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PubMed2000

Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days.

OBJECTIVE: To assess the association between changes in nutritional status in hospitalized patients and the occurrence of infections, complications, length of stay in hospital, and hospital charges. DESIGN: A prospective observational study with a retrospective component was conducted over a 7-month interval at a university hospital. SUBJECTS: A total of 404 adults (> or = 18 years old) admitted to the inpatient service for more than 7 days who were not pregnant or lactating and not a psychiatric patient were included. MAIN OUTCOME MEASURES: Major outcome variables included changes in nutritional status as assessed by subjective global assessment (SGA) at hospital admission and discharge, length of stay, hospital charges, complications, and infections. STATISTICAL ANALYSIS PERFORMED: Analysis of variance with a Tukey adjustment for multiple comparisons was used to examine the impact of changes in nutritional status between nutrition change categories for continuous variables (charges and length of stay). Discrete variables were assessed using chi 2 analysis. Logistic regression was used to calculate odds ratios with 95% confidence intervals for the development of complications and infections when compared with the reference group. RESULTS: Compared with the reference group (normally nourished at admission and discharge), patients who declined nutritionally, regardless of nutritional status at admission, had significantly higher hospital charges ($28,631 +/- 1,835 vs $45,762 +/- 4,021). Odds of complications were significantly greater for patients who declined nutritionally, regardless of nutritional status at admission, compared with the reference group. APPLICATIONS/CONCLUSIONS: Declines in patients' nutritional status while they are hospitalized, regardless of their nutritional status at admission, were associated with significantly higher hospital charges and a higher likelihood of complications. Practicing clinicians should make reducing declines in patients' nutritional status a priority regardless of patients' nutritional status at admission.

Chicago↗
PubMedDate not supplied

Functional decline and nutritional status in a hospitalized geriatric population: sequential study.

We analyzed the relations between nutritional status and several measures of the ability to perform the normal activities of daily living (ADL) in a long-term institutionalized geriatric population and also studied whether changes in this ability, as found ten months later, were associated with changes in the nutritional status. Nutritional status was assessed using objective anthropometric measurements (triceps skinfold, mid upper-arm circumference, midarm muscle area [AMA], midarm fat area [AFA]) and subjective clinical features (temporal muscle atrophy [TMA] and Bichat's fat atrophy [BFA]). The capacity to perform ADL was analyzed considering ability to eat and to walk, dental status, and mental performance status. Patients with total absence or loss of more than 50% of the teeth showed less AMA and AFA and greater degrees of TMA and BFA; the same happened with regard to deterioration of mental performance status. Those patients fed through a nasogastric tube showed less AFA and serum albumin and also a greater degree of TMA and BFA. Patients unable to walk without aid showed less AMA and AFA. Patients whose capacity to walk improved or whose mental performance status ameliorated showed an increase of their AMA, whereas AFA slightly decreased in those patients whose abilities to eat and to walk deteriorated. Long-term hospitalization in our center led to improvement and to deterioration of ADL in approximately the same number of patients, and similar changes were seen in the nutritional measures.

Activities of Daily Living↗
PubMed1985

Nutritional status in hospital inpatients: implications for nutritional support services.

In a population of 473 inpatients, a profile of nutritional status from obesity to marasmic-kwashiokor was observed. Thirty-two per cent of the population were overweight or obese (n = 153), forty-five per cent were of normal weight (n = 211), 8% were at risk of protein-energy malnutrition (n = 39), and 15% (n = 70) had grades of protein-energy malnutrition from marasmus to marasmic-kwashiokor. The implications for improved nutritional support services for hospitalised patients are discussed.

Adult↗
PubMed1988

Food intake and nutritional status after total gastrectomy: results of a nutritional follow-up.

We studied dietary intake and nutritional status of 23 patients for 6 months after total gastrectomy with Roux-en-Y reconstruction. At discharge, patients were instructed to keep to recommended dietary allowances (RDA) and to record food intake on a specific form twice weekly. Nutritional follow-up was performed monthly and consisted of a computerized determination of food intake and of a nutritional assessment. The average daily energy intake was 6.10 MJ (1457.9 kcal) in the first postoperative month and 8.87 MJ (2118.4 kcal) in the sixth (P less than 0.0005). In the first monthly follow-up no patient reached RDA. By the sixth month mean daily calorie intake was greater than or equal to RDA in 14 patients (group A), while 9 patients (group B) did not reach RDA. A significant increase in body weight, serum albumin, total iron binding capacity and arm muscular circumference was observed in group A, while a significant decrease in body weight and arm muscular circumference was noted in group B. Moreover, of the seven patients who showed weight loss at 6 months only one was group A. These data indicate that malnutrition is not an inevitable consequence of total gastrectomy and can be prevented by an adequate calorie intake. A close relationship between dietary intake and postoperative nutritional parameters was observed. In gastrectomized patients a strict nutritional follow-up is very important to obtain an adequate dietary intake.

