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PP256 COMPARING OUTCOME, PROCESS AND STRUCTURE INDICATORS OF CARE FOR MALNOURISHED RESIDENTS IN GERMAN AND DUTCH NURSING HOMES
122
Poster presentations
References Dunne JL and Dahl WJ (2007) Nutr Rev 65(3), 135 138. Wright L, Cotter D, Hickson M and Frost G (2005) J Hum Nutr Diet 18 213 219. Disclosure of Interest: None declared
PP254 SURVIVAL ESTIMATES USING ABC INDEX
3RD REPORT
M. Hasegawa , Y. Mizuno , H. Takeyama . 1 Surgery, Taigenkai Hospital, Ichinomiya, 2 Internal medicine, Nagoya-shi Kouseiin, 3 Surgery, Nagoya City University, Nagoya, Japan 1
2
3
Rationale: Three years ago in Prague, I reported ABC index is a more useful predictor of mortality for nonambulatory tube-fed patients. This time we report five years survival and annual change of indexes. Methods: Eighty-six patients were divided into two groups based on (1) ABC index (s-Alb × body weight/administered calorie), (2) s-Alb and (3) GNRI in September 2004. High index group (HI: 0.16) vs. Low index group (LI: <0.16), High albumin group (HA: 3.5) vs. Low albumin group (LA: <3.5), High GNRI group (HG: 82.75[median]) vs. Low GNRI group (LG: <82.75). Statistical analysis was performed by use of the T-test for assessing differences between groups, and the Kaplan-Meier method for estimating survival curves and the log-rank test for assessing differences in survival between groups. A p value of <0.05 was considered significant. Results: 1. Five year mortalities were 69.0% in HI and 86.4% in LI (p = 0.0200). ABC index were 0.204±0.032 gkg/dl/Cal vs. 0.133±0.020 gkg/dl/Cal (p = 4.75×10 19 ) at first, 0.180±0.037 vs. 0.147±0.026 (p = 2.95×10 4 ) 1 year after, 0.178±0.033 vs. 0.146±0.040 (p = 5.17×10 3 ) 2 year after, 0.183±0.039 vs. 0.141±0.039 (p = 4.14×10 3 ) 3 year after, 0.169±0.034 vs. 0.151±0.036 (NS) 4 year after, 0.163±0.026 vs. 0.175±0.022 (NS) 5 year after. 2. 71.4% in HA and 82.4% in LA (NS). s-Alb were 3.74±0.19 g/dl vs. 3.12±0.30 g/dl (p = 3.05×10 19 ), 3.50±0.28 vs. 3.09±0.31 (p = 2.01×10 6 ), 3.40±0.32 vs. 3.05±0.34 (p = 1.10×10 3 ), 3.35±0.31 vs. 3.08±0.35 (p = 0.021), 3.40±0.44 vs. 3.14±0.40 (NS), 3.41±0.28 vs. 3.24±0.43 (NS), respectively. 3. 67.4% in HG and 88.3% in LG (p = 0.0028). GNRI were 89.1±5.25 vs. 76.3±5.39 (p = 3.16×10 18 ), 83.7±6.18 vs. 78.0±6.20 (p = 8.34×10 4 ), 81.1±5.78 vs. 77.5±8.25 (NS), 80.1±6.20 vs. 77.3±7.74 (NS), 79.5±7.82 vs. 78.9±4.90 (NS), 82.1±5.77 vs. 76.7±4.27 (NS), respectively. Conclusion: If these patients were divided based on GNRI (cut off 92). Only 12 patients belonged to high GNRI group.ABC index is predictor of mortality for nonambulatory tube-fed patients in Japan. Disclosure of Interest: None declared
PP255 NUTRITIONAL STATUS OF VERY OLD PERSONS IN SOCIAL HOMES Z. Lelovics1 , E. Hartmann2 , R. Bozo-Kegyes3 , M. Hiesmayr4 . 1 Association for Healthy Hungary, Budapest, 2 Faculty of Health Sciences, University of Pecs, Pecs, 3 Domb´ ov´ ar Hospital, Domb´ ov´ ar, Hungary; 4 Div. of Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria Rationale: The prevalence of malnutrition depends on criteria and number of criteria used. It is between 15% and 60% in Europe. Nutritional screening has to be simple and quick to perform, e.g. the Malnutrition Universal Screening Tool (MUST). Our aim is to present the main outcomes of the nutritionDay study and the results of MUST survey done at the same time in the group of residents older than 80. Methods: All the residents who gave informed consent were assessed with the standardised questionnaires for nursing homes provided by the nutritionDay office and the MUST questionnaire. Data are presented as mean and standard deviations and 95% confidential intervals where applicable. Results: Altogether 840 residents (17.7% were men)was mean age 86.0±4.1 