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NUTRITION SCREENING / ASSESSMENT
1) R-185: Are serum plasma carnitine and BIA and other parameters good markers to assess the nutritional status in CAPD? V. Jayanthi, Georgi Abraham, Geetha. K, Obulakshmi.O., Shanmuga Bhaskar Department of Nutrition and Dietetics, Chennai Transplant Centre, Madras Medical Mission Hospital, Chennai.
2) R-186: Comparison of BIA, CPC on pre and post transplant patients - an on-going study. V. Jayanthi, Georgi Abraham, Geetha.K, Obulakshmi.O., Shanmuga Bhaskar Madras Medical Mission, Chennai, India.
3) R-197: Relationship of nutritional status at time of admission to length of hospital stay and mortality. KH Choi, M.D. KY Yoon, M.D. SM Ann (2), YM Sin M.D MK Jang (1), SH Lee (1), JY Park (2). Department of Surgery, (1) Pharmacy, and (2) Nutrition, Gospel Hospital, Kosin Medical College, Pusan, Korea
4) R-275: Nutritional status of gastric cancer patients after radical gastrectomy. Seung wan Ryu, Hwa jin Lee, Sun kyung Park, Young ae Kong, Yung gil Son, In ho Kim. NST Team, Keimyung University Dong-San medical center, Daegu, Korea
5) R-286: Assessment of malnutrition in hospitalized gastric cancer patients: comparison of different methods. Sun kyung Park, Seung wan Ryu, Hwa jin Lee,, Young ae Kong, Yung gil Son, In ho Kim. NST Team, Keimyung University Dong-San medical center, Daegu, Korea
6) R-297: Follow Up Study of Nutritional State in Acute and Chronic Stroke Patients. Be-Na Lee M.D., Soon-Hee Yoo M.D., Dae-Heon Song M.D. Department of Rehabilitaiton Medicine, College of Medicine, The Catholic University of Korea, Seoul, S. Korea
7) R-331: The differences of Subjective Global Assessment between nurses anddietitians. Rie Furukawa, RD, Keiko Zama, RD, Atsuo Ohashi, RD, Fumiaki Katada, MD, MPH, CNSP*. Kameda Medical Center, Kamogawa, Japan.
8) R-342: The development of nutrition screening based on nursing assessment tool of hospital. Mi Jin Jeong, Soo Taik Lee, Dong Chan Kim, Hee Chul Yu, Won Kim, Haeng Sun Kim, Ju Sin Kim, Seon Hyeong Kim, Baik Hwan Cho. Chonbuk National University Hospital, jeon-ju, Korea
9) R-364: Prevalence of patients at nutritional risk among those who underwent gastrointestinal surgery for cancer. Hosun Lee, Choong Bae Kim (1). Department of Dietetics, Severance Hospital, Yonsei University Health System, Department of Surgery, Yonsei University College of Medicine (1), Seoul, Korea
10) R-386: Wernike’s encephalopathy following gastrectomy. Do Sang Lee* and Myung Duk Lee. Department of Surgery, The Catholic University of Korea
11) R-431: Bioelectric impedance analysis (BIA) data of Filipino geriatric patients assessed by mini-nutritional assessment (MNA). Francisco LM (2), Quizon O (2), Navarrete DI (2), Ramos M (1), Llido LO (2). (1) Geriatric Center and (2) Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
12) R-442: Nutritional status in malignancy of the gastrointestinal tract and other malignancies – comparison of characteristics and pattern: a two year study in a private tertiary care hospital in the Philippines (years 2003 and 2004). Tolentino R (1), Quizon O (2), Llido L (2). (1) Cancer Center, St. Luke’s Medical Center, Quezon City, Philippines, (2) Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Quezon City, Philippines
13) R-464: The value of the Mid-Arm Circumference (MAC) in the nutrition screening for malnutrition in geriatric patients. Francisco LM (2), Felicilda F (2), Navarette DN (2), Ramos M (1), Llido LO (2). (1) Geriatric Center and (2) Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
14) R-486: Nutritional Assessment Of Malaysian Patients With Advanced Liver Cirrhosis. Tai MLS (1), Mahadeva S (1), Siti H (2), Goh KL (1). (1) Division of Gastroenterology, Department of Medicine; (2) Department of Dietitics, University Malaya Medical Centre, Kuala Lumpur
15) R-497: Validity of knee height measurement as proxy indicator for height and weight in Filipino patients in a private tertiary care hospital in the Philippines. Franciscon EP, Del Rosario DC, Frane RG, and Llido LO. Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Lukes Medical Center, Metro Manila, Philippines
16) R-498: Correlation Of The Mini-Nutritional Assessment And The Tinetti Gait And Balance Scores Among Patients Admitted At The St. Luke’s Medical Center (Geriatric Center). Amane RM(1), Francisco EP (2), Ramos Jr. MA (1), Poblete ERS (1). (1) Geriatric Center, St. Luke’s Medical Center, (2) Nutrition Support Team. St. Luke’s Medical Center
17) R-508: Body composition data using bioelectric impedance analysis (BIA) of Filipino patients seen in a weight management center in the Philippines Balatbat B, Felicilda F, Sioson M, Reyes MC, Carlos C, Llido LO Weight Management and Clinical Nutrition Center, St. Luke’s Medical Center, Philippines
ABSTRACTS OF POSTER PRESENTATION
R - 185 (top)
Are serum plasma carnitine, BIA, and other parameters good markers to assess the nutritional status in CAPD?
