- Email: [email protected]
PP139 NUTRITIONAL CARE ROUTINES IN ITALY: RESULTS FROM THE PIMAI STUDY
Nutritional epidemiology I expenditure according to Harris & Benedict 1984 + 30%. Logistic regression analyses were performed in complete cases to investigate predictors for achieving protein and energy requirements. Results: Protein and energy intake was reported for 610 patients, of whom 25.6% had sufficient protein and energy intake, 2.6% only had sufficient protein intake and 13.4% only had sufficient energy intake. Complete case analyses (n = 575) showed that negative predictors for achieving the protein and energy requirements were: nausea (OR = 0.18; 95% CI=0.06 0.53), cancer (0.57; 0.35 0.93), acute infections (0.63; 0.37 1.01) and having a higher BMI (0.84; 0.79 0.89). Patients with a higher age (1.01; 1.00 1.03), chronic lung disease (3.76; 2.33 6.07) and receiving tube feeding (3.89; 1.56 9.73) were more likely to achieve the requirements. Conclusion: Only one in four undernourished hospital patients meets the protein and energy requirements on the fourth day of admission. Possibilities for improvement may be found in treatment of nausea and earlier nutritional support. Disclosure of Interest: None declared
PP138 NUTRITIONAL STATUS PREDICTS LENGTH OF HOSPITAL STAY AND MORTALITY IN PATIENTS WITH CLOSTRIDIUM DIFFICILE (C.DIFF) INFECTION S.S.H. Wong1,2 , J. O’Driscoll3 , M. Weldon4 , C.Y. Yau5 . 1 Nutrition and Dietetics, National Spinal Injuries Centre, Aylesbury, 2 Centre of Gastroenterology and Clinical Nutrition, University College London, London, 3 Department of Microbiology, 4 Department of Gastroenterology, 5 Medicine for Older People, Stoke Mandeville Hospital, Aylesbury, United Kingdom Rationale: Malnutrition is associated with adverse consequences regarding health outcomes and healthcare expenditures. There is limited data reporting the association between nutritional status and hospital outcomes in patients with C. diff infection. The aim of the present study was to investigate the outcomes in patients with hospital acquired C. diff infection. Methods: 106 patients were assessed by Malnutrition Universal Screening Tool (MUST), and functional assessment of handgrip (HG). The impact of nutritional status on prevalence and hospital outcomes was analysed for these individuals. The outcomes measured were 1. length of hospital stay (LOS) and 2. mortality rate in 180 d. Results: The present study found that the prevalence of undernutrition was 58.3% (MUST =2) at the time of C. diff diagnosis, 74.5% of whom were aged greater than 65 years old. The average LOS was 68±85.3 day (range: 8 to 508d) and 180d mortality was 45.4%. Compared to patients at low risk of malnutrition (MUST = 0, HG > 85%), those who were malnourished (MUST =2, HG < 85%) fared worse. LOS was longer (72d vs. 42d, p < 0.047, 77d vs. 40d, p < 0.02) and mortality at 180d was significantly higher [32 (43%) vs. 1 (1.4%), p < 0.0001]. Conclusion: It is suggests that individuals with nosocomial clostridium difficile infection are associated with a significant clinical and financial burden to the health care system. The present study suggests both MUST score and
77 HG may predict clinical outcomes in patients with C. diff infection. Clinicians should be aware of the need to identify and treat malnutrition in hospitalised patients to prevent the development of severe C. diff infection. This may reduce both length of stay and mortality in this vulnerable group of patients. Disclosure of Interest: None declared
PP139 NUTRITIONAL CARE ROUTINES IN ITALY: RESULTS FROM THE PIMAI STUDY E. Cereda1 , L. Lucchin2 , C. Pedrolli3 , A. D’Amicis4 , R. Caccialanza1 , M.G. Gentile5 , N.C. Battistini6 , M.A. Fusco7 , A. Palmo8 , M. Muscaritoli9 , and PIMAI Group. 