years, and they spent on average 55.3±68.3 months in the social home.Demographic and anthropometrical data did not differ between the two surveys. Approximately once a month is screened the 53.9% of the residents and never is assessed 13.7% of them. 11.9% of the surveyed people were malnourished according to the BMI, and 3.4% of them according to weight loss. Using the MUST criteria, 17.0% of the residents have high risk of malnutrition. Different severity of cognitive function was in significant (r = 0.33, p < 0.001) relation with the MUST score.Only 8.8% of the residents received any kind of artificial nutrition support. 23.3% of the residents ate less than half of the portions. They presented the following reasons for this: the food was not properly made in 41.3%; the food was not served in proper time in 17.4%. Conclusion: Any kind of nutritional screening is done rarely, and the estimation of malnutrition is inaccurate. The prevalence of malnutrition in Hungarian nursing homes is in accordance with international data. Most of the patients with high risk of malnutrition did not receive the proper nutritional therapy, and the declined food intake was due to cooking and timing problems. Disclosure of Interest: None declared
PP256 COMPARING OUTCOME, PROCESS AND STRUCTURE INDICATORS OF CARE FOR MALNOURISHED RESIDENTS IN GERMAN AND DUTCH NURSING HOMES N.V. Nie-Visser1 , J. Meijers1 , S. Bartholomeyczik2 , S. Reuther2 , J. Schols3 , R. Halfens1 . 1 Health Care and Nursing Science, Maastricht Univeristy, Maastricht, ur Pflegewissenschaft, Universit¨ at Netherlands; 2 Institur f¨ Witten-Herdecke, Witten, Germany; 3 General Practice, Maastricht University, Maastricht, Netherlands Rationale: Although malnutrition is a major problem in all health care settings all over the world, there are not
Geriatrics II many studies comparing outcome (prevalence), process (screening and treatment of malnutrition) and structure indicators of nutritional care in different countries, using the same methodology. Therefore we conducted a study in Germany (G) and the Netherlands (NL). Methods: A cross-sectional international prevalence study was performed in 151 nursing homes (NL n = 5848, G n = 4923). A standardized questionnaire (3 levels) was used: at institutional and ward level structure indicators of nutritional care were assessed, whereas at patient level demographic data, care dependency and nutritional screening and treatment interventions for malnutrition were measured. Malnutrition was measured by assessing BMI, undesired weight loss and nutritional intake. Results: Dutch residents were older, more often male, more care dependent, and have a lower BMI than German residents. Dutch residents were more at risk of malnutrition (NL = 31.7% and G = 29.1%, p = 0.03), but no significant difference was found in the prevalence of malnutrition between both countries. About half of the malnourished residents received a nutritional intervention. Structure indicators at institutional level were more often fulfilled in the NL, only education was given more often in G. Besides having a specialized person in malnutrition, all other indicators on ward level were more often fulfilled in G. Conclusion: Malnutrition is a problem in more than a quarter of nursing home residents in each of the countries. Despite the fact that nutritional screening is rather frequently performed, nutritional interventions are provided only in about 50% of the malnourished patients. Structure indicators at ward level are more fulfilled in G, whereas at institutional level they are more fulfilled in NL. Disclosure of Interest: None declared
