
h
e
i
n
c
i
d
e
n
c
e
o
f
s
u
r
g
i
c
a
l
si
t
e
i
n
f
e
c
t
i
o
n
a
f
t
e
r
e
m
e
r
g
e
n
c
y
a
b
d
o
mi
n
a
l
su
r
g
e
r
y
i
n
C
h
i
n
a
,
”
S
c
i
e
n
t
i
f
i
c
R
e
p
o
r
t
s
,
v
o
l
.
1
1
,
n
o
.
1
,
p
p
.
1
–
1
0
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
3
8
/
s
4
1
5
9
8
-
0
2
1
-
8
7
3
9
2
-
8.
[
6
]
B
.
A
k
u
l
a
a
n
d
N
.
D
o
c
t
o
r
,
“
A
p
r
o
s
p
e
c
t
i
v
e
r
e
v
i
e
w
o
f
p
r
e
o
p
e
r
a
t
i
v
e
n
u
t
r
i
t
i
o
n
a
l
st
a
t
u
s
a
n
d
i
t
s
i
n
f
l
u
e
n
c
e
o
n
t
h
e
o
u
t
c
o
me
o
f
a
b
d
o
m
i
n
a
l
su
r
g
e
r
y
,
”
C
u
r
e
u
s
,
v
o
l
.
1
3
,
n
o
.
1
1
,
2
0
2
1
,
d
o
i
:
1
0
.
7
7
5
9
/
c
u
r
e
u
s.
1
9
9
4
8
.
[
7
]
D
.
G
.
A
.
W
i
l
l
i
a
ms
,
J
.
M
o
l
i
n
g
e
r
,
a
n
d
P
.
E
.
W
i
sc
h
me
y
e
r
,
“
Th
e
m
a
l
n
o
u
r
i
sh
e
d
su
r
g
e
r
y
p
a
t
i
e
n
t
:
A
si
l
e
n
t
e
p
i
d
e
mi
c
i
n
p
e
r
i
o
p
e
r
a
t
i
v
e
o
u
t
c
o
mes
?
,
”
C
u
rr
e
n
t
O
p
i
n
i
o
n
i
n
An
a
e
st
h
e
si
o
l
o
g
y
,
v
o
l
.
3
2
,
n
o
.
3
,
p
p
.
4
0
5
–
4
1
1
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
9
7
/
A
C
O
.
0
0
0
0
0
0
0
0
0
0
0
0
0
7
2
2
.
[
8
]
A
.
R
i
a
d
e
t
a
l
.
,
“
I
mp
a
c
t
o
f
m
a
l
n
u
t
r
i
t
i
o
n
o
n
e
a
r
l
y
o
u
t
c
o
m
e
s
a
f
t
e
r
c
a
n
c
e
r
su
r
g
e
r
y
:
a
n
i
n
t
e
r
n
a
t
i
o
n
a
l
,
m
u
l
t
i
c
e
n
t
r
e
,
p
r
o
sp
e
c
t
i
v
e
c
o
h
o
r
t
st
u
d
y
,
”
T
h
e
L
a
n
c
e
t
G
l
o
b
a
l
H
e
a
l
t
h
,
v
o
l
.
1
1
,
n
o
.
3
,
p
p
.
3
4
1
–
3
4
9
,
2
0
2
3
,
d
o
i
:
1
0
.
1
0
1
6
/
S
2
2
1
4
-
1
0
9
X
(
2
2
)
0
0
5
5
0
-
2.
[
9
]
M
.
D
u
r
á
n
-
P
o
v
e
d
a
,
A
.
S
u
á
r
e
z
-
de
-
la
-
R
i
c
a
,
E
.
C
.
M
i
n
c
h
o
t
,
J.
O
c
ó
n
-
B
r
e
t
ó
n
,
A
.
S
á
n
c
h
e
z
-
P
e
r
n
a
u
t
e
,
a
n
d
G
.