1 Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, 2 Dietetic and Clinical Nutrition Unit, Regional General Hospital, Bolzano, 3 Dietetic and Clinical Nutrition Unit, Trento Hospital, Trento, 4 National Institute for Research on Food and Nutrition (INRAN), Roma, 5 Dietetic and Clinical Nutrition Unit, “Niguarda-Ca Granda” Hospital, Milano, 6 Department of Applied Dietetic Technical Science, University of Modena and Reggio Emilia, Modena, 7 Dietetic and Clinical Nutrition Unit, “S.Camillo-Forlanini” Hospital, Roma, 8 Dietetic and Clinical Nutrition Unit, University Hospital San Giovanni Battista, Torino, 9 Department of Clinical Medicine, University “La Sapienza”, Roma, Italy Rationale: Disease-related malnutrition is a common comorbidity at hospital referral. The purpose of the present report was to describe the data on nutritional care routines collected during the PIMAI (Project: Iatrogenic MAlnutrition in Italy) study as these may be helpful to avoid iatrogenic malnutrition and improve nutritional policies. Methods: Standards of nutritional care were assessed on the basis of 1) adherence to study protocol (completeness of data collected); 2) attitude in assessing the nutritional status; 3) prescription of nutritional treatment (within 3 days) at least in patients presenting with overt malnutrition (BMI < 18.5 kg/m2 or significant weight loss [10% in 3 months and/or 5% in the last month]), regardless of its adequacy and adherence to current guidelines; 4) attitude in monitoring nutritional status during the stay (number of weight measurements performed compared to those expected). Results: In total 1583 subjects were assessed. A minimum data set for performing the NRS-2002 tool was available in 1284 patients (81.1%) but nutritional screening was possible in every patient by alternative analytical criteria related to food intake, anthropometry and biochemistry. However, several missing values were recorded, particularly in biochemical parameters due to lack of prescription by admission wards. According to ward practices, only 38.2% of the patients had the BMI calculated. A nutritional support was prescribed only to 26 of 191 patients (13.6%) presenting with overt malnutrition. Finally, we recorded that only 21.6% of the patients (207 of 960 randomly selected) received an adequate weight monitoring during the stay. This reality was worse in surgical rather than medical departments (17% vs 26%; P < 0.001).
78
Poster presentations
Conclusion: Present results from the PIMAI study confirm that in Italy nutritional routines towards the management of disease-related malnutrition are still poor and need improvements.
PP141 GENDER DIFFERENCES IN CONSUMPTION OF NUTRITIONAL SUPPLEMENTS AMONG GREEK MALE AND FEMALE EXERCISING IN COMMERCIAL GYMS
Disclosure of Interest: None declared
M. Chourdakis1 , D. Vassilakou1 , D. Papatsimpas1 , D. Kouvelas1 . 1 School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
PP140 NUTRITIONAL PARAMETERS ASSOCIATED WITH PROLONGED HOSPITALIZATION IN AMBULATORY ADULT PATIENTS R. Caccialanza1 , C. Klersy2 , E. Cereda1 , B. Cameletti1 , A. Bonoldi3 , C. Bonardi1 , M. Marinelli1 , P. Dionigi4 . 1 Servizio di Dietetica e Nutrizione Clinica, 2 Biometry and Clinical Epidemiology Service, 3 Hospital Management Unit, Fondazione IRCCS Policlinico San Matteo, 4 Institute of Hepatopancreatic Surgery, Fondazione IRCCS Policlinico San Matteo and Department of Surgical Sciences, University of Pavia, Pavia, Italy Rationale: Comprehensive evaluations of the nutritional parameters associated with length of hospital stay (LOS) are lacking. The study aim was to investigate the association between malnutrition and LOS by multivariable models adjusted for several confounders. Methods: This 3-year hospital cohort study (1274 ambulatory adult patients). The associations with prolonged LOS (>75th percentile of its distribution) were evaluated by multivariable loglinear models including nutritional and clinical confounders recorded at admission (Nutritional Risk Index [NRI], BMI, weight loss, admission ward, comorbidities, presence of malignancy, physician’s assessed disease severity) and collected during and at the end of hospital stay (in-hospital starvation and weight loss, death risk, the number of ICD-9 procedures). Results: Patients at nutritional risk (NRI < 97.5) were more likely to have prolonged LOS (>17 days; RR = 1.6; 95% CI, 1.3 2.1; p < 0.001). Also in-hospital weight loss 5% (RR = 1.6 [1.3 2.0]; p < 0.001), cancer (RR = 1.63 [1.3 2.0]; p < 0.001), hospitalization in surgical wards (RR = 1.2 [1.0 1.5]; p = 0.04) and higher physician-assessed severity score (RR = 1.2 [1.0 1.4]; p = 0.013) were independently associated with prolonged LOS. Sensitivity analysis on patients