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Prevalence of patients at nutritional risk in Danish hospitals
NUTRITIONAL
EPIDEMIOLOGY,
s99
COMMUNICATION
quested by GP or hospital dietitian at outpatients. Community patients xe reassessed every l-6 months, depending on the patient, type of feed (tube/sip) and community dietitian availability. No fomal guidelines exist for screening/treating patients or advising on tube/sip feeds in hospital or community. Conclusions: Nutritional screening is mainly perfomed in hospital and rxely in the community. Hospital screening is inconsistent and I-eassessment in the community performed sporadically. Some patients may remain untreated and others prescribed inappropriate nutritional support. Guidelines for screening and management of malnutrition xe required to improve patient exe.
370-P. MINI NUTRITIONAL ASSESSMENT AND A THREE YEAR FOLLOW-UP IN ELDERLY SUBJECTS RECEIVING MUNICIPAL SUPPORT A. Saletti’, L. Johanson’, E. Yifter-Lindgren3, K. sterberg4, U. Wissinn’. T. Cederholm6 ‘Institution of Neurotec, Karolinska institute c.o Stockholms sjukhem, Stockholm, 2School of Science, J nk ping University, J nk ping, 3Department of Geriattic Medicine, Ume University Hospital, Ume , 4Mj ljr mjandet, Sk rhmn, ‘Sophiahemmet, University College, 6Department of Geriattic Medicine, Huddinge University Hospital, Stockholm, Sweden Y
score 3 3 was considered at nutritional risk. Undernutrition was evaluated by 3 variables (BMI, recent weight loss, recent food intake) ( NRS 2002). Results: Out of 590 patients, 39.9% were nutritionally at risk, most often in departments of gas&o-surgery (57%). BMI was 5 18.5 in 10.9%, and between 18.5 and 20.5 in 16.7% of the patients. In 7.6% the records contained information about nutritional risk, in 14.2% about a nutrition plan of which only 55.2% included a plan for monitoring. BMI was found in 3% of the records. Both severity of disease (piO.02) and weightloss (piO.04) were predictive for making a nutrition plan. Conclusions: About one-third of patients in departments of internal medicine, gash-o- and ortopedic surgery xe at nutritional risk, and only a minor part of these patients are identified. As a consequence only few patients at a nutritional risk have a nutrition plan and a plan for monitoring. Sponsor: Fresenius-Kabi A/S
372-P. NUTRITIONAL STATUS AND TREATMENT ON F R O M THE KING’S FUND REPORT
10 YEARS
,
Rationale: W e evaluated nutritional status and long-telm outcome in homeliving frail elderly. Method: Of 507 eligible subjects in five Swedish municipalities, 353 (82f7 ye=, 64% female) were assessedaccording to Mini Nutritional Assessment (MNA), e.g. body mass index (BMI), kg/m2, global and dietay issues. 3ye= mortality was evaluated in 224 participants. In one municipality, 31 of 64 elderly were I-e-examined after three yezus Results: Eight and 41% of the elderly were malnourished or at risk for malnutrition, respectively. BMIi23 was found in 31% of the subjects. Chewing and swallowing problems and reduced appetite, were more often reported in those at risk or being malnourished as compared to the well-nourished (piO.001). Meals-on-wheels service was given to l/3, of whom 2/3 used one portion for several meals. Feelings of depression and reduced ADL functions were common in the malnourished groups. The 3-ye= mortality was 50%, 40% and 28% for those being malnourished, at risk for malnutrition and for the well-nourished, respectively (piO.05). Corresponding mortality was 45%, 36% and 22% for subjects with BMI 123, BMI 23-28 and BMI >28, respectively (p=O.O5). After three yezus a weight loss of 4f5.8 kg was registered (piO.001). Conclusions: About half of home-living elderly with community support were or sustained the risk of malnutrition. Malnutrition was associated with decreased ADL functions, depressed mood and mortality. Elderly with BMI >28 displayed the lowest risk for death within 3 years.
