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A longitudinal assessment of maternal zinc status in normal pregnant women
WEDNESDAY, OCTOBER 19 ORIGINAL CONTRIBUTIONS: CLINICAL NUTRITION A LONGITUDINAL ASSESSMENT OF MATERNAL ZINC STATUS IN NORMAL PREGNANT WOMEN. T.M. Reilly, PhD, RD, E. Lerner, PhD, and P. Erhard, BS, Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH
Maternal zinc (zn) status has been extensively studied. Debate continues regarding what should be the anticipated changes in zn indices throughout gestation.
The purpose of this study was to assess zn status during pregnancy in a well-defined group of pregnant women. Maternal zn status was assessed serially in 33 healthy, non-smoking women throughout pregnancy at 9, 17, 25, 34 weeks gestation and again at delivery. The concentrations of zn in plasma (pl), red blood cells (rbc), and neutrophils (neut) were quantified by atomic absorption spectrophotometry. Total plasma alkaline phosphatase (alk phos) activity was determined by colorimetric methods. Study subjects were (mean ± SD) age 28.3 ± 5.1 years. The following changes in biochemical indices (mean ± SD) were noted at 9, 17, 25, and 34 weeks gestation, and again at delivery, respectively. P zn (micrograms/deciliter (mog/dl)) was 77.5 (± 12.8), 67.5 (± 8.2), 59.5 (± 7.2), 56.8 (± 9.7), and 47.7 (± 12.2). Rbc zn (mcg/dl) was 1105.3 (± 119.8), 1118.8 (± 116.9), 1198.5 (± 108.2), 1267.4 ( 122.5), and 1343.3 (± 125.8). Neut zn (mcg/1010 cells) was 42.4 (± 3.9), 42.4 (± 3.0), 42.5 (± 2.0), 44.5(+± 2.9), and 43.7 (± 3.1). Total plasma alk phos activity (Units/liter) was 3.3 (± 0.7), 3.4 (± 1.0), 3.9 (± 0.8), 6.6 (± 1.9), and 8.7 (± 2.4). The concentrations of zn in pl progressively declined over the course of gestation. The concentrations of zn in rbc and neut, as well as the total plasma alk phos activity progressively increased throughout pregnancy. Significant (p < 0.05) time-dependent changes by analysis of variance with repeated measures (ANOVA) were noted throughout gestation for maternal concentrations of pl zn (p - 0.0001), rbc zn (p - 0.0001), neut zn (p=0.0091), and total plasma alk phos activity (p - 0.0001). These findings may help formulate standards which may be useful in the assessment of maternal zinc nutriture in the future.
'DETERMINE YOUR NUTRITIONAL HEALTH CHECXLIST SCREEN RESULTS OF ELDERLY RENAL DIALYSIS PATIENTS. R.L. Rittgers-Simonds, B.S.,E.A. Fox, PhD, RD, LD, and L. Clement, HS, RD, LD, Texas Tech University and Dialysis Center of Lubbock, Lubbock, TX. The Nutrition Screening Initiative (NSI) suggests that as people become aware of factors that affect their nutritional health, they will be motivated to improve their eating habits and modify their lifestyle to reduce their risk of nutrition-related health problems. The purpose of this study was to determine any nutritional-risk indicators that could negatively impact the health of elderly renal dialysls patients. Seventy-four conmunity-living, elderly patients were interviewed, either in English or Spanish, using a 43-item expansion of the NSI checklist and a 23-item demographic profile. The participant characteristics include, females 41, males 33; white 36, Hispanic 23, Black 15; married 65%. Means were 68.5 years for age (range 59.5-85.9 yrs), 7.8 for years of schooling and 2.3 for household size (range 1-6 persons). DETERMINE checklist showed 4.1% (3 of 74) in good nutritional health, 21.6 (16 of 74) at moderate risk and 74.3 (55 of 74) at high nutritional risk. Mean score was 8.2 with a range of 2 to 19, which is within the high-risk range (a score of 6 or abovel. Frequently checked risk factors were have an illness-induced change in eating habits, 87.8% (65 of 74); polypharmacy, 87.8% (65 of 741; have physical problems in shopping, cooking and feeding self, 47.3% (35 of 74); and lack sufficient money to buy needed food, 39.28 (29 of 74). Females were shown by Chi-square 0 1 1analyses to be at greater risk for tooth and 3mouth problems; p . ; for eating 2 or less meals each day, p-0.0 1; and for having a yearly income less than 6,000 p-. 024. Hispanic participants were less able to buy needed food, p-0.004 (47.8% were receiving food staps); and admitted to sadness that affected interest in shopping, cooking and eating, p-.O001. All Hispanic participants indicated that they took 3 or more prescribed medications each day. Hispanic and 81Bck participants demonstrated a significant risk for eating 2 or less meals each day and for having tooth problems. Unmarried participants demonstrated risk for eating alone and married participants demonstrated risk for taking 3 or more over-thecounter drugs daily. Gender differences indicated that females more frequently had an annual income less than $6,000, p-0.024; had 11 more tooth problems, p0.0 ; and ate 2 or less meals a day, p0.032. The renal dialysis participants In this study appear to be at greater nutritional risk than the general elderly population. The combined risk indicators of less food buying ability, susceptibility to sadness which influences interest in shopping, cooking and eating, and polypharmacy contributes to a compromied nutritional status of the Hispanic participant. Black patients were at greater risk for eating 2 or less meals each day and having tooth problems. Referral to supportive nutrition services by the Registered Dietitian is cruial if the nutrition-related needs of the dialysis client are to be met. (1) Nutrition Screening Initiative is a joint project of American Academy of Family Physicians, The American Dietetic Association and National Council on the Aging, Inc.