Adult↗
PubMed1988

Nutritional status of patients with acquired immunodeficiency syndrome.

Nutritional status may be an important factor in the prognosis of morbidity and mortality. We assessed the nutritional status of individuals seropositive for human immunodeficiency virus (HIV) (as confirmed by Western blot) and of patients with AIDS, by determining the concentration in serum of total protein, albumin, prealbumin (transthyretin), and retinol-binding protein. HIV-seropositive individuals showed no significant difference from normal volunteers in values for prealbumin, albumin, and retinol-binding protein. Patients with AIDS showed significantly smaller prealbumin and albumin concentrations than did normal and HIV-positive individuals. There was no significant difference in the concentration of retinol-binding protein among the three groups. The concentration of total serum protein was significantly greater in HIV-positive individuals and in patients with AIDS than in normal individuals. Thus, the nutritional status of patients with AIDS may be a factor for morbidity and mortality.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Methodological issues in the development and use of instruments to assess patient nutritional status or the level of risk of nutritional compromise.

This paper presents the results of an appraisal of the evidence for the effectiveness of methods of nutritional assessment currently in use by nurses and from this develops concepts which may be applied to many areas of nursing practice. The paper first shows how the approach to nutritional assessment by nurses has changed over time, producing the present search for methods which are relatively quick and easy to use. It then describes the limited nature of the evidence of effectiveness of these methods and considers the reasons for this situation. It suggests that the difficulty of validation is an important factor and describes the three most common approaches to validation, showing how problems arise from lack of clarity in the definition of terms and the assumption of a simple relationship between the level of risk of nutritional compromise and actual nutritional status. In conclusion, it is suggested that these difficulties illustrate principles applicable to many areas of nursing care, and a definition of 'segments' of care processes, each with well-defined purposes and outcome measures, is proposed. Such an approach will help to demonstrate the complexity and value of nursing activity.

Humans↗
PubMed1995

[How to assess preoperative nutritional status?].

The assessment of nutritional status of patients should rely on sensitive and specific evaluation tools. However a universally recognized criterion of severity of denutrition is still lacking. The most important clinical indicator is the weight. The speed of weight loss is an important point to consider: a loss of 2% within one week is equivalent to 5% in one month and 10% in six months. Other anthropometric indices such as the triceps skin fold and the mid arm muscle circumference have not shown, when considered alone, to increase the risk carried by denutrition. Therefore other clinical indicators have to be considered, the association of which is suggestive of malnutrition, but none when considered alone is neither specific nor pathognomonic. Food intake is quantified by questioning. Among the biological markers representative of the pool of circulating visceral proteins is albumin. Numerous studies have demonstrated a morbidity and mortality increase when the plasmatic albumin concentration is less than 30 g.L-1. Other proteins with a shorter half-life, such as transferin, prealbumin and retinal binding protein have been recommended. The determination of muscular mass is also a tool for nutritional assessment. The muscular function and immunologic tests such as the lymphocyte count and cutaneous reactivity to various antigens have been assessed as denutrition indices. The determination of body mass composition by bioelectrical impedance could become the technique of choice for nutritional assessment. However its use for peri-operative evaluation has not been validated prospectively. Because of the lack of reliability of markers when considered alone, several authors produced multivariate nutritional indices.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

Lack of impact of a water and sanitation intervention on the nutritional status of children in rural Bangladesh.

The nutritional impact of a water and sanitation intervention in a rural community of Bangladesh, comprising the provision of handpumps, construction of latrines and hygiene education was assessed. During 3 years, the quarterly anthropometric measures of about 200 children aged 12-35 months from the intervention community were compared with those of a similar number of children from a control area. The interventions reduced the incidence of diarrhoea by 25 per cent among the children less than 5 years of age. There was no significant difference in nutritional status, however, between the two groups of children. Moreover, within the intervention area, indicators of water and latrine use were not significantly related to the children's nutritional status. This suggests that either the obtained reduction of diarrhoea was not large enough to have an impact on nutritional status or that diarrhoea is not an important cause of malnutrition in this community.

Bangladesh↗
PubMed1993

Thyroxine-induced changes in metabolic rate and cytochrome oxidase activity in Thamnophis sirtalis: effects of nutritional status.