371-P. PREVALENCE DANISH HOSPITALS
O F PATIENTS AT NUTRITIONAL
RISK IN
H.H. Rasmussen’, J. Kondrup’, M. Staun3, K. Ladefoged4, H. Kristensen’ , A. Wengler3 ‘Medical Gastroenterology, Aalborg Hospital, Aalborg, 2Nutrition Unit, 3Medical Gastroenterology, Rigshospitalet, Copenhagen, 41nternal Medicine, K@geHospital, K@ge,Denmark Rationale: Undernutrition is associated with increased morbidity and mortality and is common in patients admitted to hospital. W e examined 1) the prevalence of patients at nutritional risk, 2) whether these patients wele identified by the staff, and 3) whether a nutritional plan and monitoring was made for patients at nutritional risk. Method: A cross-sectional study in 15 randomly selected depatments (> 200 beds, depzutments of internal medicine, gash-o- and orthopedic surgery) in Danish hospitals. The patients were chxacterized by scoring the components ‘undernutrition’ and ‘severity of disease’in 4 categories (absent, mild, moderate or severe). The patient could have a score of O-3 for each component (undernutrition and severity of disease), and any patient with a total
E.R. Stoppard’, S.T. Burden’, J.L. Shaffer’, K. W x d ’, M.J. Connolly3, A.J. Makin’ ’NSI; Manchester Royal InJirmary, ‘IFU, Hope Hospital, 3 Geriattics, Manchester Royal InJirmary, Manchester; United Kingdom Rationale: This prospective study aimed to assessdetection rates for malnourished patients and use of appropriate treatment to prevent decline in nutritional state as promoted by the King’s Fund Report 1992. Method: Consecutive general medical patients (n.158) admitted to a University Teaching hospital from Sept to Nov 2002 were assessed weekly by weight and Subjective Global Assessment (SGA: A=well-nourished, B=mild-moderately malnourished, C=severely malnourished). Dietitian consult and nutritional supplements (NS) were recorded. Results: Mean (Mn) age was 64 (median 69, range 16-99) with 83 (53%) males. Median hospital stay for those remaining > 10 days was 18, range 1 l-99 days. On admission 28 patients could not be weighed in sitting scales with nursing help. These patients scored significantly higher on SGA than pts who could be weighed: A 9 (32%), B/C 19 (68%) (chi’ p=O.O09)) Patients who could not be weighed as their admission progressed also scored higher. On admission, 50(46%) patients scored SGA B/C. In those 90 patients staying > 10 days, 32 (37%) lost weight including half with initial SGA of A (20/40). Only 25% (5/20) of these were referred to a dietitian. Table
1
SGA n. pts (W)
pts remaining Dietitian Given NS Mn. kg loss exe Mn. kg gain > 10 days consult ascitesloss
SGA A X6 (54%)
40 (47%)
9
6 (15%)
2.5 (n.20)
SGA
B 57 (36%)
39 (68%)
20
22 (56%)
3.2 (n.7)
2.3 (n.9)
SGA
C 15 (10%)
11(73%)
4
5 (45%)
2.3 (~5)
3.3 (n.1)
1.1 (n.13)
Conclusions: Almost half of malnourished patients staying > 10 days wele not detected or referred for treatment (23/50). Patients who could not be weighed on admission were more likely to be malnourished according to SGA with important implications for tracking nutritional status with weight and omitting such patients when surveying malnutrition rates.
373-P. LEVELS O F PLASMA MALONDIALDEHYDE SOCIOECONOMIC LEVEL SCHOOLCHILDREN
IN L O W
R.S. Smi, S. Hix, T.S. Pitta, A. Fernandes, F.I. Souza, D.O. Schoeps Department of Mother and Child Health, ABC School of Medicine, Santa Andr , Brazil, S o Paula, Brazil Rationale: There is evidence that plasma lipid peroxide level measured with thiobarbitmic acid reaction substances (TBARS) are elevated in adult patients with atherosclerosis. However, no study of chil&en has so fx I-eported evidence of oxidative damage. For this purpose, we measured plasma malondialdehyde (MDA), a product of lipid peroxidation, and related it to lipid status, body mass index (BMI) and waist circumference (WC).