ORIGINAL CONTRIBUTIONS: CLINICAL NUTRITION LOW SERUM CHOLESTEROL AND RISK FOR PROTEIN CALORIE MALNUTRITION. K. A. Brown, MS, RD, P. L. Beyer, MS, RD, Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, KS The purpose of the study was to determine if low serum cholesterol would be valuable in screening for protein calorie malnutrition (PCM), and if low cholesterol was associated with adverse clinical outcomes. Data were collected retrospectively on 206 adult patients admitted to the University of Kansas Medical Center within the last three years. Subjects met inclusion criteria. Associations were evaluated for cholesterol and diagnosis, percent desired body weight (%DBW), percent weight loss ( wt. loss), albumin, total lymphocyte count (TLC), length of stay, and number of days 'nothing by mouth' (NPO) and/or on clear liquid diet out of the total days hospitalized (NPO ratio). Variables were grouped using cutpoints. Scattergraphs and multiple logistic regression (MLR) were used to make correlations between individual variables and among combinations of the variables and cholesterol. Cholesterol was significantly and independently associated with %DBW and serum albumin. Low albumin (<3.15 g/dl) was predictive of cholesterol <100 mg/dl and <150 mg/dl. Low albumin strengthened the association when diagnosis predicted cholesterol <150 mg/dl. Low albumin and mortality were predictive of cholesterol <100 mg/dl. The percentage change of albumin was strongly associated with the percentage change in cholesterol. Results indicate that serum cholesterol <150 mg/dl would be valuable for nutrition screening.
THE EFFECT OF NUTRITIONAL STATUS ON LENGTH OF STAY AND CLINICAL OUTCOMES FOLLOWING LIVER TRANSPLANTATION. J.M. Hasse, PhD, RD; L.S. Blue, MS, RD; J.S. Crippin, MD; R.M. Goldstein, MD; L.W. Jennings, PhD; T.A. Gonwa, MD; B.S. Husberg, MD, PhD; M.F. Levy, MD; G.B. Klintmalm, MD, PhD. Transplantation Services, Baylor University Medical Center, Dallas, TX. Malnutrition has been shown to adversely affect outcomes in general surgical and medical patient populations. A study using a prospectively maintained database was conducted to determine the effect of nutritional status on clinical outcomes and length of stay (LOS) in a large number of patients following liver transplantation (tx). Methods: From 4/85 - 5/92, 624 pts received liver txs. Records from 500 pts (50% female, overall mean age of 45.7 years) were analyzed to determine the effect of nutritional status on survival, infection rates, and initial posttx LOS Results: 70% of the patients were malnourished (55.4%-moderately malnourished, 14.6%-severely malnourished). Nutritional status did not affect graft or survival rates or infection rates by type or site of infection. Well Nourished n=150
Moderately Malnourished n=277
Severely Malnourished n=73
p value claim Rx ,r
Hospital LOS Mean (range)
24.4 +13.9' (1-84)
30.8 + 26.1 (1-169)
33.0 + 32.7' (2-223)
'0.052
ICU LOS Mean (range)
4.9 + 6.4 (148)
9.5 + 17.9 (0-126)
10.2 + 17.8 (1-115)
b
b<0.00 6
Discussion: The average daily patient charges for liver transplant patients in this institution in 1992 were $3655. Using the average daily patient charges and mean LOS, the expected charge for a posttx hospitalization based on nutritional status would be: well nourished - $89,182; moderately malnourished - $112,574; and severely malnourished -$120,615. Conclusions: Malnutrition was prevalent in liver tx recipients but affected only posttx LOS. The prevalence of pretx malnutrition and its adverse effect on posttx LOS implies increased hospitalization costs and suggests a need for aggressive perioperative medical nutrition therapy.