The effects of nutritional status on thyroxine-induced changes in standard metabolic rate (SMR), and the activity of hepatic cytochrome oxidase were examined in the garter snake Thamnophis sirtalis. Twelve snakes were fed ad libitum, and 12 more were fed a maintenance diet, which was half as many fish per gram of body weight as that eaten by ad libitum snakes. Snakes in the first group gained weight during the 3-week treatment, while individual snakes in the second group either maintained their original weight or showed a slight loss (less than 10%). Within each diet treatment, half of the snakes received a 5-mg thyroxine (T4) pellet implant, and half received placebo implants. Plasma [T4] was unchanged by treatment. Plasma [T3] was elevated in T4-supplemented snakes fed ad libitum, but the difference was not statistically significant (P = 0.09). Standard metabolic rate and cytochrome oxidase activity at 25 degrees were increased significantly (34 and 24%, respectively) only in the T4-supplemented snakes on the ad libitum diet. Thus, T. sirtalis must be in a positive energy balance for thyroid hormones to have an effect on SMR or hepatic cytochrome oxidase activity.

Animals↗
PubMed1998

The effect of intervention methods on nutritional status and cognitive function of primary school children infected with Ascaris lumbricoides.

The prevalence rate of ascariasis in primary school children in northern Jakarta, Indonesia varies from 60% to 90%. An association between helminthic infection and educational achievement has long been recognized. This study was carried out in the northern part of Jakarta among primary school children 6-8 years of age. Treatment of ascariasis and health education were used as the interventions. Before the interventions, basic data on socioeconomic status, epidemiology, infection with Ascaris lumbricoides, nutritional status, and cognitive function were collected. After the interventions, only data on infection with A. lumbricoides, nutritional status, and cognitive function were collected. The children were divided into five groups. Group I was given an anthelminthic (mebendazole), group II was provided with health education, group III was given an antihelminthic and provided with health education, group IV was given a placebo (controls), and group V consisted of egg-negative children, who also served as controls. Data from 336 students were analyzed by analysis of covariance. Parasitologic examinations showed a mean prevalence rate of 58.4% for A. lumbricoides infection in the pre-intervention children and a mean prevalence rate of 40.6% in the post-intervention children. Concerning nutritional status, approximately 80% of the children showed good scores in the pre- and post-treatment data, and only a small percentage (0.9-16.2%) showed mild or moderate malnutrition. No significant difference was found between the pre- and post-treatment nutritional status. The results of the cognitive test showed that the group treated with mebendazole showed significant improvement in the Colored Progressive Matrices and Coding test. Children also showed an improvement in their learning ability, concentration, and eye-hand coordination after five months of receiving this intervention.

Antinematodal Agents↗
PubMed2003

The evolution of human phenotypic plasticity: age and nutritional status at maturity.

Several evolutionary optimal models of human plasticity in age and nutritional status at reproductive maturation are proposed and their dynamics examined. These models differ from previously published models because fertility is not assumed to be a function of body size or nutritional status. Further, the models are based on explicitly human demographic patterns, that is, model human life-tables, model human fertility tables, and, a nutrient flow-based model of maternal nutritional status. Infant survival (instead of fertility as in previous models) is assumed to be a function of maternal nutritional status. Two basic models are examined. In the first the cost of reproduction is assumed to be a constant proportion of total nutrient flow. In the second the cost of reproduction is constant for each birth. The constant proportion model predicts a negative slope of age and nutritional status at maturation. The constant cost per birth model predicts a positive slope of age and nutritional status at maturation. Either model can account for the secular decline in menarche observed over the last several centuries in Europe. A search of the growth literature failed to find definitive empirical documentation of human phenotypic plasticity in age and nutritional status at maturation. Most research strategies confound genetics with phenotypic plasticity. The one study that reports secular trends suggests a marginally insignificant, but positive slope. This view tends to support the constant cost per birth model.

Age Factors↗
PubMed1987

Preschool child feeding, health and nutritional status in Gualaceo, Ecuador.