PP257 Outstanding abstract META-ANALYSIS SHOWS REDUCED HEALTH CARE USE AND COSTS WITH ORAL NUTRITIONAL SUPPLEMENTS A.L. Cawood1 , M. Elia2 , R.J. Stratton1 . 1 Medical Affairs, Nutricia Ltd, Trowbridge, 2 Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom Rationale: Despite use of oral nutritional supplements (ONS) in clinical practice there is limited information of their effect on health care use. This systematic review and meta-analysis (update of Cawood 2008) investigated the effect of high protein ONS versus control (routine care, placebo) on length of stay, readmissions and costs. Methods: Searches of electronic databases and bibliographies (up to Jan 2010) identified 36 RCT (n3790) using high protein ONS (20% energy from protein, (Lochs 2006)) in addition to diet. 9 RCT (n1227), in patients with hip fracture and acute illness, (prescribed daily intake 149 995 kcal, 10 50 g protein, 0.5 6mo) reported data on length of stay, including acute and rehab hospitals. 2 RCT (n546) in patients with GI disease and acute illness reported data on readmissions. One used ONS in both hospital and community and one in community only (prescribed daily intake 900 995 kcal,
123 50 60 g protein, 6wks-6mo).Meta-analysis was performed using Comprehensive Meta-Analysis. Results: Meta-analysis of hospital admissions showed that high protein ONS significantly reduced length of stay compared to control ( 4.5d, 95% CI 8 to 1 d, p = 0.013, random effects). The associated reduction in bed-day costs (Curtis 2009) corresponded to £1405 per patient enrolled in the study. Two RCT which reported readmissions showed significant reductions in favour of ONS (28% and 46% reductions; OR 0.58; 95% CI 0.4 to 0.8, p = 0.004, fixed effects), with associated significant cost savings (£323; 95% CI £110 533 per patient enrolled; p = 0.003) (Curtis 2009). Conclusion: This systematic review and meta-analysis shows that high protein ONS can significantly reduce the length of stay associated with hospital admissions and the number of hospital readmissions, both of which have important economic implications. References Cawood A. Proc Nut Soc 2008; 67: E118. Curtis L. Unit Costs of health and social care, 2009. Lochs H. Clin Nutr 2006; 25: 180 186. Disclosure of Interest: None declared
PP258 Outstanding abstract SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECTS OF HIGH PROTEIN ORAL NUTRITIONAL SUPPLEMENTS (ONS) ON NUTRITIONAL STATUS AND INTAKE A.L. Cawood1 , M. Elia2 , R. Freeman1 , R.J. Stratton1 . 1 Medical Affairs, Nutricia Ltd, Trowbridge, 2 Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom Rationale: High protein ONS are used in clinical practice to improve intake, weight and lean tissue in wasted and catabolic patients. This systematic review and metaanalysis aimed to synthesise the evidence for high protein ONS versus control (routine care, placebo) on nutritional intake, weight and muscle mass. Methods: Searches of electronic databases and bibliographies (up to Jan 2010) identified 36 RCT (n3790) in which multi-nutrient high protein ONS (20% energy from protein, Lochs 2006) were added to the diets of a range of patient groups including elderly, respiratory disease, hip fracture, cancer, GI disease and other critical and acute illnesses. Fifteen RCT, across settings (n = 1473) (prescribed daily intake 200 900 kcal; 11.75 60 g protein; 15 days 12 months) reported changes in total energy and/or protein intakes (diet + ONS). Twelve RCT (n = 1244) (prescribed daily intake 200 995 kcal; 10 60 g protein; 28 days 12 months) reported changes in weight and four RCT changes in mid arm muscle circumference (MAMC). Meta-analysis was performed using Comprehensive MetaAnalysis v2. Results: Meta analysis showed high protein ONS: significantly increased intake of total energy (313.6 kcal, 95% CI 145.7 to 481.6, 12 RCT, p < 0.001), total protein (22 g, 95% CI 10 34 g, 10 RCT, p < 0.001) and significantly improved weight (1.8 kg, 95% CI 1.0 2.7, 12 RCT, p < 0.001) all compared to control. All 4 RCT reported changes in