V. Jayanthi, Georgi Abraham, Geetha. K, Obulakshmi.O, Shanmuga Bhaskar
Department of Nutrition and Dietetics, Chennai Transplant Centre, Madras Medical Mission Hospital, Chennai.
Objectives: To determine the good marker of nutritional status on CAPD subject by assessing the plasma carnitine levelsand BIA.
Methods: Patients from 2 medical centres undergoing peritoneal dialysis were selected. Total number of patients were assessed by Maltron BFA after the fl uid is drained.Total number of patients were 18, their mean age was 61.7. Fasting serum plasma carnitine levels were assessed and their body composition were analysed using Maltron BF 907 Body fat analyser after the fl uid is drained. Among 18 patients 2 were vegetarians and 16 were non-vegetarians and 10 were non diabetics and 8 diabetics.
Results: The mean carnitine levels was 52.1455, The mean BMI is 24.0932, the BIA values were noted, the values are ,the mean weight was 62.2, the mean body fat% was 30.43, the mean body fat Kg 19.1667, the mean lean% was 71.0278, the mean lean kg was 44.1778, the mean water% was 52.9111, the mean water ltrs was 31.9500. The average urine output(ml) is 688.3333. The lipid profi le were assessed. The mean total cholesterol is 177.8857, the mean triglyceride is 135.6667, the mean HDL is 45.6667, the mean LDL is 114.6667, the mean calorie intake is 85% and the protein intake is 73% respectively. Similarly 2% were vegetarians , 98% non-vegetarians,40% were diabetics and 60% were non-diabetics. In our CAPD population the average carnitine level was 52.1455. While correlating carnitine with albumin, the ‘r’ value is o.237.Total protein level was 6.4308gm/dl. The average albumin level was 3.2462gm/dl, the protein achieved is 73%, r=0.290.
CONCLUSION: Our study revealed that the carnitine level was found to be normal among CAPD subjects. There was a signifi cant difference in BIA of CAPD subjects. Theoretical references show that in dialysis population there is a decreased carnitine levels, but in our CAPD subjects, the carnitine levels, were found to be normal. The protein intake and the albumin were found to be normal. Hence, to assess the nutritional status of CAPD subjects in Indian population, carnitine is not good marker.
R – 186 * (top) / Oral presentation
Comparison of BIA, CPC on pre and post transplant patients – an on-going study
V. Jayanthi, Georgi Abraham, Geetha.K, Obulakshmi.O, Shanmuga Bhaskar
Madras Medical Mission, Chennai, India.
Objective: To assess the BIA and CPC of hemodialysis subjects pre and post transplant.
Methodology: 16 patients who were on hemodialysis were selected and their body composition were assessed by Maltron BF Analyser 907 after dialysis. The same subjects were again assessed post transplant after a month. Of which 14 patients were and 2 were vegetarianism.
Result: The mean weight pre transplant was 54.16 and post transplant 57.23. The body fat% pre transplant was 26.78 and post transplant 25.55, the lean body mass% pre transplant was 73.03 and post transplant 74.36. The total body water% pre transplant was 53.21and post transplant 54.59. The calorie intake pre transplant was 1445.31 and post transplant 1533.06 (p<0.05). The
protein intake pre transplant was 39.31 and post transplant 46.62(P<0.01). 98% non-vegetarians and 2% vegetarians.
Conclusion: The BIA of the study group was done at 1 month interval. There is signifi cant difference. It is suggested that it should be done at 1 month, 6 months and 12 months interval to see the difference in the BIA. The study showed that there was defi nite improvement in their calorie and protein intake after transplant. PTP had a better modality of BIA, CPC when compared
to the HD patients. This is an ongoing study.
Abbreviations:
BIA: Bioelectrical Impedence Analysis
CPC: Calorie Protein Count.
PTP : Post Transplant Patient
R - 197* (top) / Oral presentation
Relationship of nutritional status at time of admission to length of hospital stay and mortality
KH Choi, M.D. KY Yoon, M.D. SM Ann(2), YM Sin M.D MK Jang(1), SH Lee(1), JY Park(2)
Department of Surgery, (1)Pharmacy, and (2)Nutrition, Gospel Hospital, Kosin Medical College, Pusan, Korea
Background/Aims: The length of hospital stay (LHS) is an indication of the patient’s recovery rate. LHS has also become an important economic factor for hospitals. This study was conducted to determine the relationship of nutritional status at time of admission to LHS and mortality.