A-38 / SEPTEMBER 1994 SUPPLEMENT VOLUME 94 NUMBER 9
Maternal zinc (zn) status has been extensively studied. Debate continues regarding what should be the anticipated changes in zn indices throughout gestation.
The purpose of this study was to assess zn status during pregnancy in a well-defined group of pregnant women. Maternal zn status was assessed serially in 33 healthy, non-smoking women throughout pregnancy at 9, 17, 25, 34 weeks gestation and again at delivery. The concentrations of zn in plasma (pl), red blood cells (rbc), and neutrophils (neut) were quantified by atomic absorption spectrophotometry. Total plasma alkaline phosphatase (alk phos) activity was determined by colorimetric methods. Study subjects were (mean ± SD) age 28.3 ± 5.1 years. The following changes in biochemical indices (mean ± SD) were noted at 9, 17, 25, and 34 weeks gestation, and again at delivery, respectively. P zn (micrograms/deciliter (mog/dl)) was 77.5 (± 12.8), 67.5 (± 8.2), 59.5 (± 7.2), 56.8 (± 9.7), and 47.7 (± 12.2). Rbc zn (mcg/dl) was 1105.3 (± 119.8), 1118.8 (± 116.9), 1198.5 (± 108.2), 1267.4 ( 122.5), and 1343.3 (± 125.8). Neut zn (mcg/1010 cells) was 42.4 (± 3.9), 42.4 (± 3.0), 42.5 (± 2.0), 44.5(+± 2.9), and 43.7 (± 3.1). Total plasma alk phos activity (Units/liter) was 3.3 (± 0.7), 3.4 (± 1.0), 3.9 (± 0.8), 6.6 (± 1.9), and 8.7 (± 2.4). The concentrations of zn in pl progressively declined over the course of gestation. The concentrations of zn in rbc and neut, as well as the total plasma alk phos activity progressively increased throughout pregnancy. Significant (p < 0.05) time-dependent changes by analysis of variance with repeated measures (ANOVA) were noted throughout gestation for maternal concentrations of pl zn (p - 0.0001), rbc zn (p - 0.0001), neut zn (p=0.0091), and total plasma alk phos activity (p - 0.0001). These findings may help formulate standards which may be useful in the assessment of maternal zinc nutriture in the future.
'DETERMINE YOUR NUTRITIONAL HEALTH CHECXLIST SCREEN RESULTS OF ELDERLY RENAL DIALYSIS PATIENTS. R.L. Rittgers-Simonds, B.S.,E.A. Fox, PhD, RD, LD, and L. Clement, HS, RD, LD, Texas Tech University and Dialysis Center of Lubbock, Lubbock, TX. The Nutrition Screening Initiative (NSI) suggests that as people become aware of factors that affect their nutritional health, they will be motivated to improve their eating habits and modify their lifestyle to reduce their risk of nutrition-related health problems. The purpose of this study was to determine any nutritional-risk indicators that could negatively impact the health of elderly renal dialysls patients. Seventy-four conmunity-living, elderly patients were interviewed, either in English or Spanish, using a 43-item expansion of the NSI checklist and a 23-item demographic profile. The participant characteristics include, females 41, males 33; white 36, Hispanic 23, Black 15; married 65%. Means were 68.5 years for age (range 59.5-85.9 yrs), 7.8 for years of schooling and 2.3 for household size (range 1-6 persons). DETERMINE checklist showed 4.1% (3 of 74) in good nutritional health, 21.6 (16 of 74) at moderate risk and 74.3 (55 of 74) at high nutritional risk. Mean score was 8.2 with a range of 2 to 19, which is within the high-risk range (a score of 6 or abovel. Frequently checked risk factors were have an illness-induced change in eating habits, 87.8% (65 of 74); polypharmacy, 87.8% (65 of 741; have physical problems in shopping, cooking and feeding self, 47.3% (35 of 74); and lack sufficient money to buy needed food, 39.28 (29 of 74). Females were shown by Chi-square 0 1 1analyses to be at greater risk for tooth and 3mouth problems; p . ; for eating 2 or less meals each day, p-0.0 1; and for having a yearly income less than 6,000 p-. 024. Hispanic participants were less able to buy needed food, p-0.004 (47.8% were receiving food staps); and admitted to sadness that affected interest in shopping, cooking and eating, p-.O001. All Hispanic participants indicated that they took 3 or more prescribed medications each day. Hispanic and 81Bck participants demonstrated a significant risk for eating 2 or less meals each day and for having tooth problems. Unmarried participants demonstrated risk for eating alone and married participants demonstrated risk for taking 3 or more over-thecounter drugs daily. Gender differences indicated that females more frequently had an annual income less than $6,000, p-0.024; had 11 more tooth problems, p0.0 ; and ate 2 or less meals a day, p0.032. The renal dialysis participants In this study appear to be at greater nutritional risk than the general elderly population. The combined risk indicators of less food buying ability, susceptibility to sadness which influences interest in shopping, cooking and eating, and polypharmacy contributes to a compromied nutritional status of the Hispanic participant. Black patients were at greater risk for eating 2 or less meals each day and having tooth problems. Referral to supportive nutrition services by the Registered Dietitian is cruial if the nutrition-related needs of the dialysis client are to be met. (1) Nutrition Screening Initiative is a joint project of American Academy of Family Physicians, The American Dietetic Association and National Council on the Aging, Inc.
