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PP151-MON: Improving Early Nutritional Intervention in Hospitalised Patients; Laboratory Testing (Prealbumin) Versus Routine Clinical Assessment
Nutritional assessment
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counselling to standard practice. At baseline the patients filled out the SGA questionnaire and recorded their consumption of food and beverages for four consecutive days, including one weekend day. The quantities of food and beverages were described in household measures. Energy intake (EI) was calculated by using the Norwegian National Food Composition Tables and was reported in absolute amounts (kcal), as well as divided by kilogram body weight (EI/kg) and basal metabolic rate (EI/BMR) calculated using Harris Benedict equation. Results: Twenty six male and 24 female were included. Median age was 64 years (range 41 85). Three patients did not fill in the food diary. Mean EI was 1833 kcal (SD 468, range 639 2902 kcal/day). Mean EI/kg was 25.2 kcal/kg (SD 6.2, range 9 42). Mean EI/BMR was 127 (SD 31, range 47 209). Food intake
N
EI (kcal)
EI/kg BW
EI/BMR
Unchanged More than usual Less than usual
27 4 16
1934±442 1869±225 1653±520 P = 0.280
25.9±5.8 25.5±3.2 23.9±7.5 P = 0.682
131±38 120±10 117±32 P = 0.251
expenditure rate strongly and inversely correlated with body fat percentage in Group A. Conclusion: REE was below the calculated BEE in patients with low ADL. The higher the percentage of body fat the greater the difference of REE and BEE. We must take caution in respect to excess energy administration in obese and low ADL patients. Disclosure of Interest: None Declared.
PP151-MON IMPROVING EARLY NUTRITIONAL INTERVENTION IN HOSPITALISED PATIENTS; LABORATORY TESTING (PREALBUMIN) VERSUS ROUTINE CLINICAL ASSESSMENT R. Walmsley1,2 , T. Eccles3 , A. Pountney4 , W. Stonehouse3 , G. Hardy2,3 . 1 Gastroenterology, North Shore Hospital, 2 Faculty of Medical and Health Sciences, University of Auckland, 3 Institute of Food, Nutrition & Human Health, Massey University, 4 Laboratory, North Shore Hospital, Auckland, New Zealand
P values: Kruskal Wallis ANOVA.
Conclusion: In this cohort of patients self-reported food intake was not associated with calculated energy intake. With the aim of assessing energy intake in patients with advanced cancer the PG-SGA questionnaire is not a valid instrument. Disclosure of Interest: None Declared.
PP150-MON ENERGY REQUIREMENTS IN OBESE PATIENTS WITH LOW ACTIVITIES OF DAILY LIVING H. Asakura1 , M. Hayasaki1 , K. Hamaguchi1 , T. Inaba2 , R. Fukushima2 . 1 Nutrition, 2 Surgery, Teikyo University hospital, Tokyo, Japan Rationale: Nutritional requirements are estimated by multiplying coefficients with basal energy expenditure (BEE) calculated by the Harris Benedict equation (HB). However, in patients with low activities of daily living (ADL), resting energy expenditures (REE) measured by indirect calorimeter are often below the BEE probably due to the loss of lean body mass. The aim of this study was to investigate the relations between BEE, REE and body compositions in patients with low ADL. Methods: We divided patients into a bedridden group who could not move by themselves (group A, n = 5) and an almost bedridden group who could keep a sitting position (group B, n = 6). Body fat percentage, skeletal muscle percentage, and total body water were measured using a Multifrequency Bioelectrical Impedance Analysis (In Body), and REE was measured using the indirect calorimeter (V max). BEE was calculated using the HB equation. Results: The following were noted: mean age (Group A: 51.0±16.7, Group B: 59.0±14.3), body mass index (BMI; 30.1±5.2, 33.9±9.7), body fat percentage (40.7±8.2%, 43.7±10.7%), Barthel index (16±9 pts, 62±12 pts), REE (1088±153 kcal, 1193±155 kcal), and HB-BEE (1491±224 kcal, 1507±118 kcal). REE was less than HB-BEE in both groups. In particular, REE in Group A was positively correlated with BMI and negatively correlated with body fat percentage. The energy expenditure rate, where REE is divided by BEE, was 74±12% in Group A and 79±6% in Group B, with the energy
