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Resting energy expenditure of elderly patients in acute hospital settings
PHYSIOLOGY
AND
NUTRITIONAL
ASSESSMENT
s5
was thereafter used as the standxd. ANST and NRA were unspecific but highly sensitive (>95%). SGA was highly sensitive (100%) not quite specific (69%), and was the only method with a significant Youden value (0.7). Conclusions: ANST and NRA xe sensitive screening methods, though NRA sets up boundaries for nutritional intervention. SGA identifies patients at high nutritional risk and evaluates nutritional status; weight loss>/=lO% was once again the best method that effectively detected mild to extreme nutritional changes.
Method: LBM was measured by DEXA (Hologic QDR-4500) and TBK by whole body counter at time 0 (TO) and 3 years later (T3). Physical activity was evaluated by means of a validated frequency questionnaire. Statistical analysis between T O and T3 data were done by means of paired t-test. Results: 191 volunteers were enrolled. Preliminay data at T O and T3 for 28 men (73.4f5.5 yrs, BMI=25.9f3.0 kg/m2) and 33 women (74.1f5.7 yrs, BMI=26.9f4.2 kg/m2) xe shown in the table. All of them, reported engaging in at least lh of physical activity/week. Table
016-P. RESTING ENERGY EXPENDITURE O F ELDERLY PATIENTS IN ACUTE HOSPITAL SETTINGS
TO WOMEN
N. Bamk’, E. Allonso-Wall’, M.D. Sitrin3 ‘Medicine D, Beilinson Hospital, Peath-Tikva, Israel, ‘CNRU, University of Chicago, Illinois, 3Nutrition, State University NY, Buffalo, United States Rationale: Studies on hospitalized elderly subjects have demonstrated that negative energy balance is common during hospitalization, but have concentrated primarily on long-stay and psychogeriatric patients. There is little information on energy balance in elderly patients admitted with acute illness from the community. W e herein report our findings in comparing the Resting Energy Expenditue (EE) of elderly patients to young patients in acute hospital settings. Method: All indirect calorimetries done at 0~1’hospital between 1991-2000 were reviewed. Measured EE (MEE) and estimated EE (Harris-Benedict equation) were compared between patients younger or older than 70 years. Data shown is meanfSD. Statistical significance was noted if piO.05 (mxked by *). Table
1
n Male570
Weight
234
4x*14
X5.6&36.3
Male>70
59
76&S*
76.3&21.5
Female~70
231
4x*14
74.1&35.6
Female>70
51
76&S*
71.1&24.3
Results: A total of 567 studies were reviewed. Although thele was a difference between measured and estimated EE the ratio between the two was the same in both age groups. When measured EE was collected to weight significance was observed only in males. Table
1 Measured
EE
Estimated
EE
MEEkmight
MEElEstimated
Male570
2144&663
1710*357
26.7&7.1
1.25&0.24
Male>70
1X22&412*
1457&252*
24.6&4.7*
1.27&0.26
Female~70
1732&485
1374*195
24.1&X.0
1.25&0.26
Female>70
1518~352*
1194*157*
23.0&6.X
1.24&0.24
EE
Conclusions: EE in elderly hospitalized elderly patients is significantly lower than that of young patients. In women, col7-ection of MEE to weight showed no difference between both groups. The ratio between measured and expected EE (stress factor) was unchanged in all groups, suggesting that the metabolic response to stress is not different in the elderly.
017-P. LONGITUDINAL IN HEALTHY ELDERLY
1
Body
weight
LBM (kg) TBK/LBM
(mmolkg)
MEN
weight
Body
(kg)
(kg)
6X.4&12.5
T3 69.6&13.X*
40.9*4.x
40.7*5.4
56.7&4.5
54.7*5.5*
72.5&7.X
75.0&7.6
53.5*5.3
53.2&5.4
60.1&4.1
54.1*5.0**
LBM (kg) TBK/LBM
(mmoVkg)
Mean&SD;
T3 vs TO* P5 0.05, ** P5 0.001
Conclusions: In healthy and physically active elderly people, LBM is pieserved. However, TBK content is reduced suggesting qualitative changes in LBM.