Methods: The study subjects were 1,619 patients with cancer admitted to Kosin University Gospel Hospital during 2005 who met study criteria were included in the study. Patients were classifi ed to Not at risk, At risk ¥°, At risk ¥±, At risk ¥², At risk ¥³. for malnutrition on the basis of established criteria serum albumin <3.0 g/dl, total lymphocyte count £¼1500 cells/mm3, cholesterol ¡Ã240 mg/ dl or ¡Â130 mg/dl, weight for height ¡Ã120% or £¼90% ideal body weight.
Results: 24.3% of the patients were classifi ed as Not at risk Group, 37.6% as At risk Group ¥°, 24.2% as At risk Group ¥±, 10.3% as At risk Group ¥², 3.6% as At risk Group ¥³. The at risk group(At risk ¥², At risk ¥³) had a signifi cantly higher prevalence of liver disease. The relationship between liver disease and low serum albumin levels may have confounded the data. Although the estimated LOS was similar in all groups, the average length of stay was 14.4¡¾16.38 days in the malnourished group(At risk Group ¥³) compared to approximately 2.8 days in Not at risk Group. The more the patients had the nutritional risk factors, the longer the LHS and signifi cant the higher the mortality rate were. Correlation was not observed risk factors and LHS but as well as correlation mortality rate.
Conclusions: These results suggest that a patient’s nutritional status upon admission has an effect on the LHS for patients with carcinoma.
Yoon Ki Young M.D. Ph.D
Kosin Medical School Department of Surgery,
Gospel Hospital Am-Mam 34, Se-Gu, Busan
Korea,Tel 82 51 990 6462 Fax 82 51 246 6093
R – 275 * (top) / Oral presentation
Nutritional status of gastric cancer patients after radical gastrectomy
Seung wan Ryu, Hwa jin Lee, Sun kyung Park, Young ae Kong, Yung gil Son, In ho Kim
NST Team, Keimyung University Dong-San medical center, Daegu, Korea
Objective: Gastrectomy is associated with poor oral intake and poor nutritional status in almost all cases. For the purpose of aiding the evaluation of the postoperative clinical course of gastric cancer patients, we have prospectively compared patient nutritional status following both total gastrectomy and subtotal gastrectomy.
Methods: We have prospectively studied 80 patients with no evidence of recurrent disease and follow up loss following curative surgery for gastric cancer from October 2005. Among this group 9 underwent total gastrectomy and 71 subtotal gastrectomy. At admission, postoperative 7 days, postoperative 6 months and 12 months, the patients were assessed on the following items: Subjective Global Assessment (SGA), Nutritional Risk Index(NRI), Anthropometric measurements(TSF, MAC, MAMC), body weight, Body Mass Index(BMI),
Total lymphocyte count(TLC), serum total protein, serum albumin, total serum cholesterol, serum iron and Vitamin B12.
Results: At admission, 31% of the patients were malnourishd according to the SGA, while 60% of the patients were malnourished according to the NRI. At postoperative 6months, 51% of the patients were severe malnourished and total 70% of the patients were malnourished according to the SGA. During the postoperative 6month, Body weight, BMI, Triceps skin fold(TSF) and Mid arm circumference(MAC) were signifi cantly decreased, but there was no difference between postoperative 6months and 12months. Especially Total gastrectomy patients showed signifi cantly decreased nutritional status in anthropometric measurement compared subtotal gastrectomy patients at post operative 12months. Total lymphocyte count, Total protein, choresterol and serum iron level were no difference during the postoperative period. But, In case of total gastrectomy patients, vitamin B12 level was severe decreased during the postoperative 12 months.
Conclusion: Malnutrition in patients undergoing gastrectomy was severe at postoperative 6month. Subjective Global Assessment, Nutritional Risk Index nutrition tests and Anthropometric measurements are predictive for malnutrition and postoperative status in gastrectomy patients. Poor nutritional status can result in decreased quality of life, functional status and response to therapy. Therefore
the early diagnosis and management is essential.
R - 286 (top)
Assessment of malnutrition in hospitalized gastric cancer patients: comparison of different methods
Sun kyung Park, Seung wan Ryu, Hwa jin Lee, Young ae Kong, Yung gil Son, In ho Kim
NST Team, Keimyung University Dong-San Medical Center, Daegu, Korea
Objective: Malnutrition is defi ned as the imbalance resulted from inappropriate nutrient intake and demand. Such state is responsible for
several organic alterations, that, when associated with some sort of injury, such as surgeries, raise the chance of postoperative complications. The assessment of malnutrition is essential because of its prognostic relevance. Various methods are used which measure different aspects of nutritional state. Aim of this study was to examine anthropometric measurements as well as albumin and nutritional risk index (NRI) with respect to sensitivity and specifi city compared with the subjective global assessment (SGA)
Methods: We studied 100 gastric cancer patients, who were admitted to the general ward in Keimyung University Hospital. Korea. Nutritional state was assessed at admission by different methods: body mass index (BMI), weight loss, anthropometry (TSF(Triceps skin fold), MAC(Mid arm circumference)), serum albumin, total protein, cholesterol and NRI. SGA was used as reference method, because its validity to predict the malnutrition-associated risk for a worse outcome has been shown in several studies.