Rationale: Malnutrition occurs in 30% of Australian and New Zealand Hospitals surveyed in 2010 [1]. In Waitemata District Health Board hospitals nutrition screening is by the Malnutrition Universal Screening Tool (MUST). Universal screening of hospital admission with Prealbumin (PAB) has been proposed as a more effective method of detecting patients at risk of malnutrition [2]. Aims: To assess whether introducing mandatory PAB screening increases referral to dietitians for assessment of malnutrition. Methods: Population: Consecutive patients admitted to 2 acute surgical, one orthopaedic and 2 acute medical wards. Two consecutive phases: Phase I, routine clinical care; which should involve nutrition screening by MUST; Phase II: routine clinical care + prealbumin testing taken within 36 hours of admission. End point: referrals to dietitian for assessment of malnutrition. Statistics: Chi squared analysis. Results: See the table. In phase II 27% of all admissions tested had a low PAB indicating malnutrition risk. 30% of those referred for dietitian assessment had a low PAB.
Phase I Phase II
No. of days
Admissions subject to screening method
Referrals to dietitians
25 22
970 (50.4% male) 564 (51% male)
77 (7.9%) 43 (7.6%) No sig. diff.
Conclusion: Risk of malnutrition is badly recognized by clinicians and universal PAB screening did not improve this. Universal screening with PAB might result in improved rates of detection of malnutrition if abnormal levels automatically triggered dietitian review. References [1] Agarwal E, et al. Nutrition care practices in hospital wards: Results from the Nutrition Care Day Survey 2010. Clinical Nutrition. 2011; 31(1): 41 47. [2] Robinson MK, et al. Improving nutritional screening of hospitalized patients: The role of prealbumin. Journal of Parenteral and Enteral Nutrition. 2003 Nov Dec; 27(6): 389 95. Disclosure of Interest: None Declared.
S185
counselling to standard practice. At baseline the patients filled out the SGA questionnaire and recorded their consumption of food and beverages for four consecutive days, including one weekend day. The quantities of food and beverages were described in household measures. Energy intake (EI) was calculated by using the Norwegian National Food Composition Tables and was reported in absolute amounts (kcal), as well as divided by kilogram body weight (EI/kg) and basal metabolic rate (EI/BMR) calculated using Harris Benedict equation. Results: Twenty six male and 24 female were included. Median age was 64 years (range 41 85). Three patients did not fill in the food diary. Mean EI was 1833 kcal (SD 468, range 639 2902 kcal/day). Mean EI/kg was 25.2 kcal/kg (SD 6.2, range 9 42). Mean EI/BMR was 127 (SD 31, range 47 209). Food intake
N
EI (kcal)
EI/kg BW
EI/BMR
Unchanged More than usual Less than usual
27 4 16
1934±442 1869±225 1653±520 P = 0.280
25.9±5.8 25.5±3.2 23.9±7.5 P = 0.682
131±38 120±10 117±32 P = 0.251
expenditure rate strongly and inversely correlated with body fat percentage in Group A. Conclusion: REE was below the calculated BEE in patients with low ADL. The higher the percentage of body fat the greater the difference of REE and BEE. We must take caution in respect to excess energy administration in obese and low ADL patients. Disclosure of Interest: None Declared.
PP151-MON IMPROVING EARLY NUTRITIONAL INTERVENTION IN HOSPITALISED PATIENTS; LABORATORY TESTING (PREALBUMIN) VERSUS ROUTINE CLINICAL ASSESSMENT R. Walmsley1,2 , T. Eccles3 , A. Pountney4 , W. Stonehouse3 , G. Hardy2,3 . 1 Gastroenterology, North Shore Hospital, 2 Faculty of Medical and Health Sciences, University of Auckland, 3 Institute of Food, Nutrition & Human Health, Massey University, 4 Laboratory, North Shore Hospital, Auckland, New Zealand
P values: Kruskal Wallis ANOVA.