discharged alive and with a LOS 3 days (n = 1073) produced similar substantial associations (adjusted RR for NRI < 97.5, RR = 1.5 [1.2 1.9]; p < 0.001). A significant association was also found with in-hospital starvation 3 days (RR = 1.1 [1.0 1.3]; p = 0.028). Conclusion: Nutritional risk at admission is strongly associated with prolonged LOS in ambulatory adult patients. Another parameter associated with LOS is the worsening of nutritional status during hospitalization, whose cause-effect relationship with LOS should be clarified by intervention trials. Clinicians should be aware of the impact of malnutrition and of the potential role of nutritional status deterioration in prolonging hospital stay. Disclosure of Interest: None declared
Rationale: Exercising is getting popular in Greece and is associated with lower indices of obesity. Increased consumption of nutritional supplements has been observed in exercisers and present’s study objective was to assess gender differences in the use of nutritional supplements. Methods: 368 males (29±7.2 years) and 346 females (28±5.9 years) living in Thessaloniki, randomly recruited, completed a questionnaire (demographic data, nutritional supplements practices)developed for the study. Results: More (p < 0.01) male (53.4%) than female (29.2%) reported any supplements’ use during the last 3 months and for at least 21 consecutive days. Most males and females (65.1% vs. 52.8%) reported not to have received any professional consultation about nutritional supplements consumed, despite that 33.1% of males and more females (p < 0.01) were visiting a dietitian on a regular basis. “Friends’ recommendation” and “advise by trainer” were reported as the main sources of consultation when choosing a product. More males (p < 0.01) than females reported receiving supplements for improved physical performance. More females (p < 0.01) reported aesthetic reasons to be their main trigger. Proteins and amino acids supplements (shakes/bars) (p < 0.01), were more frequently consumed by males. Natural and herbal products were mostly (p < 0.01) consumed by females. No significant difference was found for isotonic drinks and multivitamins supplements intake. More males (p < 0.05) reported simultaneous use of products of more than 1 category. Conclusion: Our findings demonstrate extensive use of supplements, especially for males. Both genders receive relevant information by unqualified sources and many of them report to simultaneously receive more than one supplement. Since this practice may be harmful, it is necessary to target our efforts in educating this population where to seek for information on this subject. Disclosure of Interest: None declared
PP142 THE NUTRITION DAY SURVEY IN HOSPITALS AND IN THE COMMUNITY: ISRAEL 2010 D. Pinsker1 , Z. Stahl2 , I. Poraz3 , S. Kaplan4 , R. Endevelt5 , E. Merzon6 , D. Dvir7 , M. Grinev1 , P. Singer1 . 1 General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilisnon Hospital, Petah Tikva, 2 Nutrition, Ministry of Health, Jerusalem, 3 Dietetics, Clalit Health Services, Petah Tikva, 4 Dietietics, Mehuhedet HMO, Rehovot, 5 Dietetics, Maccabi HMO, 6 Family Practice, Leumit HMO, 7 Family Practice, Maccabi HMO, Tel Aviv, Israel Rationale: The Nutrition Day nationwide implementation has not been tested. Israel hospitals participated at
PP138 NUTRITIONAL STATUS PREDICTS LENGTH OF HOSPITAL STAY AND MORTALITY IN PATIENTS WITH CLOSTRIDIUM DIFFICILE (C.DIFF) INFECTION S.S.H. Wong1,2 , J. O’Driscoll3 , M. Weldon4 , C.Y. Yau5 . 1 Nutrition and Dietetics, National Spinal Injuries Centre, Aylesbury, 2 Centre of Gastroenterology and Clinical Nutrition, University College London, London, 3 Department of Microbiology, 4 Department of Gastroenterology, 5 Medicine for Older People, Stoke Mandeville Hospital, Aylesbury, United Kingdom Rationale: Malnutrition is associated with adverse consequences regarding health outcomes and healthcare expenditures. There is limited data reporting the association between nutritional status and hospital outcomes in patients with C. diff infection. The aim of the present study was to investigate the outcomes in patients with hospital acquired C. diff infection. Methods: 106 patients were assessed by Malnutrition Universal Screening