Results: On admission 31% of patients were malnourished according to the Subjective Global Assessment and 33% according to the Nutrition Risk Index. According to the SGA, body weight loss is higher in the malnourished patients, but MAC, TSF, and BMI were lower in the malnourished patients. Albumin, total cholesterol and protein were not signifi cant difference between two groups. Concordance was observed in 66 of the 100(66%) patients with both assessment (SGA&NRI).
Conclusion: SGA is a clinical assessment and that the NRI is an objective test. Both tests correlated with each other with other nutritional marker. These two techniques can be used for nutritional assessment in hospitalized patients. Due to the high prevalence of malnutrition in patients the assessment of nutritional state should be part of every medical examination.
R – 297 (top)
Follow Up Study of Nutritional State in Acute and Chronic Stroke Patients
Be-Na Lee M.D., Soon-Hee Yoo M.D., Dae-Heon Song M.D.
Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, S. Korea
Objectives: To follow up the nutritional state of acute and chronic stroke patients and to evaluate factors that may affect the patient’s nutritional state in Korea
Methods: A retrospective study. Medical histories of stroke patients were reviewed who were hospitalized in the St. Paul’s hospital from Jenuary 2005 to Febrary 2007. Applied measurement scales were body mass index (BMI, a nutritional information of anthropometric measurement) and biochemical fi ndings such as albumin, total lymphocyte count (TLC) and hemoglobin. Considerable factors that might affect the patient’s nutritional state include patient’s mobility, mode of feeding, type of medical insurance, socioeconomic status, diabetes mellitus, dysphagia, and medication for depression. In our study, 34 males and 27 females were studied and mean age of patients was 60.13 years old. Mean fallow up duration was 456.64 days.
Results: BMI was decreased from 23.85 to 23.16 kg/m2 (p-value=0.049), albumin was decreased from 4.09 to 3.88 g/dl (p-value=0.012) and TLC was decreased from 2056.64 to 1772.26/ L (p-value=0.034) in chronic state. Specially, nutritional imbalance was severe in chronic
patients with tube feeding or poor mobility or dysphagia or taking a medication for depression.
Conclusions: Control of patients’ nutritional state is crucial for better outcome not only at acute stage but also at chronic stage in stroke patients. Therefore, medical institute should care for patient’s nutritional state especially in patients in chronic state who might be unable to care for themselves or who is no longer concern about their nutritional status.
R - 331* (top) / Oral presentation
The differences of Subjective Global Assessment between nurses and dietitians
Rie Furukawa, RD, Keiko Zama, RD, Atsuo Ohashi, RD, Fumiaki Katada, MD, MPH, CNSP*
Kameda Medical Center, Kamogawa, Japan
Background: A number of doctors, nurses, and dietitians are evaluating Subjective Global Assessment (SGA) every day. However, there are
few studies reporting the tendency of assessment depending on their specialties.
Objectives: To clarify the concordance proportion of SGA between nurses and dietitians, and to examine the tendency of assessment between them.
Setting: A tertiary emergency hospital in Chiba, Japan.
Methods: Consecutive patients who were newly admitted Kameda Medical Center in July 2007 were included. All patients were evaluated SGA by one nurse and one dietitian. They assessed SGA independently and the results were masked to each other. The concordance proportion of SGA between nurses and dietitians were calculated. When the SGA evaluation between nurses and dietitians disagree, the tendency of assessment of each SGA items depending on their specialties were assessed.
Results: During the study period, a total of 201 patients were evaluated. The concordance proportion of SGA was 82.1% (165/201). The concordance proportion of each SGA items was 80% or more, except for two items (Gastrointestinal symptoms 78.6%, Nutritional requirements 56.2%). The “disagree” cases were 17.9% (36/201). Among them, nurses evaluated SGA lower than dietitian in 12 cases, and SGA items related to “History” (e.g. gastrointestinal symptoms, Functional capacity) were tended to score lower by nurses. On the other hand, dietitians evaluated SGA lower than nurses in 24 cases, and SGA items related to “Physical” (e.g. Loss of subcutaneous fat, Muscle wasting) were tended to score lower by dietitians.
Conclusion: The concordance proportion of SGA was 82.1% between nurses and dietitians. When they disagree, nurses tended to think the
patients’ history important, and dietitians tended to regard the patients’ physical important. To do a better assessment, it is important to consider each other’s viewpoint.