R
o
d
r
í
g
u
e
z
-
C
a
r
a
v
a
c
a
,
“
K
n
o
w
l
e
d
g
e
a
n
d
p
r
a
c
t
i
c
e
s
o
f
d
i
g
e
s
t
i
v
e
s
u
r
g
e
o
n
s
c
o
n
c
e
r
n
i
n
g
sp
e
c
i
a
l
i
z
e
d
n
u
t
r
i
t
i
o
n
a
l
su
p
p
o
r
t
i
n
c
a
n
c
e
r
p
a
t
i
e
n
t
s
:
a
su
r
v
e
y
st
u
d
y
,
”
N
u
t
ri
e
n
t
s
,
v
o
l
.
1
4
,
n
o
.
2
2
,
p
p
.
1
–
1
3
,
2
0
2
2
,
d
o
i
:
1
0
.
3
3
9
0
/
n
u
1
4
2
2
4
7
6
4
.
[
1
0
]
G
.
L.
J
e
n
s
e
n
e
t
a
l
.
,
“
G
LI
M
c
r
i
t
e
r
i
a
f
o
r
t
h
e
d
i
a
g
n
o
s
i
s
o
f
mal
n
u
t
r
i
t
i
o
n
:
a
c
o
n
s
e
n
su
s
r
e
p
o
r
t
f
r
o
m
t
h
e
g
l
o
b
a
l
c
l
i
n
i
c
a
l
n
u
t
r
i
t
i
o
n
c
o
mm
u
n
i
t
y
,
”
J
o
u
r
n
a
l
o
f
P
a
re
n
t
e
ra
l
a
n
d
E
n
t
e
ra
l
N
u
t
ri
t
i
o
n
,
v
o
l
.
4
3
,
n
o
.
1
,
p
p
.
3
2
–
4
0
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
0
2
/
j
p
e
n
.
1
4
4
0
.
[
1
1
]
M
.
A
.
E.
d
e
v
a
n
d
e
r
S
c
h
u
e
r
e
n
e
t
a
l
.
,
“
G
l
o
b
a
l
Le
a
d
e
r
sh
i
p
I
n
i
t
i
a
t
i
v
e
o
n
M
a
l
n
u
t
r
i
t
i
o
n
(
G
LI
M
)
:
G
u
i
d
a
n
c
e
o
n
v
a
l
i
d
a
t
i
o
n
o
f
t
h
e
o
p
e
r
a
t
i
o
n
a
l
c
r
i
t
e
r
i
a
f
o
r
t
h
e
d
i
a
g
n
o
s
i
s
o
f
p
r
o
t
e
i
n
-
e
n
e
r
g
y
m
a
l
n
u
t
r
i
t
i
o
n
i
n
a
d
u
l
t
s,
”
C
l
i
n
i
c
a
l
N
u
t
ri
t
i
o
n
,
v
o
l
.
3
9
,
n
o
.
9
,
p
p
.
2
8
7
2
–
2
8
8
0
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
l
n
u
.
2
0
1
9
.
1
2
.
0
2
2
.
[
1
2
]
J.
I
.
P
o
r
t
u
o
n
d
o
e
t
a
l
.
,
“
M
a
l
n
u
t
r
i
t
i
o
n
i
n
e
l
e
c
t
i
v
e
su
r
g
e
r
y
:
H
o
w
t
r
a
d
i
t
i
o
n
a
l
m
a
r
k
e
r
s
m
i
g
h
t
b
e
f
a
i
l
i
n
g
s
u
r
g
e
o
n
s
a
n
d
p
a
t
i
e
n
t
s,”
S
u
r
g
e
r
y
(
U
n
i
t
e
d
S
t
a
t
e
s)
,
v
o
l
.
1
6
8
,
n
o
.
6
,
p
p
.
1
1
4
4
–
1
1
5
1
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
s
u
r
g
.