Poster presentations
References Dunne JL and Dahl WJ (2007) Nutr Rev 65(3), 135 138. Wright L, Cotter D, Hickson M and Frost G (2005) J Hum Nutr Diet 18 213 219. Disclosure of Interest: None declared
PP254 SURVIVAL ESTIMATES USING ABC INDEX
3RD REPORT
M. Hasegawa , Y. Mizuno , H. Takeyama . 1 Surgery, Taigenkai Hospital, Ichinomiya, 2 Internal medicine, Nagoya-shi Kouseiin, 3 Surgery, Nagoya City University, Nagoya, Japan 1
2
3
Rationale: Three years ago in Prague, I reported ABC index is a more useful predictor of mortality for nonambulatory tube-fed patients. This time we report five years survival and annual change of indexes. Methods: Eighty-six patients were divided into two groups based on (1) ABC index (s-Alb × body weight/administered calorie), (2) s-Alb and (3) GNRI in September 2004. High index group (HI: 0.16) vs. Low index group (LI: <0.16), High albumin group (HA: 3.5) vs. Low albumin group (LA: <3.5), High GNRI group (HG: 82.75[median]) vs. Low GNRI group (LG: <82.75). Statistical analysis was performed by use of the T-test for assessing differences between groups, and the Kaplan-Meier method for estimating survival curves and the log-rank test for assessing differences in survival between groups. A p value of <0.05 was considered significant. Results: 1. Five year mortalities were 69.0% in HI and 86.4% in LI (p = 0.0200). ABC index were 0.204±0.032 gkg/dl/Cal vs. 0.133±0.020 gkg/dl/Cal (p = 4.75×10 19 ) at first, 0.180±0.037 vs. 0.147±0.026 (p = 2.95×10 4 ) 1 year after, 0.178±0.033 vs. 0.146±0.040 (p = 5.17×10 3 ) 2 year after, 0.183±0.039 vs. 0.141±0.039 (p = 4.14×10 3 ) 3 year after, 0.169±0.034 vs. 0.151±0.036 (NS) 4 year after, 0.163±0.026 vs. 0.175±0.022 (NS) 5 year after. 2. 71.4% in HA and 82.4% in LA (NS). s-Alb were 3.74±0.19 g/dl vs. 3.12±0.30 g/dl (p = 3.05×10 19 ), 3.50±0.28 vs. 3.09±0.31 (p = 2.01×10 6 ), 3.40±0.32 vs. 3.05±0.34 (p = 1.10×10 3 ), 3.35±0.31 vs. 3.08±0.35 (p = 0.021), 3.40±0.44 vs. 3.14±0.40 (NS), 3.41±0.28 vs. 3.24±0.43 (NS), respectively. 3. 67.4% in HG and 88.3% in LG (p = 0.0028). GNRI were 89.1±5.25 vs. 76.3±5.39 (p = 3.16×10 18 ), 83.7±6.18 vs. 78.0±6.20 (p = 8.34×10 4 ), 81.1±5.78 vs. 77.5±8.25 (NS), 80.1±6.20 vs. 77.3±7.74 (NS), 79.5±7.82 vs. 78.9±4.90 (NS), 82.1±5.77 vs. 76.7±4.27 (NS), respectively. Conclusion: If these patients were divided based on GNRI (cut off 92). Only 12 patients belonged to high GNRI group.ABC index is predictor of mortality for nonambulatory tube-fed patients in Japan. Disclosure of Interest: None declared
PP255 NUTRITIONAL STATUS OF VERY OLD PERSONS IN SOCIAL HOMES Z. Lelovics1 , E. Hartmann2 , R. Bozo-Kegyes3 , M. Hiesmayr4 . 1 Association for Healthy Hungary, Budapest, 2 Faculty of Health Sciences, University of Pecs, Pecs, 3 Domb´ ov´ ar Hospital, Domb´ ov´ ar, Hungary; 4 Div. of Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria Rationale: The prevalence of malnutrition depends on criteria and number of criteria used. It is between 15% and 60% in Europe. Nutritional screening has to be simple and quick to perform, e.g. the Malnutrition Universal Screening Tool (MUST). Our aim is to present the main outcomes of the nutritionDay study and the results of MUST survey done at the same time in the group of residents older than 80. Methods: All the residents who gave informed consent were assessed with the standardised questionnaires for nursing homes provided by the nutritionDay office and the MUST questionnaire. Data are presented as mean and standard deviations and 95% confidential intervals where applicable. Results: Altogether 840 residents (17.7% were men)was mean age 86.0±4.1 years, and they spent on average 55.3±68.3 months in the social home.Demographic and anthropometrical data did not differ between the two surveys. Approximately once a month is screened the 53.9% of the residents and never is assessed 13.7% of them. 11.9% of the surveyed people were malnourished according to the BMI, and 3.4% of them according to weight loss. Using the MUST criteria, 17.0% of the residents have high risk of malnutrition. Different severity of cognitive function was in significant (r = 0.33, p < 0.001) relation with the MUST score.Only 8.8% of the residents received any kind of artificial nutrition support. 