EPIDEMIOLOGY,
s99
COMMUNICATION
quested by GP or hospital dietitian at outpatients. Community patients xe reassessed every l-6 months, depending on the patient, type of feed (tube/sip) and community dietitian availability. No fomal guidelines exist for screening/treating patients or advising on tube/sip feeds in hospital or community. Conclusions: Nutritional screening is mainly perfomed in hospital and rxely in the community. Hospital screening is inconsistent and I-eassessment in the community performed sporadically. Some patients may remain untreated and others prescribed inappropriate nutritional support. Guidelines for screening and management of malnutrition xe required to improve patient exe.
370-P. MINI NUTRITIONAL ASSESSMENT AND A THREE YEAR FOLLOW-UP IN ELDERLY SUBJECTS RECEIVING MUNICIPAL SUPPORT A. Saletti’, L. Johanson’, E. Yifter-Lindgren3, K. sterberg4, U. Wissinn’. T. Cederholm6 ‘Institution of Neurotec, Karolinska institute c.o Stockholms sjukhem, Stockholm, 2School of Science, J nk ping University, J nk ping, 3Department of Geriattic Medicine, Ume University Hospital, Ume , 4Mj ljr mjandet, Sk rhmn, ‘Sophiahemmet, University College, 6Department of Geriattic Medicine, Huddinge University Hospital, Stockholm, Sweden Y
score 3 3 was considered at nutritional risk. Undernutrition was evaluated by 3 variables (BMI, recent weight loss, recent food intake) ( NRS 2002). Results: Out of 590 patients, 39.9% were nutritionally at risk, most often in departments of gas&o-surgery (57%). BMI was 5 18.5 in 10.9%, and between 18.5 and 20.5 in 16.7% of the patients. In 7.6% the records contained information about nutritional risk, in 14.2% about a nutrition plan of which only 55.2% included a plan for monitoring. BMI was found in 3% of the records. Both severity of disease (piO.02) and weightloss (piO.04) were predictive for making a nutrition plan. Conclusions: About one-third of patients in departments of internal medicine, gash-o- and ortopedic surgery xe at nutritional risk, and only a minor part of these patients are identified. As a consequence only few patients at a nutritional risk have a nutrition plan and a plan for monitoring. Sponsor: Fresenius-Kabi A/S
372-P. NUTRITIONAL STATUS AND TREATMENT ON F R O M THE KING’S FUND REPORT
10 YEARS
,
Rationale: W e evaluated nutritional status and long-telm outcome in homeliving frail elderly. Method: Of 507 eligible subjects in five Swedish municipalities, 353 (82f7 ye=, 64% female) were assessedaccording to Mini Nutritional Assessment (MNA), e.g. body mass index (BMI), kg/m2, global and dietay issues. 3ye= mortality was evaluated in 224 participants. In one municipality, 31 of 64 elderly were I-e-examined after three yezus Results: Eight and 41% of the elderly were malnourished or at risk for malnutrition, respectively. BMIi23 was found in 31% of the subjects. Chewing and swallowing problems and reduced appetite, were more often reported in those at risk or being malnourished as compared to the well-nourished (piO.001). Meals-on-wheels service was given to l/3, of whom 2/3 used one portion for several meals. Feelings of depression and reduced ADL functions were common in the malnourished groups. The 3-ye= mortality was 50%, 40% and 28% for those being malnourished, at risk for malnutrition and for the well-nourished, respectively (piO.05). Corresponding mortality was 45%, 36% and 22% for subjects with BMI 123, BMI 23-28 and BMI >28, respectively (p=O.O5). After three yezus a weight loss of 4f5.8 kg was registered (piO.001). Conclusions: About half of home-living elderly with community support were or sustained the risk of malnutrition. Malnutrition was associated with decreased ADL functions, depressed mood and mortality. Elderly with BMI >28 displayed the lowest risk for death within 3 years.