R - 342 (top)
The development of nutrition screening based on nursing assessment tool of hospital
Mi Jin Jeong, Soo Taik Lee, Dong Chan Kim, Hee Chul Yu, Won Kim, Haeng Sun Kim, Ju Sin Kim, Seon Hyeong Kim, Baik Hwan Cho
Chonbuk National University Hospital, jeon-ju, Korea
Objectives: It is emphasized recently the importance of early detection for the patient to be malnourished or at risk of becoming malnourished. But it is hard to identify patients rapidly who need the nutrition management with the limited workers. Thus the nutrition support team of our hospital wanted to use the nursing assessment record which is documented by the admitting nurse from all admitting patients for the nutrition screening with various parameters of subjective global assessment. The aim of this study was to develop the program which includes nutrition screening using the nursing assessment tool, assessment, care plan, monitoring and reevaluation for more effective and early nutrition management with limited workers.
Methods: The task force team within nutrition support team is composed of a physician, nurse, pharmacist, dietitian for development of the
practical and fast screening program. The reports express the score depending on the impact of the symptom and nutritional status in the nursing assessment tool, then a total score is summed, it is defi ned that the score of 0~5 is mild malnutrition, 6~10 is moderate or suspected malnutrition and 11 or more is severe malnutrition. It used the diet, % ideal weight, albumin and TLC by the objective index. They defi ned the malnutrition in case of more than 2 items of 4 those being the abnormality.
Results: This program consists of whole procedures in the following order: the nutrition screening, assessment, malnutrition and monitor.
The computerized system is as follows.
1. The nutrition screening
2. The consultation
3. The assessment and care plan,
4. The reply
5. The monitoring and reevaluation
6. The end
Conclusion: It is expected that this program will execute nutrition screening rapidly using adult nursing assessment tool providing service of early nutrition management through cooperation with various occupation. It is just thought to need a study assessing validity about how to identify malnourished patients using adult nursing assessment tool.
R - 364 (top)
Prevalence of patients at nutritional risk among those who underwent gastrointestinal surgery for cancer
Hosun Lee, Choong Bae Kim(1)
Department of Dietetics, Severance Hospital, Yonsei University Health System, Department of Surgery, Yonsei University College of Medicine(1), Seoul, Korea
Background: Undernutrition is associated with increased morbidity and mortality and is common in patients admitted to hospital for gastrointestinal(GI) surgery. We examined the prevalence at nutritional risk among those who underwent GI surgery and whether a nutritional support was provided for patients at nutritional risk after surgery.
Methods: We prospectively studied 100 patients admitted to Severance Hospital, Yonsei University Health System for elective GI surgery
from September, 2006 to February, 2007. The NRS-2002 was used to evaluate nutritional risk. Patients were characterized by scoring the
components ‘undernutrition’ and ‘severity of disease’ in 4 categories (absent, mild, moderate or severe). The patient could have a score of 0-3 for each component (undernutrition and severity of disease), and any patient with a total score ≥ 3 was considered at nutritional risk. Undernutrition was evaluated by 3 variables (BMI, recent weight loss, recent food intake). We recorded primary physicians’ order of nutrition support after surgery.
Results: Patients’ mean age was 57.4 11.8 years old; 69 cases were male and 31 were female. Out of the 95 patients underwent gastric or colon surgery, 47.4% were at nutritional risk. There was no signifi cant difference between the 2 groups according to the site of surgery (46.8% of 62 gastric surgery patients vs. 48.5% of 33 colon surgery patients, p=0.67). Although 41.7% of the patients at nutritional risk were not provided nutrition support at all, 58.3% of the patients without nutritional risk were provided parenteral nutrition support after surgery.
Conclusion: We concluded that the introduction of a screening system for nutritional risk seems to be necessary for the improvement of GI surgery patients’ nutritional status through the costeffective nutrition therapy protocol.
R - 386 (top)
Wernike’s encephalopathy following gastrectomy
Do Sang Lee* and Myung Duk Lee
Department of Surgery, The Catholic University of Korea
Wernicke’s encephalopathy is a neurological disorder, caused by thiamine defi ciency, characterized by acute confusion, ataxia, change of mentality and abnormal eye movement (opthalmophlegia and nystagmus). This encephalopathy can be found in patients with chronic alcoholism, anorexia nervosa, hemodialysis, AIDS and gastroplasty for morbid obesity. The diagnosis of this disease is not easy because not all cases display its typical symptoms. So this disease can be confi rmed by not only clinical symptoms but also brain MRI fi ndings, low
thiamine level and clinical response following thiamine replacement. We experienced two cases of Wernicke’s encephalopathy in patients who underwent gastrectomy for gastric cancer. But we did not remind of this condition until patients showed neurological symptoms and typical MRI fi ndings. These patients were improved after vitamin B1 (thiamine) replacement.
Key words: Wernicke encephalopathy, Thiamine defi ciency, Gastrectomy
R - 431 (top)
Bioelectric impedance analysis (BIA) data of Filipino geriatric patients assessed by mini-nutritional assessment (MNA)
Francisco EP (2), Carlos CS 2, Navarrete DI (2), Ramos M (1), Llido LO (2)
(1) Geriatric Center and (2) Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
Background/Objective(s): MNA is considered the “gold standard” in the nutritional assessment of geriatric patients. The study was done to
determine if the clinical assessment agrees well with body composition data using the BIA instrument in Filipino geriatric patients.