Conclusion: In this cohort of patients self-reported food intake was not associated with calculated energy intake. With the aim of assessing energy intake in patients with advanced cancer the PG-SGA questionnaire is not a valid instrument. Disclosure of Interest: None Declared.
PP150-MON ENERGY REQUIREMENTS IN OBESE PATIENTS WITH LOW ACTIVITIES OF DAILY LIVING H. Asakura1 , M. Hayasaki1 , K. Hamaguchi1 , T. Inaba2 , R. Fukushima2 . 1 Nutrition, 2 Surgery, Teikyo University hospital, Tokyo, Japan Rationale: Nutritional requirements are estimated by multiplying coefficients with basal energy expenditure (BEE) calculated by the Harris Benedict equation (HB). However, in patients with low activities of daily living (ADL), resting energy expenditures (REE) measured by indirect calorimeter are often below the BEE probably due to the loss of lean body mass. The aim of this study was to investigate the relations between BEE, REE and body compositions in patients with low ADL. Methods: We divided patients into a bedridden group who could not move by themselves (group A, n = 5) and an almost bedridden group who could keep a sitting position (group B, n = 6). Body fat percentage, skeletal muscle percentage, and total body water were measured using a Multifrequency Bioelectrical Impedance Analysis (In Body), and REE was measured using the indirect calorimeter (V max). BEE was calculated using the HB equation. Results: The following were noted: mean age (Group A: 51.0±16.7, Group B: 59.0±14.3), body mass index (BMI; 30.1±5.2, 33.9±9.7), body fat percentage (40.7±8.2%, 43.7±10.7%), Barthel index (16±9 pts, 62±12 pts), REE (1088±153 kcal, 1193±155 kcal), and HB-BEE (1491±224 kcal, 1507±118 kcal). REE was less than HB-BEE in both groups. In particular, REE in Group A was positively correlated with BMI and negatively correlated with body fat percentage. The energy expenditure rate, where REE is divided by BEE, was 74±12% in Group A and 79±6% in Group B, with the energy
Rationale: Malnutrition occurs in 30% of Australian and New Zealand Hospitals surveyed in 2010 [1]. In Waitemata District Health Board hospitals nutrition screening is by the Malnutrition Universal Screening Tool (MUST). Universal screening of hospital admission with Prealbumin (PAB) has been proposed as a more effective method of detecting patients at risk of malnutrition [2]. Aims: To assess whether introducing mandatory PAB screening increases referral to dietitians for assessment of malnutrition. Methods: Population: Consecutive patients admitted to 2 acute surgical, one orthopaedic and 2 acute medical wards. Two consecutive phases: Phase I, routine clinical care; which should involve nutrition screening by MUST; Phase II: routine clinical care + prealbumin testing taken within 36 hours of admission. End point: referrals to dietitian for assessment of malnutrition. Statistics: Chi squared analysis. Results: See the table. In phase II 27% of all admissions tested had a low PAB indicating malnutrition risk. 30% of those referred for dietitian assessment had a low PAB.
Phase I Phase II
No. of days
Admissions subject to screening method
Referrals to dietitians
25 22
970 (50.4% male) 564 (51% male)
77 (7.9%) 43 (7.6%) No sig. diff.
Conclusion: Risk of malnutrition is badly recognized by clinicians and universal PAB screening did not improve this. Universal screening with PAB might result in improved rates of detection of malnutrition if abnormal levels automatically triggered dietitian review. References [1] Agarwal E, et al. Nutrition care practices in hospital wards: Results from the Nutrition Care Day Survey 2010. Clinical Nutrition. 2011; 31(1): 41 47. [2] Robinson MK, et al. Improving nutritional screening of hospitalized patients: The role of prealbumin. Journal of Parenteral and Enteral Nutrition. 2003 Nov Dec; 27(6): 389 95. Disclosure of Interest: None Declared.