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Combined physical and mental function profile is a better measure of response than body mass in patients on nutritional support
ss
EUROPEAN
Conclusions: These data indicate that the physical activity measured by accelerometer may be a new and useful parameter for evaluating integral physical function as a parameter of nutritional assessment.
027-P. COMBINED PHYSICAL AND MENTAL FUNCTION PROFILE IS A BETTER MEASURE OF RESPONSE THAN BODY MASS IN PATIENTS ON NUTRITIONAL SUPPORT A. Mzutinez-Riquelme, J.K. Rawlings, K. Bjamason, .I. Field, S.P. Allison Clinical Nutrition, University Hospital, Queen’s Medical Centre, Nottingham, United Kingdom Rationale: Hill, Jeejeebhoy and others have emphasised the role of function rather than anthropometric parameters as goals of nutritional support. We report the results of a profile of tests of mental and physical function compaed with body mass changes for routine clinical use in patients receiving oml, enteral or parenteral nutritional support. Method: 23 patients, mean age 46.5f12.8 yezus, with prior mean percent weight loss of 17.4f9.1% (21.7% with visible cedema). 82.6% on parenteral nutrition and 17.4 on oral-enteral support. Height, weight and body mass index (BMI), digital dynamometry in non-dominant hand (HG), peak expiratory flow (PEFR) by mini-Wright PEFR-meter and Mood score: positive (vigour), negative (depresion, tension and fatigue), were measured at baseline, end of hospital care for a mean of 1 month (period l), and after a 1 month follow-up as outpatient (period 2). All values expressed as meanfSD, HG and PEFR calculated as % of reference values (%Ref). Results: Functional improvements occurred mainly during period 1 whereas BMI increased non significantly (table). PEFR increased only when baseline was 5 70% Ref. HG increased only when baseline was 5 85% Ref. Correlation between prior % of weight loss and BMI or function parameters was non-significant. Table 1 Baseline
Period
20.0&4.X
20.S4.5
21.1&4.4
0.06
HG (W Ref)
69.2&26.0
X1.1&26.7
91.X&21.6
5 0.001
PEFR (W Ret)
67.3&16.0
X0.0&17.8
X8.0&17.8
5 0.001
9140
14/2X
16 I25
0.01 *
BMI
Mood
(K&I?)
ScoresPositive/Negative
1
Period
2
P
SOCIETY
G. Fax n-Irving, T. Cederholm, H. Basun Neurotec, Karolinska Institutet, Stockholm, Sweden Rationale: Alzheimer’s disease has a lethal outcome in general within 10 years. Weight loss in other chronic diseases is associated with increased mortality. About 50% of patients with dementia display protein energy malnutrition. Demented elderly weigh about 5-10 kg less than cognitively intact elderly. In this study we have evaluated possible prognostic factors, eg body mass index (BMI) for mortality in people with dementia. Method: 226 consecutively admitted patients (79.8f6.8 y, 65% woman) were examined between 1994 and 1996 for cognitive function in a geriatric ward. Simultanously weight, height and Mini Mental State Examination (MMSE) (O-30) was registered along with s-albumin, B 12 and folic acid. BMI was calculated (kg/m2, refmnge: 20-25). The prognostic value of these variables for long telm mortality (5-7 y) was evaluated using logistic iegression. Results: 40% were diagnosed as AD, 15% VaD, 17% MCI, 8% mixed dementia, and 20% other dementia diagnoses. The mean value for BMI was 23f4. BMI 123 was found in 106 (52%) subjects. 175 patients (78%) died during the observation period, mean sulliival was 3,5 years. BMI 123 seemed to be a cut-off point (p= 0.017) for long telm mortality in the survival analysis (Kaplan Meier and log rank test). The group of patients diagnosed
ENTERAL
029-P. PROGNOSTIC VALUE OF NUTRITIONAL SURVIVAL IN NEUROLOGY
NUTRlTION
CRITERIA
ON