23.3% of the residents ate less than half of the portions. They presented the following reasons for this: the food was not properly made in 41.3%; the food was not served in proper time in 17.4%. Conclusion: Any kind of nutritional screening is done rarely, and the estimation of malnutrition is inaccurate. The prevalence of malnutrition in Hungarian nursing homes is in accordance with international data. Most of the patients with high risk of malnutrition did not receive the proper nutritional therapy, and the declined food intake was due to cooking and timing problems. Disclosure of Interest: None declared
PP256 COMPARING OUTCOME, PROCESS AND STRUCTURE INDICATORS OF CARE FOR MALNOURISHED RESIDENTS IN GERMAN AND DUTCH NURSING HOMES N.V. Nie-Visser1 , J. Meijers1 , S. Bartholomeyczik2 , S. Reuther2 , J. Schols3 , R. Halfens1 . 1 Health Care and Nursing Science, Maastricht Univeristy, Maastricht, ur Pflegewissenschaft, Universit¨ at Netherlands; 2 Institur f¨ Witten-Herdecke, Witten, Germany; 3 General Practice, Maastricht University, Maastricht, Netherlands Rationale: Although malnutrition is a major problem in all health care settings all over the world, there are not
Geriatrics II many studies comparing outcome (prevalence), process (screening and treatment of malnutrition) and structure indicators of nutritional care in different countries, using the same methodology. Therefore we conducted a study in Germany (G) and the Netherlands (NL). Methods: A cross-sectional international prevalence study was performed in 151 nursing homes (NL n = 5848, G n = 4923). A standardized questionnaire (3 levels) was used: at institutional and ward level structure indicators of nutritional care were assessed, whereas at patient level demographic data, care dependency and nutritional screening and treatment interventions for malnutrition were measured. Malnutrition was measured by assessing BMI, undesired weight loss and nutritional intake. Results: Dutch residents were older, more often male, more care dependent, and have a lower BMI than German residents. Dutch residents were more at risk of malnutrition (NL = 31.7% and G = 29.1%, p = 0.03), but no significant difference was found in the prevalence of malnutrition between both countries. About half of the malnourished residents received a nutritional intervention. Structure indicators at institutional level were more often fulfilled in the NL, only education was given more often in G. Besides having a specialized person in malnutrition, all other indicators on ward level were more often fulfilled in G. Conclusion: Malnutrition is a problem in more than a quarter of nursing home residents in each of the countries. Despite the fact that nutritional screening is rather frequently performed, nutritional interventions are provided only in about 50% of the malnourished patients. Structure indicators at ward level are more fulfilled in G, whereas at institutional level they are more fulfilled in NL. Disclosure of Interest: None declared