371-P. PREVALENCE DANISH HOSPITALS
O F PATIENTS AT NUTRITIONAL
RISK IN
H.H. Rasmussen’, J. Kondrup’, M. Staun3, K. Ladefoged4, H. Kristensen’ , A. Wengler3 ‘Medical Gastroenterology, Aalborg Hospital, Aalborg, 2Nutrition Unit, 3Medical Gastroenterology, Rigshospitalet, Copenhagen, 41nternal Medicine, K@geHospital, K@ge,Denmark Rationale: Undernutrition is associated with increased morbidity and mortality and is common in patients admitted to hospital. W e examined 1) the prevalence of patients at nutritional risk, 2) whether these patients wele identified by the staff, and 3) whether a nutritional plan and monitoring was made for patients at nutritional risk. Method: A cross-sectional study in 15 randomly selected depatments (> 200 beds, depzutments of internal medicine, gash-o- and orthopedic surgery) in Danish hospitals. The patients were chxacterized by scoring the components ‘undernutrition’ and ‘severity of disease’in 4 categories (absent, mild, moderate or severe). The patient could have a score of O-3 for each component (undernutrition and severity of disease), and any patient with a total
E.R. Stoppard’, S.T. Burden’, J.L. Shaffer’, K. W x d ’, M.J. Connolly3, A.J. Makin’ ’NSI; Manchester Royal InJirmary, ‘IFU, Hope Hospital, 3 Geriattics, Manchester Royal InJirmary, Manchester; United Kingdom Rationale: This prospective study aimed to assessdetection rates for malnourished patients and use of appropriate treatment to prevent decline in nutritional state as promoted by the King’s Fund Report 1992. Method: Consecutive general medical patients (n.158) admitted to a University Teaching hospital from Sept to Nov 2002 were assessed weekly by weight and Subjective Global Assessment (SGA: A=well-nourished, B=mild-moderately malnourished, C=severely malnourished). Dietitian consult and nutritional supplements (NS) were recorded. Results: Mean (Mn) age was 64 (median 69, range 16-99) with 83 (53%) males. Median hospital stay for those remaining > 10 days was 18, range 1 l-99 days. On admission 28 patients could not be weighed in sitting scales with nursing help. These patients scored significantly higher on SGA than pts who could be weighed: A 9 (32%), B/C 19 (68%) (chi’ p=O.O09)) Patients who could not be weighed as their admission progressed also scored higher. On admission, 50(46%) patients scored SGA B/C. In those 90 patients staying > 10 days, 32 (37%) lost weight including half with initial SGA of A (20/40). Only 25% (5/20) of these were referred to a dietitian. Table
1
SGA n. pts (W)
pts remaining Dietitian Given NS Mn. kg loss exe Mn. kg gain > 10 days consult ascitesloss
SGA A X6 (54%)
40 (47%)
9
6 (15%)
2.5 (n.20)
SGA
B 57 (36%)
39 (68%)
20
22 (56%)
3.2 (n.7)
2.3 (n.9)
SGA
C 15 (10%)
11(73%)
4
5 (45%)
2.3 (~5)
3.3 (n.1)
1.1 (n.13)
Conclusions: Almost half of malnourished patients staying > 10 days wele not detected or referred for treatment (23/50). Patients who could not be weighed on admission were more likely to be malnourished according to SGA with important implications for tracking nutritional status with weight and omitting such patients when surveying malnutrition rates.
373-P. LEVELS O F PLASMA MALONDIALDEHYDE SOCIOECONOMIC LEVEL SCHOOLCHILDREN
IN L O W
R.S. Smi, S. Hix, T.S. Pitta, A. Fernandes, F.I. Souza, D.O. Schoeps Department of Mother and Child Health, ABC School of Medicine, Santa Andr , Brazil, S o Paula, Brazil Rationale: There is evidence that plasma lipid peroxide level measured with thiobarbitmic acid reaction substances (TBARS) are elevated in adult patients with atherosclerosis. However, no study of chil&en has so fx I-eported evidence of oxidative damage. For this purpose, we measured plasma malondialdehyde (MDA), a product of lipid peroxidation, and related it to lipid status, body mass index (BMI) and waist circumference (WC).