Clin Nutr

Poor performance of mandatory nutritional screening of in-hospital patients.

May 112013

Poor performance of mandatory nutritional screening of in-hospital patients.

Clin Nutr. 2012 Dec;31(6):862-7

Authors: Geiker NR, Hørup Larsen SM, Stender S, Astrup A

Abstract
BACKGROUND & AIMS: Since 2006 it has been mandatory at Copenhagen University Hospital Gentofte to screen all patients for nutritional risk within 24 h of admittance. Audits conducted by department staff estimate that 70-80% of assessments are correctly executed, but the validity of this estimate is unknown. The aim of the present study was to discover the true proportion of hospitalized patients receiving nutritional risk screening within the stipulated time limit and to evaluate the validity of the screening by comparison with medical records.
METHODS: Retrospective examination of medical records of all patients (N = 3278) hospitalized in September 2008 in 11 different medical specialities were analysed in 2009-2010.
RESULTS: Of 2393 medical records 24% of the patients were screened, of these only 65% were screened within the stipulated time limit. Half of the conducted screenings were inaccurate, the most common error being underestimation of nutritional status. Forty-six percent of patients required a secondary nutritional risk screening and 30% were found to be nutritionally at risk.
CONCLUSION: Only 8% of patients received the mandatory nutritional risk screening without procedural errors. We conclude that pre-scheduled, self-conducted audits are not viable as the basis of an assessment of the use of nutritional risk screening.

PMID: 22531501 [PubMed - indexed for MEDLINE]

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Effect of ?-hydroxy-?-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults.

Clin Nutr Start a Discussion »

Mar 222013

Effect of ?-hydroxy-?-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults.

Clin Nutr. 2013 Mar 4;

Authors: Deutz NE, Pereira SL, Hays NP, Oliver JS, Edens NK, Evans CM, Wolfe RR

Abstract

BACKGROUND: Loss of muscle mass due to prolonged bed rest decreases functional capacity and increases hospital morbidity and mortality in older adults. OBJECTIVE: To determine if HMB, a leucine metabolite, is capable of attenuating muscle decline in healthy older adults during complete bed rest. DESIGN: A randomized, controlled, double-blinded, parallel-group design study was carried out in 24 healthy (SPPB ? 9) older adult subjects (20 women, 4 men), confined to complete bed rest for ten days, followed by resistance training rehabilitation for eight weeks. Subjects in the experimental group were treated with HMB (calcium salt, 1.5 g twice daily - total 3 g/day). Control subjects were treated with an inactive placebo powder. Treatments were provided starting 5 days prior to bed rest till the end rehabilitation phase. DXA was used to measure body composition. RESULTS: Nineteen eligible older adults (BMI: 21-33; age: 60-76 year) were evaluable at the end of the bed rest period (Control n = 8; Ca-HMB n = 11). Bed rest caused a significant decrease in total lean body mass (LBM) (2.05 ± 0.66 kg; p = 0.02, paired t-test) in the Control group. With the exclusion of one subject, treatment with HMB prevented the decline in LBM over bed rest -0.17 ± 0.19 kg; p = 0.23, paired t-test). There was a statistically significant difference between treatment groups for change in LBM over bed rest (p = 0.02, ANOVA). Sub-analysis on female subjects (Control = 7, HMB = 8) also revealed a significant difference in change in LBM over bed rest between treatment groups (p = 0.04, ANOVA). However, differences in function parameters could not be observed, probably due to the sample size of the study. CONCLUSIONS: In healthy older adults, HMB supplementation preserves muscle mass during 10 days of bed rest. These results need to be confirmed in a larger trial. This trial is registered at http://ClinicalTrials.gov under NCT00945581.

PMID: 23514626 [PubMed - as supplied by publisher]

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Performance of the Geriatric Nutritional Risk Index in predicting 28-day hospital mortality in older adult patients with sepsis.

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Feb 092013

Performance of the Geriatric Nutritional Risk Index in predicting 28-day hospital mortality in older adult patients with sepsis.

Clin Nutr. 2013 Jan 23;

Authors: Lee JS, Choi HS, Ko YG, Yun DH

Abstract
BACKGROUND & AIMS: The Geriatric Nutritional Risk Index (GNRI) is a screening tool for nutrition-related risk that correlates with mortality rate in hospitalized older patients and is simple, objective, and readily available to clinicians. In this study, we aimed to validate the performance of the GNRI in predicting short-term hospital mortality in older patients with sepsis. METHODS: This observational study enrolled 401 older patients presenting with infection and systemic inflammatory response syndrome in an emergency department. Demographic, physiological, and laboratory data were collected. The GNRI score was categorized into five classes. The primary outcome was 28-day hospital mortality. Univariate and multivariate analyses were performed to identify clinical predictors of outcome. A logistic regression model was used. RESULTS: 51 patients (12.7%) died in the hospital within 28 days. Co-morbid metastatic cancer, heart rate, respiratory rate, temperature, serum creatinine, total lymphocyte count, and GNRI (<87) were independently related to the outcome in the multivariable logistic regression analysis. CONCLUSIONS: The GNRI is a prognostic factor for short-term hospital mortality in older patients with sepsis. A GNRI below 87 can be suggested as an indicator of nutritional support need in an acute-care setting.

PMID: 23391456 [PubMed - as supplied by publisher]

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Early nasogastric tube feeding versus nil per os in mild to moderate acute pancreatitis: A randomized controlled trial.

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Jan 242013

Early nasogastric tube feeding versus nil per os in mild to moderate acute pancreatitis: A randomized controlled trial.