D. Seguy’, P. Devos’, A. Dest e3, M. Roman’ ‘Nutrition, ‘Biostatistics, 3Neurology, University Hospital, Lille, France Rationale: In a precedent study of 146 patients hospitalized in neurology (aged of 59 f 20 years) with 36% of severe undernutrition (SU), we have identified clinical parameters related to SU: body weight (BW), weighting posture (WP), triceps skinfold (TS), mid zmn circumference (MAC), and semi-quantitative evaluation of oral food intake (OFI). These parameters allowed to build up a screening strategy of SU using a chi-squared automatic interaction detection (CHAID) method. The aim of the present study was to determine the influence of age and SU related parameters on survival at 1 year. Method: Quantitative variables were transformed into qualitative vzuiables by determination of cut-off values using the receiver operating characteristics (ROC) curves: age = 56 yr, BW = 55 kg, TS = 10 mm, MAC = 27 cm and OF1 = 50%. Classes for WP were standing I supine or sitting. Influence of age and SU related parameters on l-year survival was estimated by the Kaplan-Meier method and compared by the log-rank test. The independent prognostic factors were assessedby the Cox model. Results: The overall l-ye= survival rate was 81.5% (27 patients died). In univzuiate analysis all variables were associated with l-year survival: age (98.3% /67.1%, p 5 O.OOOl), BW (60.2 % /87.2%, p 5 O.OOOl), WP (92.6% /51.8%, p 5 0.0004), TS (57.4% I S&S%, p 5 O.OOOl),MAC (70.3% /89.5%, p 5 0.005) and OFI (64.8% /92.8%, p 5 0.0001). The multivzuiate analysis identified only fom independent prognostic vzuiables (p 5 0.0001) (Table). Independentprognosticfactorsof l-year suvival (stepwiseCox model) Body weight WV RR* 95% a**
028-P. BODY MASS INDEX IS A PREDICTOR OF MORTALITY IN SUBJECTS WITH DEMENTIA AND MILD COGNITIVE IMPAIRMENT
AND
as “other dementia diagnoses” seemed to have the highest mortality (89%). In a logistic regression analysis we found that male gender (OR 3.5 95% CI 1.5-8.3), BMI 123 (OR 2.1, 95% CI 1.0-4.2) and age (OR 0.9, 95% CI 0.8-0.9) were independent prognostic factors for mortality within 5-7 years. Conclusions: BMI 123 together with male gender and age were independently related to reduced long telm survival in individuals with dementia and MCI.
* significantonly betweenbaselineto period 1 Conclusions: A profile of function tests is useful in routine practice, and better than anthropometrics to measure the response to nutritional care.
OF PARENTERAL
P
Weightingposture WP)
Oral food intake corn
4.0
4.2
4.0
2.7
[1.2-14.01
[2.0-X.X]
[1.X-X.5]
[1.2-6.11
0.03
0.0001
0.0004
0.02
“relative risk, ““95% confidenceinterval Conclusions: In summary, among the clinical pxameters related to SU, only SW, WP and OFI were independent prognostic factors. Age was also associated independently.
030-P. MUSCLE MASS DEPLETION PREDICTS MEDICAL COMPLICATIONS IN ANOREXIA NERVOSA L. Di Pascoli, E. Zola, A. Lion, D. Milazzo, M. Nardi, G. Boffo, F. Rancini, L. Cxegaro Dept of Clinical and Experimental Medicine, Univ of Padua, P&m, Italy Rationale: The study aimed to define the relationship between nutritional status and medical complications in anorexia nervosa (AN). Method: We retrospectively analysed nutritional and biochemical data of 209 female patients with AN. All met DSM-IV criteria for AN. Mean age was 23.4f7.3y, BMI 15.4f1.6. Nutritional evaluation included: BMI, am muscle area (AMA), zum fat area (AFA) derived from skinfold anthropometry, and muscle strength (HG) evaluated by handgrip dynamometry. Biochemical analysis included: cell blood count, renal, liver and pancreatic tests, electrolytes, lactic dehydrogenase (LDH), thyroid hormones, LH, FSH, 17fiestradio1, cortisol, GH and IGF-1. Bone mineral density was measured by DEXA at the lumbar spine (L-BMD) and femoral neck (F-BMD) sites in 63 patients.