018-P. NUTRITION WEIGHT ON QUALITY HAEMODIALYSIS PATIENTS
O F LIFE IN
P. Ravasco, P. Raimundo, V. Proen a, M. Camilo Centre Nutrition Metabolism, IMM, Faculty Medicine University Lisbon, Lisbon, Portugal Rationale: In patients with renal failure under chronic haemodialysis we have previously shown that Quality of Life (QoL) is influenced by nutrition. This study further investigates the inter-relationships and relative contributions of disease and nutrition on QoL. Method: Collected data in 60 adult patients comprised: co-morbidities (multiple medicines, other chronic diseases), duration of renal failure and of haemodialysis (in months), % weight changes since haemodialysis, nutrient intake derived from diet history analysis (DIETPLANS 2002, UK) and dietxy supplements. The EuroQoL instrument that includes 5 dimensions, mobility, self-care, activities, pain/discomfort, anxiety/depression, and an overall health visual analogue scale evaluated QoL. Results: Estimates of effect size attributed to each vxiable included in the general line= model (sum of percentages may not equal 100% due to corrected error size) revealed that 47% of patients’ mobility/self-care scores were worsened by deficient protein/energy intake and 30% by weight loss >/=lO%. Poorperfolmance of usual activities was attributed in 45% to dmation of haemodialysis and of disease, 35% to protein/vitamin B12/zinc/iron deficits, and 20% to weight loss >/=lO%. Pain/discomfort were worsened in 45% by the duration of haemodialysis and of disease, and in 15% by co-morbidities. Higher anxiety/depression were related in 43% to protein/selenium/vitamin C deficits, in 40% to the duration of haemodialysis and of disease, in 10% to weight loss >/=lO%, and in 3% to comorbidities. Likewise, 53% of poor overall health was determined by protein/energy/zinc/vitamin B12/selenium/vitamin C deficits, 25% by weight loss >/=lO%, 10% by disease duration, and 7% by co-morbidities. Conclusions: In these patients nutrition appexs to play a major role in Quality of Life functional and psychosocial dimensions.
TOTAL BODY POTASSIUM CHANGES PEOPLE: PRELIMINARY RESULTS
C.A. Raguso’, C.E. Roynette’, A. Paoloni-Giacobino’, L. Genton’, C. Pichard ’ ‘Clinical Nutrition Unit, 2Nutrition Unit, Geneva University Hospital, Geneva, Switzerland Rationale: Age-related diseases and consequent decreased physical activity xe main contributors to lean body mass (LBM) loss associated to aging. W e hypothesize that total body potassium (TBK), an index of metabolically active LBM, would be decreased in healthy, physically active, elderly volunteers over a 3-year period.
019-P. NUTRITIONAL RISK ASSESSMENT IN MAJOR ELECTIVE ABDOMINAL SURGERY PATIENTS I. Grecu L. Mirea, M. Nicolau, I. Grintescu Anesthesia and Intensive Care, Clinical Emergency Hospital of Bucharest, Bucharest, Romania Rationale: Malnutrition is well recognized as a risk factor in major surgery. Preoperative assessment of nutritional risk is the first step in the perioperative therapeutic strategy and finally can improve the outcome of these patients.
AND
NUTRITIONAL
ASSESSMENT
s5
was thereafter used as the standxd. ANST and NRA were unspecific but highly sensitive (>95%). SGA was highly sensitive (100%) not quite specific (69%), and was the only method with a significant Youden value (0.7). Conclusions: ANST and NRA xe sensitive screening methods, though NRA sets up boundaries for nutritional intervention. SGA identifies patients at high nutritional risk and evaluates nutritional status; weight loss>/=lO% was once again the best method that effectively detected mild to extreme nutritional changes.
Method: LBM was measured by DEXA (Hologic QDR-4500) and TBK by whole body counter at time 0 (TO) and 3 years later (T3). Physical activity was evaluated by means of a validated frequency questionnaire. Statistical analysis between T O and T3 data were done by means of paired t-test. Results: 191 volunteers were enrolled. Preliminay data at T O and T3 for 28 men (73.4f5.5 yrs, BMI=25.9f3.0 kg/m2) and 33 women (74.1f5.7 yrs, BMI=26.9f4.2 kg/m2) xe shown in the table. All of them, reported engaging in at least lh of physical activity/week. Table
016-P. RESTING ENERGY EXPENDITURE O F ELDERLY PATIENTS IN ACUTE HOSPITAL SETTINGS
TO WOMEN
N. Bamk’, E. Allonso-Wall’, M.D. Sitrin3 ‘Medicine D, Beilinson Hospital, Peath-Tikva, Israel, ‘CNRU, University of Chicago, Illinois, 3Nutrition, State University NY, Buffalo, United States Rationale: Studies on hospitalized elderly subjects have demonstrated that negative energy balance is common during hospitalization, but have concentrated primarily on long-stay and psychogeriatric patients. There is little information on energy balance in elderly patients admitted with acute illness from the community. W e herein report our findings in comparing the Resting Energy Expenditue (EE) of elderly patients to young patients in acute hospital settings. Method: All indirect calorimetries done at 0~1’hospital between 1991-2000 were reviewed. Measured EE (MEE) and estimated EE (Harris-Benedict equation) were compared between patients younger or older than 70 years. Data shown is meanfSD. Statistical significance was noted if piO.05 (mxked by *). Table
1
n Male570
Weight
234
4x*14
X5.6&36.3
Male>70
59
76&S*
76.3&21.5
Female~70
231
4x*14
74.1&35.6
Female>70
51
76&S*
71.1&24.3
Results: A total of 567 studies were reviewed. Although thele was a difference between measured and estimated EE the ratio between the two was the same in both age groups. When measured EE was collected to weight significance was observed only in males. Table
1 Measured
EE
Estimated
EE
MEEkmight
MEElEstimated
Male570
2144&663
1710*357
26.7&7.1
1.25&0.24
Male>70
1X22&412*
1457&252*
24.6&4.7*
1.27&0.26
Female~70
1732&485
1374*195
24.1&X.0
1.25&0.26
Female>70
1518~352*
1194*157*
23.0&6.X
1.24&0.24
EE
Conclusions: EE in elderly hospitalized elderly patients is significantly lower than that of young patients. In women, col7-ection of MEE to weight showed no difference between both groups. The ratio between measured and expected EE (stress factor) was unchanged in all groups, suggesting that the metabolic response to stress is not different in the elderly.