2
0
2
0
.
0
8
.
0
1
2
.
[
1
3
]
E.
S
k
e
i
e
,
R
.
J
.
T
a
n
g
v
i
k
,
L.
S
.
N
y
m
o
,
S
.
H
a
r
t
h
u
g
,
K
.
La
sse
n
,
a
n
d
A
.
V
i
st
e
,
“
W
e
i
g
h
t
l
o
ss
a
n
d
B
M
I
c
r
i
t
e
r
i
a
i
n
G
LI
M
’
s
d
e
f
i
n
i
t
i
o
n
o
f
mal
n
u
t
r
i
t
i
o
n
i
s
a
sso
c
i
a
t
e
d
w
i
t
h
p
o
s
t
o
p
e
r
a
t
i
v
e
c
o
m
p
l
i
c
a
t
i
o
n
s
f
o
l
l
o
w
i
n
g
a
b
d
o
m
i
n
a
l
r
e
sec
t
i
o
n
s
-
R
e
su
l
t
s
f
r
o
m
a
N
a
t
i
o
n
a
l
Q
u
a
l
i
t
y
R
e
g
i
s
t
r
y
,
”
C
l
i
n
i
c
a
l
N
u
t
r
i
t
i
o
n
,
v
o
l
.
3
9
,
n
o
.
5
,
p
p
.
1
5
9
3
–
1
5
9
9
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
l
n
u
.
2
0
1
9
.
0
7
.
0
0
3
.
[
1
4
]
S
.
N
.
Zw
i
c
k
y
e
t
a
l
.
,
“
N
o
i
m
p
a
c
t
o
f
sex
o
n
s
u
r
g
i
c
a
l
si
t
e
i
n
f
e
c
t
i
o
n
s
i
n
a
b
d
o
m
i
n
a
l
su
r
g
e
r
y
:
a
m
u
l
t
i
-
c
e
n
t
e
r
s
t
u
d
y
,
”
L
a
n
g
e
n
b
e
c
k
’
s
Arc
h
i
v
e
s
o
f
S
u
r
g
e
ry
,
v
o
l
.
4
0
7
,
n
o
.
8
,
p
p
.
3
7
6
3
–
3
7
6
9
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
0
7
/
s0
0
4
2
3
-
022
-
0
2
6
9
1
-
6.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Glo
b
a
l Lea
d
ers
h
ip
I
n
itia
tive
o
n
Ma
ln
u
tr
itio
n
crit
eria
fo
r
p
r
ed
ictin
g
s
u
r
g
ica
l
…
(
P
a
u
lin
e
O
cta
via
n
i
)
1901
[
1
5
]
S
.
Ta
n
e
t
a
l
.
,
“
V
a
l
i
d
a
t
i
o
n
o
f
G
LI
M
mal
n
u
t
r
i
t
i
o
n
c
r
i
t
e
r
i
a
i
n
c
a
n
c
e
r
p
a
t
i
e
n
t
s
u
n
d
e
r
g
o
i
n
g
m
a
j
o
r
a
b
d
o
m
i
n
a
l
s
u
r
g
e
r
y
:
A
l
a
r
g
e
-
s
c
a
l
e
p
r
o
s
p
e
c
t
i
v
e
s
t
u
d
y
,
”
C
l
i
n
i
c
a
l
N
u
t
ri
t
i
o
n
,
v
o
l
.
4
1
,
n
o
.
3
,
p
p
.
5
9
9
–
6
0
9
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
l
n
u
.
2
0
2
2
.
0
1
.
0
1
0
.
[
1
6
]
B
.
T.
M
u
r
e
sa
n
e
t
a
l
.