EUROPEAN
Conclusions: These data indicate that the physical activity measured by accelerometer may be a new and useful parameter for evaluating integral physical function as a parameter of nutritional assessment.
027-P. COMBINED PHYSICAL AND MENTAL FUNCTION PROFILE IS A BETTER MEASURE OF RESPONSE THAN BODY MASS IN PATIENTS ON NUTRITIONAL SUPPORT A. Mzutinez-Riquelme, J.K. Rawlings, K. Bjamason, .I. Field, S.P. Allison Clinical Nutrition, University Hospital, Queen’s Medical Centre, Nottingham, United Kingdom Rationale: Hill, Jeejeebhoy and others have emphasised the role of function rather than anthropometric parameters as goals of nutritional support. We report the results of a profile of tests of mental and physical function compaed with body mass changes for routine clinical use in patients receiving oml, enteral or parenteral nutritional support. Method: 23 patients, mean age 46.5f12.8 yezus, with prior mean percent weight loss of 17.4f9.1% (21.7% with visible cedema). 82.6% on parenteral nutrition and 17.4 on oral-enteral support. Height, weight and body mass index (BMI), digital dynamometry in non-dominant hand (HG), peak expiratory flow (PEFR) by mini-Wright PEFR-meter and Mood score: positive (vigour), negative (depresion, tension and fatigue), were measured at baseline, end of hospital care for a mean of 1 month (period l), and after a 1 month follow-up as outpatient (period 2). All values expressed as meanfSD, HG and PEFR calculated as % of reference values (%Ref). Results: Functional improvements occurred mainly during period 1 whereas BMI increased non significantly (table). PEFR increased only when baseline was 5 70% Ref. HG increased only when baseline was 5 85% Ref. Correlation between prior % of weight loss and BMI or function parameters was non-significant. Table 1 Baseline
Period
20.0&4.X
20.S4.5
21.1&4.4
0.06
HG (W Ref)
69.2&26.0
X1.1&26.7
91.X&21.6
5 0.001
PEFR (W Ret)
67.3&16.0
X0.0&17.8
X8.0&17.8
5 0.001
9140
14/2X
16 I25
0.01 *
BMI
Mood
(K&I?)
ScoresPositive/Negative
1
Period
2
P
SOCIETY
G. Fax n-Irving, T. Cederholm, H. Basun Neurotec, Karolinska Institutet, Stockholm, Sweden Rationale: Alzheimer’s disease has a lethal outcome in general within 10 years. Weight loss in other chronic diseases is associated with increased mortality. About 50% of patients with dementia display protein energy malnutrition. Demented elderly weigh about 5-10 kg less than cognitively intact elderly. In this study we have evaluated possible prognostic factors, eg body mass index (BMI) for mortality in people with dementia. Method: 226 consecutively admitted patients (79.8f6.8 y, 65% woman) were examined between 1994 and 1996 for cognitive function in a geriatric ward. Simultanously weight, height and Mini Mental State Examination (MMSE) (O-30) was registered along with s-albumin, B 12 and folic acid. BMI was calculated (kg/m2, refmnge: 20-25). The prognostic value of these variables for long telm mortality (5-7 y) was evaluated using logistic iegression. Results: 40% were diagnosed as AD, 15% VaD, 17% MCI, 8% mixed dementia, and 20% other dementia diagnoses. The mean value for BMI was 23f4. BMI 123 was found in 106 (52%) subjects. 175 patients (78%) died during the observation period, mean sulliival was 3,5 years. BMI 123 seemed to be a cut-off point (p= 0.017) for long telm mortality in the survival analysis (Kaplan Meier and log rank test). The group of patients diagnosed
ENTERAL
029-P. PROGNOSTIC VALUE OF NUTRITIONAL SURVIVAL IN NEUROLOGY
NUTRlTION
CRITERIA
ON