Anthropologic, survey, dietary recall and anthropometric techniques were used to study the correlates of nutritional status of preschool children under five years of age in Gualaceo Ecuador. A widespread stunting was found among the children. Nutritional status was worst among infants comprised between 12 and 23 months old but it improved between April and August, thus suggesting seasonality changes of nutritional status. The correlates of nutritional status (expressed as Z score of weight-for-age) were dietary diversity, birth-spacing, fertility, migration, household income, material goods owned, and parental education. A regression model with these variables predicted 63% of the variability in weight-for-age. The prediction of height-for-age was similar, but only predicted 43% of the variability in height-for-age. Correlates of dietary diversity, birth-spacing, fertility, and migration were child age, maternal age and arm circumference, parental education, use of birth control, household food expenditure, material goods owned, and the raising of animals. Parental education was a correlate of dietary diversity, fertility and migration. Parental education was related to change in weight-for-age in the longitudinal subset. Pre-harvest time and a pathway of illness leading to decreased dietary diversity and to decreased nutritional status in April, were suggested as important to preschool child nutritional status. Hot-cold ideology--resulting in food withdrawal during illness and restriction of high-protein and high-calorie foods--appears to be an important mechanism determining preschool child nutritional status. Breast-feeding, sanitary, higienic, birth control, and drinking (alcohol) practices were suggested as areas that could be improved, in order to improve preschool child nutritional status. Communication between parents and western health care providers was also suggested as an area for improvement.

Body Height↗
PubMed1993

[A study of changes in the nutritional status of patients receiving cancer chemotherapy].

In an attempt to find a method for effective nursing support which would maintain a favorable nutritional status in patients receiving chemotherapy, the nutritional status of 15 patients with lung cancer receiving cisplatin therapy was evaluated, and the factors influencing their status were studied. (1) Nutritional status was evaluated in terms of 7 indicators: body weight, skinfold thickness, arm muscle circumference, grip strength, hemoglobin level, serum total protein and serum albumin. Among these, skinfold thickness proved to be the most sensitive indicator of the changes in nutritional status of cancer patients during chemotherapy. (2) Multiple regression analysis revealed that skinfold thickness was influenced by dietary intake, which in turn was related to nausea, vomiting, trait anxiety level estimated by STAI and maximum body temperature associated with infection. (3) It was concluded that the following nursing interventions are significant for maintenance of favorable nutritional status for cancer patients during chemotherapy. First, periodic evaluation of their nutritional status by anthropometric measurements is necessary. Secondly, efforts should be made to reduce nausea and vomiting, to reassure patients with severe anxiety so that they become mentally stable, and to motivate the patients to perform self-care for prevention of infection, thereby achieving a sufficient dietary intake.

Cisplatin↗
PubMedDate not supplied

Impact of nutritional status on peritonitis in CAPD patients.

OBJECTIVE: To determine the impact of nutritional status on peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in a developing country. METHODS: 56 patients with end-stage renal disease on CAPD were randomly selected for this study. These patients were assessed for nutritional status and peritonitis episodes. Nutritional parameters were assessed by anthropometry, diet, body mass index (BMI), Nutritional Risk Index (NRI), serum albumin level, and Subjective Global Assessment (SGA). Based on SGA, patients were categorized into either group 1 (malnutrition, n = 31) or group 2 (normal nutritional status, n = 25). Peritonitis was considered the primary outcome and was compared between the two groups. RESULTS: Demographic profiles, Kt/V, creatinine clearance, and mean follow-up of the two groups were similar. Number of peritonitis episodes was significantly higher in patients with malnutrition (25/31) compared to patients with normal nutritional status (4/25) (p = 0.001). Mean peritonitis rate per patient per year was also significantly higher in patients with malnutrition (0.99 +/- 1.07) compared to patients with normal nutritional status (0.18 +/- 0.42) (p = 0.007). On univariate analysis, malnutrition based on SGA (p = 0.009), NRI (p = 0.02), serum albumin level (p = 0.005), and calorie intake (p = 0.006) was a significant predictor of peritonitis. On multivariate Cox regression analysis, only SGA (p = 0.001, odds ratio 0.08, 95% confidence interval 0.02-0.36) was found to be a significant predictor of peritonitis. On general linear model, the observed power of prediction of peritonitis was 0.96 based on SGA. On Kaplan-Meier survival analysis, peritonitis-free survival in patients with normal nutrition (42 months) was significantly higher compared to patients with malnutrition (21 months) based on SGA (log rank p = 0.003). CONCLUSION: We conclude that peritonitis rate is high in patients with malnutrition and that malnutrition indices, especially SGA, can predict the peritonitis rate in CAPD patients.

Body Mass Index↗
PubMed1997

Validity of the minimum data set for assessing nutritional status in nursing home residents.