ORIGINAL CONTRIBUTIONS: CLINICAL NUTRITION LOW SERUM CHOLESTEROL AND RISK FOR PROTEIN CALORIE MALNUTRITION. K. A. Brown, MS, RD, P. L. Beyer, MS, RD, Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, KS The purpose of the study was to determine if low serum cholesterol would be valuable in screening for protein calorie malnutrition (PCM), and if low cholesterol was associated with adverse clinical outcomes. Data were collected retrospectively on 206 adult patients admitted to the University of Kansas Medical Center within the last three years. Subjects met inclusion criteria. Associations were evaluated for cholesterol and diagnosis, percent desired body weight (%DBW), percent weight loss ( wt. loss), albumin, total lymphocyte count (TLC), length of stay, and number of days 'nothing by mouth' (NPO) and/or on clear liquid diet out of the total days hospitalized (NPO ratio). Variables were grouped using cutpoints. Scattergraphs and multiple logistic regression (MLR) were used to make correlations between individual variables and among combinations of the variables and cholesterol. Cholesterol was significantly and independently associated with %DBW and serum albumin. Low albumin (<3.15 g/dl) was predictive of cholesterol <100 mg/dl and <150 mg/dl. Low albumin strengthened the association when diagnosis predicted cholesterol <150 mg/dl. Low albumin and mortality were predictive of cholesterol <100 mg/dl. The percentage change of albumin was strongly associated with the percentage change in cholesterol. Results indicate that serum cholesterol <150 mg/dl would be valuable for nutrition screening.
THE EFFECT OF NUTRITIONAL STATUS ON LENGTH OF STAY AND CLINICAL OUTCOMES FOLLOWING LIVER TRANSPLANTATION. J.M. Hasse, PhD, RD; L.S. Blue, MS, RD; J.S. Crippin, MD; R.M. Goldstein, MD; L.W. Jennings, PhD; T.A. Gonwa, MD; B.S. Husberg, MD, PhD; M.F. Levy, MD; G.B. Klintmalm, MD, PhD. Transplantation Services, Baylor University Medical Center, Dallas, TX. Malnutrition has been shown to adversely affect outcomes in general surgical and medical patient populations. A study using a prospectively maintained database was conducted to determine the effect of nutritional status on clinical outcomes and length of stay (LOS) in a large number of patients following liver transplantation (tx). Methods: From 4/85 - 5/92, 624 pts received liver txs. Records from 500 pts (50% female, overall mean age of 45.7 years) were analyzed to determine the effect of nutritional status on survival, infection rates, and initial posttx LOS Results: 70% of the patients were malnourished (55.4%-moderately malnourished, 14.6%-severely malnourished). Nutritional status did not affect graft or survival rates or infection rates by type or site of infection. Well Nourished n=150
Moderately Malnourished n=277
Severely Malnourished n=73
p value claim Rx ,r
Hospital LOS Mean (range)
24.4 +13.9' (1-84)
30.8 + 26.1 (1-169)
33.0 + 32.7' (2-223)
'0.052
ICU LOS Mean (range)
4.9 + 6.4 (148)
9.5 + 17.9 (0-126)
10.2 + 17.8 (1-115)
b
b<0.00 6
Discussion: The average daily patient charges for liver transplant patients in this institution in 1992 were $3655. Using the average daily patient charges and mean LOS, the expected charge for a posttx hospitalization based on nutritional status would be: well nourished - $89,182; moderately malnourished - $112,574; and severely malnourished -$120,615. Conclusions: Malnutrition was prevalent in liver tx recipients but affected only posttx LOS. The prevalence of pretx malnutrition and its adverse effect on posttx LOS implies increased hospitalization costs and suggests a need for aggressive perioperative medical nutrition therapy.
A-38 / SEPTEMBER 1994 SUPPLEMENT VOLUME 94 NUMBER 9