Tool (MUST), and functional assessment of handgrip (HG). The impact of nutritional status on prevalence and hospital outcomes was analysed for these individuals. The outcomes measured were 1. length of hospital stay (LOS) and 2. mortality rate in 180 d. Results: The present study found that the prevalence of undernutrition was 58.3% (MUST =2) at the time of C. diff diagnosis, 74.5% of whom were aged greater than 65 years old. The average LOS was 68±85.3 day (range: 8 to 508d) and 180d mortality was 45.4%. Compared to patients at low risk of malnutrition (MUST = 0, HG > 85%), those who were malnourished (MUST =2, HG < 85%) fared worse. LOS was longer (72d vs. 42d, p < 0.047, 77d vs. 40d, p < 0.02) and mortality at 180d was significantly higher [32 (43%) vs. 1 (1.4%), p < 0.0001]. Conclusion: It is suggests that individuals with nosocomial clostridium difficile infection are associated with a significant clinical and financial burden to the health care system. The present study suggests both MUST score and
77 HG may predict clinical outcomes in patients with C. diff infection. Clinicians should be aware of the need to identify and treat malnutrition in hospitalised patients to prevent the development of severe C. diff infection. This may reduce both length of stay and mortality in this vulnerable group of patients. Disclosure of Interest: None declared
PP139 NUTRITIONAL CARE ROUTINES IN ITALY: RESULTS FROM THE PIMAI STUDY E. Cereda1 , L. Lucchin2 , C. Pedrolli3 , A. D’Amicis4 , R. Caccialanza1 , M.G. Gentile5 , N.C. Battistini6 , M.A. Fusco7 , A. Palmo8 , M. Muscaritoli9 , and PIMAI Group. 1 Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, 2 Dietetic and Clinical Nutrition Unit, Regional General Hospital, Bolzano, 3 Dietetic and Clinical Nutrition Unit, Trento Hospital, Trento, 4 National Institute for Research on Food and Nutrition (INRAN), Roma, 5 Dietetic and Clinical Nutrition Unit, “Niguarda-Ca Granda” Hospital, Milano, 6 Department of Applied Dietetic Technical Science, University of Modena and Reggio Emilia, Modena, 7 Dietetic and Clinical Nutrition Unit, “S.Camillo-Forlanini” Hospital, Roma, 8 Dietetic and Clinical Nutrition Unit, University Hospital San Giovanni Battista, Torino, 9 Department of Clinical Medicine, University “La Sapienza”, Roma, Italy Rationale: Disease-related malnutrition is a common comorbidity at hospital referral. The purpose of the present report was to describe the data on nutritional care routines collected during the PIMAI (Project: Iatrogenic MAlnutrition in Italy) study as these may be helpful to avoid iatrogenic malnutrition and improve nutritional policies. Methods: Standards of nutritional care were assessed on the basis of 1) adherence to study protocol (completeness of data collected); 2) attitude in assessing the nutritional status; 3) prescription of nutritional treatment (within 3 days) at least in patients presenting with overt malnutrition (BMI < 18.5 kg/m2 or significant weight loss [10% in 3 months and/or 5% in the last month]), regardless of its adequacy and adherence to current guidelines; 4) attitude in monitoring nutritional status during the stay (number of weight measurements performed compared to those expected). Results: In total 1583 subjects were assessed. A minimum data set for performing the NRS-2002 tool was available in 1284 patients (81.1%) but nutritional screening was possible in every patient by alternative analytical criteria related to food intake, anthropometry and biochemistry. However, several missing values were recorded, particularly in biochemical parameters due to lack of prescription by admission wards. According to ward practices, only 38.2% of the patients had the BMI calculated. A nutritional support was prescribed only to 26 of 191 patients (13.6%) presenting with overt malnutrition. Finally, we recorded that only 21.6% of the patients (207 of 960 randomly selected) received an adequate weight monitoring during the stay. This reality was worse in surgical rather than medical departments (17% vs 26%; P < 0.001).
78
Poster presentations
Conclusion: Present results from the PIMAI study confirm that in Italy nutritional routines towards the management of disease-related malnutrition are still poor and need improvements.