The Minimum Data Set (MDS), a Health Care Financing Administration (HCFA)-mandated resident assessment system used in community nursing homes, is potentially useful for assessing nutritional status. We compared anthropometric measures of nutritional status available in the MDS [weight and body mass index (BMI)] with other anthropometric and bioelectrical measures of nutritional status, not available on the MDS. We also studied associations of MDS-measured clinical characteristics of nursing home residents with anthropometric and bioelectrical measures of lower and higher nutritional status, defined as measures in the 25th percentile and below, and 75th percentile and above, respectively. Data were from a sample of residents of an academic long-term care facility (n = 186, 75% female, mean age 89.9 +/- 5.6 y). Results were as follows: 1) MDS measures of weight and BMI were significantly correlated with all the anthropometric and bioelectrical measures of nutritional status in women, and most measures in men; 2) some MDS variables, including poor oral intake and advanced cognitive decline, were significantly associated with two or more anthropometric and bioelectrical measures of low nutritional status; and 3) complaints of hunger were significantly associated with two or more anthropometric and bioelectrical measures of high nutritional status. Results suggest that 1) weight and BMI, available in the MDS, are correlated with other measures of nutritional status not available, and 2) MDS clinical variables are associated with measures of low and high nutritional status, and may be useful in identifying patients at nutritional risk.

Aged↗
PubMed2006

Influence of infant-feeding practices on nutritional status of under-five children.

OBJECTIVES: To study the nutritional status of under-five children and to assess whether infant feeding practices are associated with the undernutrition in anganwari (AW) areas of urban Allahabad. METHODS: Under-five-years children and their mothers in selected four anganwari areas of urban Allahbad (UP) participated in the study. Nutritional assessment by WHO criterion (SD- classification) using summary indices of nutritional status: weight-for-age, height-for-age and weight-for-height was done. Normal test of proportions, Chi-square test for testing association of nutritional status with different characteristics and risk analysis using odds ratios with 95% confidence intervals was also done. RESULTS: Among all under five children surveyed, 36.4% underweight (< 2SD weight- for -age), 51.6% stunted (< 2SD height- for- age) and 10.6% wasted (< 2SD weight- for- height). Proportions of underweight (45.5%) and stunting (81.8%) were found maximum among children aged 13-24 months. Wasting was most prevalent (18.2%) among children aged 37-48 months. Initiation of breast-feeding after six hours of birth, deprivation from colostrum and improper complementary feeding were found significant (P< 0.05) risk factors for underweight. Wasting was not significantly associated (P>0.10) with any infant feeding practice studied. ICDS benefits received by children failed to improve the nutritional status of children. CONCLUSION: Delayed initiation of breast-feeding, deprivation from colostrum and improper weaning are significant risk factors for undernutrition among under-fives. There is need for promotion and protection of optimal infant feeding practices for improving nutritional status of children.

Breast Feeding↗
PubMed2006

The nutritional status of children with cystic fibrosis.

The importance of nutritional intervention for children with cystic fibrosis (CF) is well recognised. It would be expected that the increase in knowledge over the past decade would be reflected in improvements in nutritional status for the CF paediatric population. The aim of the present paper was to evaluate the nutritional status of children with CF, cross-sectionally and longitudinally. Body cell mass adjusted for gender and size (BCM/Htp) was measured in sixty-four children with CF to represent nutritional status and expressed as a Z-score. The cross-sectional results showed a mean BCM/Htp Z-score of 0.54 (sd 1.21), with males having a slightly higher Z-score than females but with a larger variation. At the initial measurement, only one female and one male were considered sub-optimally nourished. The longitudinal analysis after 2 years showed that the mean population had a significantly decreased BCM/Htp Z-score; however, when each gender was analysed separately, this decrease was significant only in the males. At the final measurement, only two females and three males were considered sub-optimally nourished. It is evident from our results that children with CF are well nourished, with only a small percentage considered malnourished. It appears that nutritional status decreases with age, with this decline being more evident in males. These results signify that although children with CF are better nourished with current treatment support, intervention needs to continue throughout a CF patient's life to counteract the changes that occur with age.

Body Height↗
PubMed1998

Nutritional status of hospitalized acute stroke patients.

The nutritional status of 201 hospitalized stroke patients was assessed from anthropometric, haematological and biochemical data in an observational prospective study. On admission, sixty-two (31%) stroke patients had BMI < 20, ninety-nine (49%) had a triceps skinfolds thickness below the 25th centile, twenty-five (12%) had a mid-arm circumference below the 25th centile and thirty-eight (19%) had a serum albumin concentration below 35 g/l. Baseline nutritional status was worse among those who later died or remained in hospital compared with those discharged and most patients who remained in hospital showed marked and significant deterioration in all measures of nutritional status within 4 weeks of hospitalization. After adjusting for age, stroke severity and co-morbidity, low serum albumin concentrations of these patients in hospital were a strong and independent predictor of death following acute stroke (odds ratio 1.13 (95% CI 1.01-1.27) for 1 g/l lower serum albumin concentration).

Aged↗