Methods: Geriatric patients admitted in the geriatric center were assessed using MNA and both malnourished and normal patients underwent BIA examination. Weight, BMI, fat weight and percent, body cell mass and percent, and total body water and percent were compared for both groups. Wilcoxon rank sum test was used to compare the differences with signifi cance set at P < 0.05.
Results: Malnourished patients showed lesser weight (43 kg vs. 55 kg, P < 0.001), lower BMI (19.5 vs. 24, P < 0.001), lesser fat weight (12 kg vs. 16 kg, P = 0.001), not signifi cant difference in fat percent (29% vs. 31%, P = 0.169), lesser total body water (25 kg vs. 27 kg, P = 0.005), higher total body water percent (59% vs. 53%, P = 0.005), lesser body cell mass (6 kg vs. 9 kg, P = 0.002), and lower body cell mass percent (13.5% vs. 17%, P = 0.01).
Conclusion: BIA data proved the accuracy and reliability of MNA in nutritional screening and assessment of Filipino geriatric patients. MNA
should be routine in the assessment of geriatric patients.
R - 442 (top)
Nutritional status in malignancy of the gastrointestinal tract and other malignancies – comparison of characteristics and pattern: a two year study in a private tertiary care hospital in the Philippines (years 2003 and 2004)
Tolentino R (1), Quizon ODG (2), Reyes MCS (2), Llido L (2)
(1)Cancer Center, St. Luke’s Medical Center, Quezon City, Philippines, (2)Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Quezon City, Philippines
Background/Objective(s): It is the aim of the study to determine whether patients with gastrointestinal tract (GI) malignancies have
poorer nutritional status compared to nongastrointestinal tract (Non-GI) malignancies and to analyze the magnitude and pattern of weight loss and BMI class change from the start to latest admission for a period of two years (2003 and 2004).
Methods: All cancer patients admitted in St. Luke’s Medical Center from 2003 to 2004 were collected, admission weight in kilograms, height
in meters, and computed Body Mass Index (BMI) were recorded. Total number of days follow up was also recorded. Nutritional status was based on BMI classifi cation. Statistical analyses used were paired and independent samples t-test for ordinal data and chi-square for nominal data.
Results: 599 patients were collected (GI = 150, Non-GI = 449) and sex distribution was for GI (males: 57.4%, females: 42.6%) and Non-GI (males: 36.7%, females: 63.3%). Follow up days range was from 6 to 467 days and similar in both groups. There was a signifi cant number of patients with Normal BMI in the GI group compared to the non-GI (61.3% vs. 53.3%). Weight loss in all malignancies was signifi cant at 1.3 kg (p < 0.001), in GI malignancies at 1.74 kg (P = 0.001) and in Non-GI at 1.17 kg (p = 0.002). No difference was noted comparing GI vs. Non-GI rate of weight loss (GI weight loss rate = 0.115 kg/week; Non-GI weight loss rate = 0.099 kg/week). In the GI group weight loss
was greatest in the stomach (rate of weight loss = 0.36 kg/week), followed by esophagus (rate of weight loss = 0.33 kg/week), and gallbladder (rate of weight loss = 0.31 kg/week). However more patients with GI malignancies converted to a lower BMI class especially the normal to underweight BMI (GI: 8% vs. Non-GI: 2%, p<0.05) in the colon (17.7%), stomach (18%), liver (1%), pancreas (1%), esophagus (1%), and ampulla of Vater (1%).
Conclusion: BMI class change from normal to underweight was greater in the GI compared to the Non-GI malignancies. Signifi cant weight loss was noted in both types of malignancies, but not when compared against each other. The rate of weight loss was also similar in both types of malignancies.
R - 464 (top)
The value of the Mid-Arm Circumference (MAC) in the nutrition screening for malnutrition in geriatric patients
Francisco EP (2), Felicilda FS (2), Navarrete DI (2), Ramos M (1), Llido LO (2), Gundao ND (2)
(1) Geriatric Center and (2) Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
Background/Objective(s): Nutrition screening of geriatric patients uses tools (MNA and SGA) that require a lot of data, which slows down the nutrition surveillance for malnutrition in all geriatric patients admitted in the hospital. The objective of the study was to determine if BMI or MAC could be used as a nutrition screening tool that would hasten the malnutrition surveillance process.
Methods: All geriatric patients, identifi ed to be malnourished by both MNA and BIA, were included in the study. Correlation of MAC and BMI to MNA and BIA data was done. Sensitivity and specifi city of BMI and MAC were determined.
Results: 18 patients were included in the study. The correlation of MAC to BMI was 0.8, MAC to MNA was 0.5, MAC to Fat Mass was 0.7, and MAC to Body Cell Mass was 0.6. The correlation of BMI to Fat Mass was 0.8 and BMI to Body Cell Mass was 0.6. The sensitivity of MAC was 94.1% while that of BMI was 27.7%. The specifi city of MAC was 34.9% while that of BMI was 96.4%.