PP141 GENDER DIFFERENCES IN CONSUMPTION OF NUTRITIONAL SUPPLEMENTS AMONG GREEK MALE AND FEMALE EXERCISING IN COMMERCIAL GYMS
Disclosure of Interest: None declared
M. Chourdakis1 , D. Vassilakou1 , D. Papatsimpas1 , D. Kouvelas1 . 1 School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
PP140 NUTRITIONAL PARAMETERS ASSOCIATED WITH PROLONGED HOSPITALIZATION IN AMBULATORY ADULT PATIENTS R. Caccialanza1 , C. Klersy2 , E. Cereda1 , B. Cameletti1 , A. Bonoldi3 , C. Bonardi1 , M. Marinelli1 , P. Dionigi4 . 1 Servizio di Dietetica e Nutrizione Clinica, 2 Biometry and Clinical Epidemiology Service, 3 Hospital Management Unit, Fondazione IRCCS Policlinico San Matteo, 4 Institute of Hepatopancreatic Surgery, Fondazione IRCCS Policlinico San Matteo and Department of Surgical Sciences, University of Pavia, Pavia, Italy Rationale: Comprehensive evaluations of the nutritional parameters associated with length of hospital stay (LOS) are lacking. The study aim was to investigate the association between malnutrition and LOS by multivariable models adjusted for several confounders. Methods: This 3-year hospital cohort study (1274 ambulatory adult patients). The associations with prolonged LOS (>75th percentile of its distribution) were evaluated by multivariable loglinear models including nutritional and clinical confounders recorded at admission (Nutritional Risk Index [NRI], BMI, weight loss, admission ward, comorbidities, presence of malignancy, physician’s assessed disease severity) and collected during and at the end of hospital stay (in-hospital starvation and weight loss, death risk, the number of ICD-9 procedures). Results: Patients at nutritional risk (NRI < 97.5) were more likely to have prolonged LOS (>17 days; RR = 1.6; 95% CI, 1.3 2.1; p < 0.001). Also in-hospital weight loss 5% (RR = 1.6 [1.3 2.0]; p < 0.001), cancer (RR = 1.63 [1.3 2.0]; p < 0.001), hospitalization in surgical wards (RR = 1.2 [1.0 1.5]; p = 0.04) and higher physician-assessed severity score (RR = 1.2 [1.0 1.4]; p = 0.013) were independently associated with prolonged LOS. Sensitivity analysis on patients discharged alive and with a LOS 3 days (n = 1073) produced similar substantial associations (adjusted RR for NRI < 97.5, RR = 1.5 [1.2 1.9]; p < 0.001). A significant association was also found with in-hospital starvation 3 days (RR = 1.1 [1.0 1.3]; p = 0.028). Conclusion: Nutritional risk at admission is strongly associated with prolonged LOS in ambulatory adult patients. Another parameter associated with LOS is the worsening of nutritional status during hospitalization, whose cause-effect relationship with LOS should be clarified by intervention trials. Clinicians should be aware of the impact of malnutrition and of the potential role of nutritional status deterioration in prolonging hospital stay. Disclosure of Interest: None declared
Rationale: Exercising is getting popular in Greece and is associated with lower indices of obesity. Increased consumption of nutritional supplements has been observed in exercisers and present’s study objective was to assess gender differences in the use of nutritional supplements. Methods: 368 males (29±7.2 years) and 346 females (28±5.9 years) living in Thessaloniki, randomly recruited, completed a questionnaire (demographic data, nutritional supplements practices)developed for the study. Results: More (p < 0.01) male (53.4%) than female (29.2%) reported any supplements’ use during the last 3 months and for at least 21 consecutive days. Most males and females (65.1% vs. 52.8%) reported not to have received any professional consultation about nutritional supplements consumed, despite that 33.1% of males and more females (p < 0.01) were visiting a dietitian on a regular basis. “Friends’ recommendation” and “advise by trainer” were reported as the main sources of consultation when choosing a product. More males (p < 0.01) than females reported receiving supplements for improved physical performance. More females (p < 0.01) reported aesthetic reasons to be their main trigger. Proteins and amino acids supplements (shakes/bars) (p < 0.01), were more frequently consumed by males. Natural and herbal products were mostly (p < 0.01) consumed by females. No significant difference was found for isotonic drinks and multivitamins supplements intake. More males (p < 0.05) reported simultaneous use of products of more than 1 category. Conclusion: Our findings demonstrate extensive use of supplements, especially for males. Both genders receive relevant information by unqualified sources and many of them report to simultaneously receive more than one supplement. Since this practice may be harmful, it is necessary to target our efforts in educating this population where to seek for information on this subject. Disclosure of Interest: None declared
PP142 THE NUTRITION DAY SURVEY IN HOSPITALS AND IN THE COMMUNITY: ISRAEL 2010 D. Pinsker1 , Z. Stahl2 , I. Poraz3 , S. Kaplan4 , R. Endevelt5 , E. Merzon6 , D. Dvir7 , M. Grinev1 , P. Singer1 . 1 General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilisnon Hospital, Petah Tikva, 2 Nutrition, Ministry of Health, Jerusalem, 3 Dietetics, Clalit Health Services, Petah Tikva, 4 Dietietics, Mehuhedet HMO, Rehovot, 5 Dietetics, Maccabi HMO, 6 Family Practice, Leumit HMO, 7 Family Practice, Maccabi HMO, Tel Aviv, Israel Rationale: The Nutrition Day nationwide implementation has not been tested. Israel hospitals participated at