PP257 Outstanding abstract META-ANALYSIS SHOWS REDUCED HEALTH CARE USE AND COSTS WITH ORAL NUTRITIONAL SUPPLEMENTS A.L. Cawood1 , M. Elia2 , R.J. Stratton1 . 1 Medical Affairs, Nutricia Ltd, Trowbridge, 2 Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom Rationale: Despite use of oral nutritional supplements (ONS) in clinical practice there is limited information of their effect on health care use. This systematic review and meta-analysis (update of Cawood 2008) investigated the effect of high protein ONS versus control (routine care, placebo) on length of stay, readmissions and costs. Methods: Searches of electronic databases and bibliographies (up to Jan 2010) identified 36 RCT (n3790) using high protein ONS (20% energy from protein, (Lochs 2006)) in addition to diet. 9 RCT (n1227), in patients with hip fracture and acute illness, (prescribed daily intake 149 995 kcal, 10 50 g protein, 0.5 6mo) reported data on length of stay, including acute and rehab hospitals. 2 RCT (n546) in patients with GI disease and acute illness reported data on readmissions. One used ONS in both hospital and community and one in community only (prescribed daily intake 900 995 kcal,
123 50 60 g protein, 6wks-6mo).Meta-analysis was performed using Comprehensive Meta-Analysis. Results: Meta-analysis of hospital admissions showed that high protein ONS significantly reduced length of stay compared to control ( 4.5d, 95% CI 8 to 1 d, p = 0.013, random effects). The associated reduction in bed-day costs (Curtis 2009) corresponded to £1405 per patient enrolled in the study. Two RCT which reported readmissions showed significant reductions in favour of ONS (28% and 46% reductions; OR 0.58; 95% CI 0.4 to 0.8, p = 0.004, fixed effects), with associated significant cost savings (£323; 95% CI £110 533 per patient enrolled; p = 0.003) (Curtis 2009). Conclusion: This systematic review and meta-analysis shows that high protein ONS can significantly reduce the length of stay associated with hospital admissions and the number of hospital readmissions, both of which have important economic implications. References Cawood A. Proc Nut Soc 2008; 67: E118. Curtis L. Unit Costs of health and social care, 2009. Lochs H. Clin Nutr 2006; 25: 180 186. Disclosure of Interest: None declared
PP258 Outstanding abstract SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECTS OF HIGH PROTEIN ORAL NUTRITIONAL SUPPLEMENTS (ONS) ON NUTRITIONAL STATUS AND INTAKE A.L. Cawood1 , M. Elia2 , R. Freeman1 , R.J. Stratton1 . 1 Medical Affairs, Nutricia Ltd, Trowbridge, 2 Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom Rationale: High protein ONS are used in clinical practice to improve intake, weight and lean tissue in wasted and catabolic patients. This systematic review and metaanalysis aimed to synthesise the evidence for high protein ONS versus control (routine care, placebo) on nutritional intake, weight and muscle mass. Methods: Searches of electronic databases and bibliographies (up to Jan 2010) identified 36 RCT (n3790) in which multi-nutrient high protein ONS (20% energy from protein, Lochs 2006) were added to the diets of a range of patient groups including elderly, respiratory disease, hip fracture, cancer, GI disease and other critical and acute illnesses. Fifteen RCT, across settings (n = 1473) (prescribed daily intake 200 900 kcal; 11.75 60 g protein; 15 days 12 months) reported changes in total energy and/or protein intakes (diet + ONS). Twelve RCT (n = 1244) (prescribed daily intake 200 995 kcal; 10 60 g protein; 28 days 12 months) reported changes in weight and four RCT changes in mid arm muscle circumference (MAMC). Meta-analysis was performed using Comprehensive MetaAnalysis v2. Results: Meta analysis showed high protein ONS: significantly increased intake of total energy (313.6 kcal, 95% CI 145.7 to 481.6, 12 RCT, p < 0.001), total protein (22 g, 95% CI 10 34 g, 10 RCT, p < 0.001) and significantly improved weight (1.8 kg, 95% CI 1.0 2.7, 12 RCT, p < 0.001) all compared to control. All 4 RCT reported changes in