,
“
R
e
l
a
t
i
o
n
o
f
ma
l
n
u
t
r
i
t
i
o
n
a
n
d
n
o
so
c
o
mi
c
a
l
i
n
f
e
c
t
i
o
n
s
i
n
c
a
n
c
e
r
p
a
t
i
e
n
t
s
i
n
h
o
s
p
i
t
a
l
:
a
n
o
b
s
e
r
v
a
t
i
o
n
a
l
s
t
u
d
y
,
”
J
o
u
rn
a
l
o
f
N
u
t
r
i
t
i
o
n
a
n
d
Me
t
a
b
o
l
i
sm
,
p
p
.
1
–
8
,
2
0
2
2
,
d
o
i
:
1
0
.
1
1
5
5
/
2
0
2
2
/
5
2
3
2
4
8
0
.
[
1
7
]
E.
S
k
e
i
e
e
t
a
l
.
,
“
A
p
o
si
t
i
v
e
a
sso
c
i
a
t
i
o
n
b
e
t
w
e
e
n
n
u
t
r
i
t
i
o
n
a
l
r
i
s
k
a
n
d
t
h
e
i
n
c
i
d
e
n
c
e
o
f
s
u
r
g
i
c
a
l
si
t
e
i
n
f
e
c
t
i
o
n
s
:
A
h
o
s
p
i
t
a
l
-
b
a
s
e
d
r
e
g
i
s
t
e
r
s
t
u
d
y
,
”
PL
o
S
O
N
E
,
v
o
l
.
1
3
,
n
o
.
5
,
p
p
.
1
–
1
0
,
2
0
1
8
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
o
n
e
.
0
1
9
7
3
4
4
.
[
1
8
]
M
.
S
a
l
a
h
u
d
d
i
n
e
t
a
l
.
,
“
E
p
i
d
e
mi
o
l
o
g
y
a
n
d
r
i
s
k
f
a
c
t
o
r
s
o
f
p
o
s
t
o
p
e
r
a
t
i
v
e
s
i
t
e
i
n
f
e
c
t
i
o
n
s
i
n
s
u
r
g
i
c
a
l
p
a
t
i
e
n
t
s:
a
s
y
st
e
ma
t
i
c
r
e
v
i
e
w
,
”
Arc
h
i
v
e
s Of
P
h
a
rm
a
c
y
Pr
a
c
t
i
c
e
,
v
o
l
.
1
3
,
n
o
.
1
,
p
p
.
3
1
–
3
6
,
2
0
2
2
,
d
o
i
:
1
0
.
5
1
8
4
7
/
z
o
i
x
q
q
g
v
c
6
.
[
1
9
]
F
.
H
u
d
a
e
t
a
l
.
,
“
R
i
sk
f
a
c
t
o
r
s
o
f
s
u
r
g
i
c
a
l
s
i
t
e
i
n
f
e
c
t
i
o
n
i
n
e
l
e
c
t
i
v
e
l
a
p
a
r
o
t
o
my
i
n
a
t
e
r
t
i
a
r
y
c
a
r
e
c
e
n
t
e
r
:
a
n
o
b
s
e
r
v
a
t
i
o
n
a
l
st
u
d
y
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
j
o
u
r
n
a
l
o
f
b
u
r
n
s
a
n
d
t
r
a
u
m
a
,
v
o
l
.
1
2
,
n
o
.
3
,
p
p
.
1
0
6
–
1
1
3
,
2
0
2
2
.
[
2
0
]
A
.
B
i
r
h
a
n
u
,
H
.
H
.
A
m
a
r
e
,
M
.
G
/
M
a
r
i
a
m,
T
.
G
i
r
ma,
M
.
T
a
d
e
sse
,
a
n
d
D
.
G
.
A
ssefa
,
“
M
a
g
n
i
t
u
d
e
o
f
s
u
r
g
i
c
a
l
si
t
e
i
n
f
e
c
t
i
o
n
a
n
d
d
e
t
e
r
mi
n
a
n
t
f
a
c
t
o
r
s
a
m
o
n
g
p
o
st
o
p
e
r
a
t
i
v
e
p
a
t
i
e
n
t
s
,
a
c
r
o
ss
s
e
c
t
i
o
n
a
l
st
u
d
y
,
”
An
n
a
l
s
o
f
M
e
d
i
c
i
n
e
a
n
d
S
u
r
g
e
r
y
,
v
o
l
.