Conclusion: The mid-arm circumference (MAC) is a good screening tool for the nutrition surveillance of malnutrition in geriatric patients. We therefore recommend it as a screening tool for malnutrition in geriatric patient population.
R - 486 (top)
Nutritional Assessment of Malaysian patients with Advanced Liver Cirrhosis
Tai MLS (1), Mahadeva S (1), Siti H (2), Goh KL (1)
(1) Division of Gastroenterology, Department of Medicine, (2) Department of Dietitics, University Malaya Medical Centre, Kuala Lumpur
Background: Malnutrition is believed to be common in patients with advanced liver cirrhosis and a recognized factor for various complications. There is limited data on the nutritional status of Asian patients with advanced liver cirrhosis.
Objective: To assess the nutritional status of Malaysian patients with advanced liver cirrhosis.
Methodology: Cross-sectional study of consecutive patients with decompensated liver cirrhosis admitted to this unit between August 2006 and March 2007. Nutritional status was assessed by a) anthropometry using triceps skinfold thickness (TSF), mid arm circumference (MAC)
and handgrip strength, b) serum albumin and transferrin, c) bioelectrical impedance analysis for body cell mass (BCM) and fat free mass (FFM) and d) subjective global assessment (SGA) questionnaire.
Results: 36 patients (mean age 60 ± 13 years ; 66.7% males) with decompensated cirrhosis were recruited. Aetiology of liver cirrhosis were as follows: Alcohol n=12 (33%), viral hepatitis n=15 (41.6%), autoimmune n=2 (5.6%) and cryptogenic n= 7 (19.4%). 16 (44.4%) and 20 (55.6%) patients had Child-Pugh grade B and C disease respectively, with 97.2% presenting with moderate to severe ascites. Anthropometry revealed the following: 15% TSF values < 5th percentile, 11% MAC values < 5th percentile and 100% handgrip strength < normal values. The mean serum albumin and transferrin levels were 20.6 ± 6.0 g/L and 1.62 ± 0.67 mg/L respectively. 44% of BCM and 19% of FFM values were noted to be < normal population, whilst 33.3% of cirrhotics had SGA grade C. When compared against patients with Child-Pugh B disease, patients with Child-Pugh C disease had lower handgrip strength values (16.3 ± 7.7 vs 16.7 ± 7.7 kgF, p=0.9), serum albumin (17.9 ± 4.4 vs 24.1 ± 6.0 g/L, p=0.001), serum transferrin (1.29 ± 0.59 vs 2.03 ± 0.54 mg/L, p<0.0001 ) and a higher proportion of SGA grade C (40% vs 25%, p=0.5). Patients with alcoholic cirrhosis had lower TSF (8.4 ± 3.6 vs 9.7 ± 3.2 mm), MAC (24.5 ± 5.1 vs 27.2 ± 5.5 cm) and more SGA grade C (41.7% vs 29.2%) compared to patients with non-alcoholic liver disease.
Conclusion: Malnutrition is common in Malaysian patients with advanced liver cirrhosis, particularly in patients with Child-Pugh grade C and alcohol aetiology.
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Validity of knee height measurement as proxy indicator for height and weight in Filipino patients in a private tertiary care hospital in the Philippines
Francisco EP, Del Rosario DC, Frane RG, and Llido LO
Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
Background/Objectives: The estimation of weight and height of bedridden, critical care, or patients whose weights could not be taken becomes crucial when nutrient requirement and/ or drug dosage data is required. The knee height caliper was designed to provide this information with equations derived from the study population when actual weights were not available. The available data are from other countries, however, hence the need for local formulas based on the local population.
Objectives: To modify the equations using formulas published from local studies and to validate the resulting weight and height estimates with actual measurements taken from volunteer patients admitted in the hospital
Methods: Formulas for estimating height and weight based from the knee height measurements were modifi ed from the existing formulas. Knee height caliper measurements, actual height, and actual weights were taken from the volunteer admitted patients after informed consent was given. Correlation coeffi cients and paired samples t-test were made on the estimated values versus the actual height and weight measurements. Signifi cance was at p < 0.05.
Results:
a) 206 patients were included with more women than men (57.6% vs. 42.4%) and more adults compared to geriatric patients (56.9% vs. 43.1%).
b) Knee height measurement correlations: adult females: vs. actual weight = 0.4 (p < 0.05), vs. actual height = 0.8 (p < 0.05) / geriatric females: vs. actual weight = 0.5 (p < 0.05), vs. actual height = 0.7 (p < 0.05) / adult males: vs. actual weight = 0.5 (p < 0.05), vs. actual height = 0.9 (p < 0.05) / geriatric males: vs. actual weight = 0.4 (p > 0.05), vs. actual height = 0.9 (p < 0.05).
c) Estimated versus actual measurement of either height or weight: differences = p > 0.05, paired sample t-test.
Conclusion: The difference between estimated measurements of either height or weight, using the derived formulas based on the knee
height caliper measurements, and the actual measurements was not signifi cant indicating that these formulas can be used to provide reliable values for computing nutritional requirements and/or drug dosages based on weight and height.