Clin Nutr. 2012 Dec 31;

Authors: Petrov MS, McIlroy K, Grayson L, Phillips AR, Windsor JA

Abstract
BACKGROUND & AIMS: Nasojejunal tube feeding is a standard of care in patients with predicted severe acute pancreatitis (AP) and several recent trials suggested that nasogastric tube feeding (NGT) is as safe and efficient as nasojejunal tube feeding in these patients. The aim was to investigate whether NGT presents any benefit to patients with mild to moderate AP. METHODS: The study design was a randomized controlled trial. The patients in the intervention group received NGT within 24 h of hospital admission. The patients in the control group were on nil per os (NPO). The severity of acute pancreatitis was determined according to the new international multidisciplinary classification. RESULTS: There were 17 patients randomly allocated to the NGT group and 18 to the NPO group. The visual analogue pain score decreased to a significantly greater extent in the NGT group (from median 9 (range 7-9) at baseline to 1 (0-3) at 72 h after randomization) compared with the NPO group (from 7 (5-9) to 3 (1-4) (p = 0.036). The number of patients not requiring opiates at 48 h after randomization was significantly different (p = 0.024) between NGT (9/17) and NPO (3/18). Oral food intolerance was observed in 1/17 patient in the NGT group and 9/18 patients in the NPO group (p = 0.004). The overall hospital stay in the NGT group was 9 (5-12) days as compared with 8.5 (6-13) days in the NPO group (p = 0.91). CONCLUSIONS: NGT commenced within 24 h of hospital admission is well tolerated in patients with mild to moderate acute pancreatitis. Further, when compared with NPO, it significantly reduces the intensity and duration of abdominal pain, need for opiates, and risk of oral food intolerance, but not overall hospital stay (ClinicalTrials.gov number, NCT01128478).

PMID: 23340042 [PubMed - as supplied by publisher]

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Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU).

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Jan 242013

Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU).

Clin Nutr. 2013 Jan 5;

Authors: Sheean PM, Peterson SJ, Chen Y, Liu D, Lateef O, Braunschweig CA

Abstract
BACKGROUND & AIMS: The nutritional status of elderly patients requiring ICU admission is largely unknown. This study evaluated the prevalence of malnutrition in elderly patients (>65 years) admitted to the surgical and medical ICUs, agreement between assessment techniques and associations between malnutrition and adverse outcomes. METHODS: For this prospective cohort, nutritional status was classified concurrently using the Mini Nutrition Assessment (MNA), Subjective Global Assessment (SGA), Nutrition Risk Score 2002 (NRS 2002) and MNA-short form (MNA-SF). Demographic and relevant medical information were collected from the medical record prior to the nutrition interview and/or following hospital discharge. Descriptive statistics, inter-rater agreement and regression analyses were conducted. RESULTS: The average patient was 74.2 (±6.8) years of age with a mean APACHE II score of 11.9 (±3.6). Malnutrition was prevalent in 23-34% of patients (n = 260) with excellent agreement between raters. Compared to MNA, NRS 2002 had the highest sensitivity, while SGA and MNA-SF had higher specificity. Malnutrition at ICU admission was associated with longer hospital LOS, a lower propensity for being discharged home and a greater need for hospice care or death at discharge (all p values <0.05). These relationships were diminished when controlling for severity of illness. CONCLUSIONS: Future work in this elderly population needs to explore the role of disease acuity, inflammation and body composition in the nutrition assessment process and in the examination of outcomes.

PMID: 23340043 [PubMed - as supplied by publisher]

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Cost-effectiveness of nutritional intervention on healing of pressure ulcers.

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May 262012

Cost-effectiveness of nutritional intervention on healing of pressure ulcers.

Clin Nutr. 2012 May 22;

Authors: Hisashige A, Ohura T

Abstract
BACKGROUND & AIMS: Pressure ulcers not only affect quality of life among the elderly, but also bring a large economic burden. There is limited evidence available for the effectiveness of nutritional interventions for treatment of pressure ulcers. In Japan, recently, a 60-patient randomized controlled trial of nutritional intervention on pressure ulcers demonstrated improvement in healing of pressure ulcers, compared with conventional management. To evaluate value for money of nutritional intervention on healing of pressure ulcers, cost-effective analysis was carried out using these trial results. METHODS: The analysis was carried out from a societal perspective. As effectiveness measures, pressure ulcer days (PUDs) and quality-adjusted life years (QALYs) were estimated. Prevalence of pressure ulcers was estimated by the Kaplan-Meier method. Utility score for pressure ulcers is derived from a cross-sectional survey among health professionals related to pressure ulcers. Costs (e.g., nutritional interventions and management of pressure ulcers) were estimated from trial data during observation and follow-up. Stochastic and qualitative sensitivity analyses were performed to examine the robustness of results. RESULTS: For observation (12 weeks) and follow-up (12-week observation plus 4-week follow-up), nutritional intervention reduced PUDs by 9.6 and 16.2 per person, and gained 0.226 × 10(-2) QALYs and 0.382 × 10(-2) QALYs per person, respectively. In addition, costs were reduced by $542 and $881 per person, respectively. This means nutritional intervention is dominant (cost savings and greater effectiveness). The sensitivity analyses showed the robustness of these results. CONCLUSION: Economic evaluation of nutritional intervention on healing pressure ulcers from a small randomized controlled trial showed that this intervention is cost saving with health improvement. Further studies are required to determine whether this is a cost-effective intervention for widespread use.

PMID: 22626888 [PubMed - as supplied by publisher]

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