8
3
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
a
msu
.
2
0
2
2
.
1
0
4
3
2
4
.
[
2
1
]
R
.
M
a
e
m
o
t
o
e
t
a
l
.
,
“
U
p
d
a
t
e
o
f
r
i
sk
f
a
c
t
o
r
s
f
o
r
su
r
g
i
c
a
l
si
t
e
i
n
f
e
c
t
i
o
n
i
n
c
l
e
a
n
-
c
o
n
t
a
mi
n
a
t
e
d
w
o
u
n
d
s
a
f
t
e
r
g
a
s
t
r
o
e
n
t
e
r
o
l
o
g
i
c
a
l
su
r
g
e
r
y
:
A
n
a
n
a
l
y
si
s
o
f
1
,
8
7
8
p
a
r
t
i
c
i
p
a
n
t
s
e
n
r
o
l
l
e
d
i
n
2
r
e
c
e
n
t
r
a
n
d
o
m
i
z
e
d
c
o
n
t
r
o
l
t
r
i
a
l
s
f
o
r
t
h
e
p
r
e
v
e
n
t
i
o
n
o
f
s
u
r
g
i
c
a
l
s
i
t
e
i
n
f
e
c
t
i
o
n
,
”
S
u
r
g
e
ry
(
U
n
i
t
e
d
S
t
a
t
e
s)
,
v
o
l
.
1
7
4
,
n
o
.
2
,
p
p
.
2
8
3
–
2
9
0
,
2
0
2
3
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
s
u
r
g
.
2
0
2
3
.
0
4
.
0
0
2
.
[
2
2
]
D
.
C
u
r
c
i
o
,
A
.
C
a
n
e
,
F
.
F
e
r
n
á
n
d
e
z
,
a
n
d
J.
C
o
r
r
e
a
,
“
S
u
r
g
i
c
a
l
s
i
t
e
i
n
f
e
c
t
i
o
n
i
n
e
l
e
c
t
i
v
e
c
l
e
a
n
a
n
d
c
l
e
a
n
-
c
o
n
t
a
mi
n
a
t
e
d
s
u
r
g
e
r
i
e
s
i
n
d
e
v
e
l
o
p
i
n
g
c
o
u
n
t
r
i
e
s,”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
I
n
f
e
c
t
i
o
u
s D
i
se
a
ses
,
v
o
l
.
8
0
,
p
p
.
3
4
–
4
5
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
i
j
i
d
.
2
0
1
8
.
1
2
.
0
1
3
.
[
2
3
]
B
.
Tse
r
e
n
p
u
n
t
sa
g
e
t
a
l
.
,
“
R
i
sk
f
a
c
t
o
r
s
f
o
r
su
r
g
i
c
a
l
s
i
t
e
i
n
f
e
c
t
i
o
n
a
f
t
e
r
a
b
d
o
mi
n
a
l
h
y
st
e
r
e
c
t
o
my
,
N
e
w
Y
o
r
k
S
t
a
t
e
,
2
0
1
5
-
2
0
1
8
,
”
Am
e
ri
c
a
n
J
o
u
r
n
a
l
o
f
I
n
f
e
c
t
i
o
n
C
o
n
t
r
o
l
,
v
o
l
.
5
1
,
n
o
.
5
,
p
p
.
5
3
9
–
5
4
3
,
2
0
2
3
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
a
j
i
c
.
2
0
2
3
.
0
1
.
0
1
6
.
[
2
4
]
A
.
M
.
O
.
A
t
i
p
o
,
S
.
A
.
O
n
d
z
i
e
l
,
A
.
W
.
S
.