017-P. LONGITUDINAL IN HEALTHY ELDERLY
1
Body
weight
LBM (kg) TBK/LBM
(mmolkg)
MEN
weight
Body
(kg)
(kg)
6X.4&12.5
T3 69.6&13.X*
40.9*4.x
40.7*5.4
56.7&4.5
54.7*5.5*
72.5&7.X
75.0&7.6
53.5*5.3
53.2&5.4
60.1&4.1
54.1*5.0**
LBM (kg) TBK/LBM
(mmoVkg)
Mean&SD;
T3 vs TO* P5 0.05, ** P5 0.001
Conclusions: In healthy and physically active elderly people, LBM is pieserved. However, TBK content is reduced suggesting qualitative changes in LBM.
018-P. NUTRITION WEIGHT ON QUALITY HAEMODIALYSIS PATIENTS
O F LIFE IN
P. Ravasco, P. Raimundo, V. Proen a, M. Camilo Centre Nutrition Metabolism, IMM, Faculty Medicine University Lisbon, Lisbon, Portugal Rationale: In patients with renal failure under chronic haemodialysis we have previously shown that Quality of Life (QoL) is influenced by nutrition. This study further investigates the inter-relationships and relative contributions of disease and nutrition on QoL. Method: Collected data in 60 adult patients comprised: co-morbidities (multiple medicines, other chronic diseases), duration of renal failure and of haemodialysis (in months), % weight changes since haemodialysis, nutrient intake derived from diet history analysis (DIETPLANS 2002, UK) and dietxy supplements. The EuroQoL instrument that includes 5 dimensions, mobility, self-care, activities, pain/discomfort, anxiety/depression, and an overall health visual analogue scale evaluated QoL. Results: Estimates of effect size attributed to each vxiable included in the general line= model (sum of percentages may not equal 100% due to corrected error size) revealed that 47% of patients’ mobility/self-care scores were worsened by deficient protein/energy intake and 30% by weight loss >/=lO%. Poorperfolmance of usual activities was attributed in 45% to dmation of haemodialysis and of disease, 35% to protein/vitamin B12/zinc/iron deficits, and 20% to weight loss >/=lO%. Pain/discomfort were worsened in 45% by the duration of haemodialysis and of disease, and in 15% by co-morbidities. Higher anxiety/depression were related in 43% to protein/selenium/vitamin C deficits, in 40% to the duration of haemodialysis and of disease, in 10% to weight loss >/=lO%, and in 3% to comorbidities. Likewise, 53% of poor overall health was determined by protein/energy/zinc/vitamin B12/selenium/vitamin C deficits, 25% by weight loss >/=lO%, 10% by disease duration, and 7% by co-morbidities. Conclusions: In these patients nutrition appexs to play a major role in Quality of Life functional and psychosocial dimensions.
TOTAL BODY POTASSIUM CHANGES PEOPLE: PRELIMINARY RESULTS
C.A. Raguso’, C.E. Roynette’, A. Paoloni-Giacobino’, L. Genton’, C. Pichard ’ ‘Clinical Nutrition Unit, 2Nutrition Unit, Geneva University Hospital, Geneva, Switzerland Rationale: Age-related diseases and consequent decreased physical activity xe main contributors to lean body mass (LBM) loss associated to aging. W e hypothesize that total body potassium (TBK), an index of metabolically active LBM, would be decreased in healthy, physically active, elderly volunteers over a 3-year period.
019-P. NUTRITIONAL RISK ASSESSMENT IN MAJOR ELECTIVE ABDOMINAL SURGERY PATIENTS I. Grecu L. Mirea, M. Nicolau, I. Grintescu Anesthesia and Intensive Care, Clinical Emergency Hospital of Bucharest, Bucharest, Romania Rationale: Malnutrition is well recognized as a risk factor in major surgery. Preoperative assessment of nutritional risk is the first step in the perioperative therapeutic strategy and finally can improve the outcome of these patients.