D. Seguy’, P. Devos’, A. Dest e3, M. Roman’ ‘Nutrition, ‘Biostatistics, 3Neurology, University Hospital, Lille, France Rationale: In a precedent study of 146 patients hospitalized in neurology (aged of 59 f 20 years) with 36% of severe undernutrition (SU), we have identified clinical parameters related to SU: body weight (BW), weighting posture (WP), triceps skinfold (TS), mid zmn circumference (MAC), and semi-quantitative evaluation of oral food intake (OFI). These parameters allowed to build up a screening strategy of SU using a chi-squared automatic interaction detection (CHAID) method. The aim of the present study was to determine the influence of age and SU related parameters on survival at 1 year. Method: Quantitative variables were transformed into qualitative vzuiables by determination of cut-off values using the receiver operating characteristics (ROC) curves: age = 56 yr, BW = 55 kg, TS = 10 mm, MAC = 27 cm and OF1 = 50%. Classes for WP were standing I supine or sitting. Influence of age and SU related parameters on l-year survival was estimated by the Kaplan-Meier method and compared by the log-rank test. The independent prognostic factors were assessedby the Cox model. Results: The overall l-ye= survival rate was 81.5% (27 patients died). In univzuiate analysis all variables were associated with l-year survival: age (98.3% /67.1%, p 5 O.OOOl), BW (60.2 % /87.2%, p 5 O.OOOl), WP (92.6% /51.8%, p 5 0.0004), TS (57.4% I S&S%, p 5 O.OOOl),MAC (70.3% /89.5%, p 5 0.005) and OFI (64.8% /92.8%, p 5 0.0001). The multivzuiate analysis identified only fom independent prognostic vzuiables (p 5 0.0001) (Table). Independentprognosticfactorsof l-year suvival (stepwiseCox model) Body weight WV RR* 95% a**
028-P. BODY MASS INDEX IS A PREDICTOR OF MORTALITY IN SUBJECTS WITH DEMENTIA AND MILD COGNITIVE IMPAIRMENT
AND
as “other dementia diagnoses” seemed to have the highest mortality (89%). In a logistic regression analysis we found that male gender (OR 3.5 95% CI 1.5-8.3), BMI 123 (OR 2.1, 95% CI 1.0-4.2) and age (OR 0.9, 95% CI 0.8-0.9) were independent prognostic factors for mortality within 5-7 years. Conclusions: BMI 123 together with male gender and age were independently related to reduced long telm survival in individuals with dementia and MCI.
* significantonly betweenbaselineto period 1 Conclusions: A profile of function tests is useful in routine practice, and better than anthropometrics to measure the response to nutritional care.
OF PARENTERAL
P
Weightingposture WP)
Oral food intake corn
4.0
4.2
4.0
2.7
[1.2-14.01
[2.0-X.X]
[1.X-X.5]
[1.2-6.11
0.03
0.0001
0.0004
0.02
“relative risk, ““95% confidenceinterval Conclusions: In summary, among the clinical pxameters related to SU, only SW, WP and OFI were independent prognostic factors. Age was also associated independently.
030-P. MUSCLE MASS DEPLETION PREDICTS MEDICAL COMPLICATIONS IN ANOREXIA NERVOSA L. Di Pascoli, E. Zola, A. Lion, D. Milazzo, M. Nardi, G. Boffo, F. Rancini, L. Cxegaro Dept of Clinical and Experimental Medicine, Univ of Padua, P&m, Italy Rationale: The study aimed to define the relationship between nutritional status and medical complications in anorexia nervosa (AN). Method: We retrospectively analysed nutritional and biochemical data of 209 female patients with AN. All met DSM-IV criteria for AN. Mean age was 23.4f7.3y, BMI 15.4f1.6. Nutritional evaluation included: BMI, am muscle area (AMA), zum fat area (AFA) derived from skinfold anthropometry, and muscle strength (HG) evaluated by handgrip dynamometry. Biochemical analysis included: cell blood count, renal, liver and pancreatic tests, electrolytes, lactic dehydrogenase (LDH), thyroid hormones, LH, FSH, 17fiestradio1, cortisol, GH and IGF-1. Bone mineral density was measured by DEXA at the lumbar spine (L-BMD) and femoral neck (F-BMD) sites in 63 patients.