O
d
z
é
b
é
,
M
.
R
.
B
a
n
g
a
,
Y
.
L
e
r
e
,
a
n
d
P
.
A
.
B
o
u
y
a
,
“
I
n
c
i
d
e
n
c
e
a
n
d
r
i
sk
f
a
c
t
o
r
s
o
f
su
r
g
i
c
a
l
si
t
e
i
n
f
e
c
t
i
o
n
s
i
n
u
r
o
l
o
g
i
c
a
l
s
u
r
g
e
r
y
a
t
b
r
a
z
z
a
v
i
l
l
e
t
e
a
c
h
i
n
g
h
o
s
p
i
t
a
l
,
”
O
p
e
n
J
o
u
r
n
a
l
o
f
U
r
o
l
o
g
y
,
v
o
l
.
9
,
n
o
.
2
,
p
p
.
4
2
–
5
0
,
2
0
1
9
,
d
o
i
:
1
0
.
4
2
3
6
/
o
j
u
.
2
0
1
9
.
9
2
0
0
5
.
[
2
5
]
J.
E.
B
r
i
t
o
e
t
a
l
.
,
“
G
LI
M
c
r
i
t
e
r
i
a
f
o
r
mal
n
u
t
r
i
t
i
o
n
d
i
a
g
n
o
si
s
o
f
h
o
s
p
i
t
a
l
i
z
e
d
p
a
t
i
e
n
t
s
p
r
e
se
n
t
s
sa
t
i
sf
a
c
t
o
r
y
c
r
i
t
e
r
i
o
n
v
a
l
i
d
i
t
y
:
A
p
r
o
s
p
e
c
t
i
v
e
c
o
h
o
r
t
s
t
u
d
y
,
”
C
l
i
n
i
c
a
l
N
u
t
r
i
t
i
o
n
,
v
o
l
.
4
0
,
n
o
.
6
,
p
p
.
4
3
6
6
–
4
3
7
2
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
l
n
u
.
2
0
2
1
.
0
1
.
0
0
9
.
[
2
6
]
D
.
B
r
o
w
n
e
t
a
l
.
,
“
R
e
l
a
t
i
o
n
s
h
i
p
b
e
t
w
e
e
n
g
l
o
b
a
l
l
e
a
d
e
r
sh
i
p
i
n
i
t
i
a
t
i
v
e
o
n
m
a
l
n
u
t
r
i
t
i
o
n
(
G
LI
M
)
d
e
f
i
n
e
d
ma
l
n
u
t
r
i
t
i
o
n
a
n
d
s
u
r
v
i
v
a
l
,
l
e
n
g
t
h
o
f
s
t
a
y
a
n
d
p
o
s
t
-
o
p
e
r
a
t
i
v
e
c
o
mp
l
i
c
a
t
i
o
n
s
i
n
p
e
o
p
l
e
w
i
t
h
c
a
n
c
e
r
:
A
sy
st
e
ma
t
i
c
r
e
v
i
e
w
,
”
C
l
i
n
i
c
a
l
N
u
t
ri
t
i
o
n
,
v
o
l
.
4
2
,
n
o
.
3
,
p
p
.
2
5
5
–
2
6
8
,
2
0
2
3
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
l
n
u
.
2
0
2
3
.
0
1
.
0
1
2
.
[
2
7
]
C
.
Li
u
,
Z
.
L
u
,
Z
.
Li
,
J
.
X
u
,
H
.
C
u
i
,
a
n
d
M
.
Z
h
u
,
“
I
n
f
l
u
e
n
c
e
o
f
m
a
l
n
u
t
r
i
t
i
o
n
a
c
c
o
r
d
i
n
g
t
o
t
h
e
G
LI
M
c
r
i
t
e
r
i
a
o
n
t
h
e
c
l
i
n
i
c
a
l
o
u
t
c
o
mes
o
f
h
o
s
p
i
t
a
l
i
z
e
d
p
a
t
i
e
n
t
s
w
i
t
h
c
a
n
c
e
r
,
”
Fr
o
n
t
i
e
rs
i
n
N
u
t
ri
t
i
o
n
,
v
o
l
.