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Correlation of the Mini-Nutritional Assessment and the Tinetti Gait And Balance Scores among patients admitted at the Geriatric Center (St. Luke’s Medical Center)
Rosary M. Amane(1), Eliza Mei P. Francisco(2)*, Miguel A. Ramos Jr. (1), Eduardo Rommel S. Poblete(1)
(1)Geriatric Center, St. Luke’s Medical Center, (2)Nutrition Support Team. St. Luke’s Medical Center
OBJECTIVES: To determine the correlation between the Mini-Nutritional Assessment (MNA) and Tinetti Gait and Balance scores among
patients admitted at the St. Luke’s Medical Center (Geriatric Center)
SETTING AND DESIGN: This is a retrospective, cross-sectional study conducted from May 1, 2005 to February 28, 2006 using the Mini-Nutritional Assessment (MNA) and Tinetti Gait and Balance Scores from the Comprehensive Geriatric Assessment (CGA) questionnaires
METHODS: A total of 103 patients were admitted at the Acute Geriatric Ward. A Comprehensive Geriatric Assessment was conducted on each patient by the Geriatric Medicine Fellows assigned in the unit. The MNA and Tinetti Gait and Balance Scores of 72 patients included in
the study were retrieved and recorded. Results were entered and analyzed using MINITAB. Selected characteristics of the geriatric patients were described using mean, standard deviation frequency and percentage. Inferential statistics included 2-sample t-test, one-way analysis of variance (ANOVA) and Pearson’s correlation coeffi cient. Signifi cance was determined by a pvalue < 0.05.
RESULTS: The correlation coeffi cient was only 0.32. Although the strength of the positive relationship is not high, the correlation between the MNA and Tinetti Gait and Balance Scores is signifi cant (p=0.006).This suggests that a higher MNA score is associated with a higher Tinetti Gait and Balance score.
CONCLUSION: The Mini-Nutritional Assessment tool remains an important validated clinical tool to assess the nutritional status of the elderly. Since malnutrition in the older population is still largely an unrecognized problem in the acute care hospitals, it should therefore be emphasized because of its demonstrated benefi ts.
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Body composition data using bioelectric impedance analysis (BIA) of Filipino patients seen in a weight management center in the Philippines
Balatbat B, Felicilda F, Sioson M, Reyes MC, Carlos C, Llido LO
Weight Management and Clinical Nutrition Center, St. Luke’s Medical Center, Philippines
Background/Objectives: BIA provides reliable body composition data of pediatric, adult, and geriatric patients especially those enrolled in
weight management programs. There is no BIA based data reported from the Philippines. The objectives of this study were: a) to provide body composition data of Filipino patients seen in a multidisciplinary weight management center in a private tertiary care hospital in the Philippines; b) to correlate these data with the body mass index (BMI) classifi cation of nutritional status in the three age groups.
Methods: All patients referred to the weight management center of this institution and who underwent BIA analysis, were included. Data
collected were: age, sex, height in meters, weight in kilograms, body mass index, and BIA data. Age classifi cation was: pediatric (1 month to 18 year old), adult (19 to 59 year old), and geriatric (60 years old and above). Statistical analysis used was ANOVA for normal or Kruskal-Wallis test for non-normal data. Signifi cance was at P < 0.05.
Results: 598 patients were analyzed; male to female ratio was 1:1.8; age group distribution was 16% pediatric, 62% adult, and 22% geriatric. Signifi cant changes were showed by geriatric patients in the following: low fat weight (18 kg vs. 30 kg, adult, vs. 29 kg, pedia), low fat % (31.5% vs. 37%, adult, vs. 36.5%, pedia), and low body cell mass (10 kg vs. 14 kg, adult, vs. 13 kg, pedia). No signifi cant difference was seen in body cell mass (BCM) % in all age groups and between pediatric and adult age groups. Signifi cant difference between sexes was seen in all age groups: male > female in weight, fat weight, and body cell mass; female > male in fat %. Underweight class showed these mean values: BMI = 16.08, weight = 40 kg, fat % = 18.5, BCM = 7.1 kg, and BCM % = 17.1. Normal showed: BMI = 22.3, weight = 54.2
kg, fat % = 25.8, BCM = 9.5 kg, and BCM % = 17.1. Overweight showed: BMI = 27.5, weight = 69.1 kg, fat % = 31.6, BCM = 12.6 kg, and BCM % = 18.1. Obese 1 showed: BMI = 32.3, weight = 83.5 kg, fat % = 36.4, BCM = 14.2 kg, and BCM % = 16.9. Obese 2 showed: BMI = 42.6, weight = 117.2 kg, fat % = 36.4, BCM = 17.8 kg, and BCM % = 15.3.
Conclusion: Body composition data of the geriatric age group was low compared to adult and pediatric population, while difference between sexes was present in all age groups. Body composition data of the BMI based nutritional status classes showed distinct and specifi c values per group.