8
,
p
p
.
1
–
8
,
2
0
2
1
,
d
o
i
:
1
0
.
3
3
8
9
/
f
n
u
t
.
2
0
2
1
.
7
7
4
6
3
6
.
[
2
8
]
X
.
G
a
o
e
t
a
l
.
,
“
Th
e
a
p
p
l
i
c
a
t
i
o
n
v
a
l
u
e
o
f
p
r
e
o
p
e
r
a
t
i
v
e
f
a
t
-
f
r
e
e
mass
i
n
d
e
x
w
i
t
h
i
n
G
l
o
b
a
l
L
e
a
d
e
r
s
h
i
p
I
n
i
t
i
a
t
i
v
e
o
n
M
a
l
n
u
t
r
i
t
i
o
n
-
d
e
f
i
n
e
d
m
a
l
n
u
t
r
i
t
i
o
n
c
r
i
t
e
r
i
a
f
o
r
p
o
st
o
p
e
r
a
t
i
v
e
o
u
t
c
o
m
e
s
i
n
p
a
t
i
e
n
t
s
w
i
t
h
e
so
p
h
a
g
o
g
a
st
r
i
c
c
a
n
c
e
r
,
”
N
u
t
ri
t
i
o
n
,
v
o
l
.
1
0
2
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
n
u
t
.
2
0
2
2
.
1
1
1
7
4
8
.
[
2
9
]
E.
C
.
G
o
i
n
s
e
t
a
l
.
,
“
M
a
l
n
u
t
r
i
t
i
o
n
a
s
a
r
i
s
k
f
a
c
t
o
r
f
o
r
p
o
st
-
o
p
e
r
a
t
i
v
e
m
o
r
b
i
d
i
t
y
i
n
g
y
n
e
c
o
l
o
g
i
c
c
a
n
c
e
r
:
A
n
a
l
y
s
i
s
u
si
n
g
a
n
a
t
i
o
n
a
l
su
r
g
i
c
a
l
o
u
t
c
o
m
e
s
d
a
t
a
b
a
s
e
,
”
G
y
n
e
c
o
l
o
g
i
c
O
n
c
o
l
o
g
y
,
v
o
l
.
1
6
5
,
n
o
.
2
,
p
p
.
3
0
9
–
3
1
6
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
y
g
y
n
o
.
2
0
2
2
.
0
1
.
0
3
0
.
[
3
0
]
M
.
M
.
Ze
w
u
d
i
e
,
D
.
Y
.
M
e
l
e
sse
,
T.
D
.
F
i
l
a
t
i
e
,
A
.
B
.
G
e
t
a
h
u
n
,
a
n
d
B
.
A
.
A
d
m
a
ss,
“
P
e
r
i
o
p
e
r
a
t
i
v
e
n
u
t
r
i
t
i
o
n
su
p
p
o
r
t
f
o
r
e
l
e
c
t
i
v
e
su
r
g
i
c
a
l
c
a
n
c
e
r
p
a
t
i
e
n
t
s
:
a
n
a
r
r
a
t
i
v
e
r
e
v
i
e
w
,
”
O
p
e
n
Ac
c
e
ss
S
u
rg
e
ry
,
v
o
l
.
1
6
,
p
p
.
3
3
–
4
5
,
2
0
2
3
,
d
o
i
:
1
0
.
2
1
4
7
/
o
a
s.s
4
0
5
7
9
9
.
[
3
1
]
A
.
W
e
i
ma
n
n
e
t
a
l
.
,
“
ESP
EN
p
r
a
c
t
i
c
a
l
g
u
i
d
e
l
i
n
e
:
C
l
i
n
i
c
a
l
n
u
t
r
i
t
i
o
n
i
n
su
r
g
e
r
y
,
”
C
l
i
n
i
c
a
l
N
u
t
ri
t
i
o
n
,
v
o
l
.
4
0
,
n
o
.
7
,
p
p
.
4
7
4
5
–
4
7
6
1
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
l
n
u
.
2
0
2
1
.
0
3
.
0
3
1
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Pa
u
li
n
e
O
c
ta
v
i
a
n
i
wa
s
a
stu
d
e
n
t
o
f
c
li
n
ica
l
n
u
tri
ti
o
n
s
tu
d
y
p
ro
g
ra
m
in
De
p
a
rtme
n
t
o
f
N
u
tri
ti
o
n
,
F
a
c
u
lt
y
o
f
M
e
d
ici
n
e
Un
i
v
e
rsit
a
s
In
d
o
n
e
sia
,
Dr.
Cip
t
o
M
a
n
g
u
n
k
u
su
m
o
H
o
sp
it
a
l,
Ja
k
a
rta
,
In
d
o
n
e
sia
.
He
r
re
se
a
r
c
h
in
tere
st
is
in
c
li
n
ica
l
n
u
tri
t
io
n
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
p
a
u
li
n
e
o
c
tav
ian
i@
g
m
a
il
.
c
o
m
.
Yo
h
a
n
n
e
ss
a
Wu
l
a
n
d
a
r
i
is
a
lec
tu
re
r
in
De
p
a
rtme
n
t
o
f
Nu
t
rit
io
n
,
F
a
c
u
l
ty
o
f
M
e
d
icin
e
Un
iv
e
rsitas
In
d
o
n
e
sia
,
Dr.
Cip
to
M
a
n
g
u
n
k
u
su
m
o
Ho
s
p
i
tal,
Ja
k
a
rta,
In
d
o
n
e
sia
.
He
r
re
se
a
rc
h
in
tere
st
is
in
c
li
n
ica
l
n
u
tri
ti
o
n
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
y
o
h
a
n
n
e
ss
a
wu
lan
d
a
ri@
u
i.
a
c
.
id
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J
Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
8
9
5
-
1
9
0
2
1902
Febi
a
n
sy
a
h
Ibra
h
im
is
a
d
ig
e
stiv
e
su
r
g
e
o
n
a
n
d
lec
tu
re
r
i
n
De
p
a
rtme
n
t
o
f
S
u
rg
e
r
y
,
F
a
c
u
lt
y
o
f
M
e
d
icin
e
Un
iv
e
rsitas
In
d
o
n
e
sia
,
Dr.
Cip
t
o
M
a
n
g
u
n
k
u
su
m
o
Ho
s
p
it
a
l
,
Ja
k
a
rta,
In
d
o
n
e
sia
.
His
re
se
a
rc
h
i
n
tere
st
is
i
n
d
ig
e
sti
v
e
su
r
g
e
ry
.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
fe
b
ian
sy
a
h
.
ib
ra
h
im
0
1
@u
i.
a
c
.
id
.
Diy
a
h
Ek
a
And
a
y
a
n
i
is
a
lec
tu
re
r
in
De
p
a
rtme
n
t
o
f
Nu
t
rit
io
n
,
F
a
c
u
lt
y
o
f
M
e
d
icin
e
Un
iv
e
rsitas
In
d
o
n
e
sia
,
Dr.
Cip
to
M
a
n
g
u
n
k
u
su
m
o
Ho
s
p
i
tal,
Ja
k
a
rta,
In
d
o
n
e
sia
.
He
r
re
se
a
rc
h
in
tere
st
is
in
c
li
n
ica
l
n
u
tri
ti
o
n
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
d
iy
a
h
e
k
a
a
n
d
a
y
a
n
i@g
m
a
il
.
c
o
m
.
Evaluation Warning : The document was created with Spire.PDF for Python.