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The mini nutritional assessment is effective in the group of elderly patients suffering from Alzheimer disease
PHYSIOLOGY
AND
NUTRITIONAL
Sl
ASSESSMENT
tecting 82% of grade C malnourished patients. Such screening tool could be systematically perfomed by the nurse or dietitian on the day of admission.
023-P. THE MINI NUTRITIONAL ASSESSMENT IS EFFECTIVE IN THE GROUP O F ELDERLY PATIENTS SUFFERING F R O M ALZHEIMER DISEASE L. Sobotka t , M. Navratilova’, R. Hyspler t , Z. Zadak’ ‘Department of Metabolic Care and Gerontology, Faculty of Medicine, Charles University, Hradec Kralove, 2Department of Psychiatry, Faculty Hospital, Brno, Czech Republic Rationale: The Mini Nutritional Assessment (MNA) is valuable method for early recognition of malnutrition in elderly persons. Weight loss is a common problem in patients with Alzheimer’s Disease, however the efficacy of MNA in this group of patient is not fully known. The aim of present study was to assessthe ability of MNA to predict the risk of malnutrition in elderly patients with dementia of AD origin or vasculzu dementia (VD). Method: The study was provided on 149 institutionalized elderly subjects. The patients weight and height was recorded; skinfold thickness was measured above left triceps muscle. Spontaneous nutritional intake was measured during three working days and one weekend day. Data were compxed by t-test and regression analysis. Results: 97 patients suffered from AD and 52 patients from VD. BMI lower than 22 kg.m-2 was recorded in 43.3% of AD patients and in 25% of VD patients. BMI was significantly lover in AD patients than in patients with VD (25.5 f 5.0 vs. 23.0 f 3.6 kg.m-2- piO.001). Triceps skinfold thickness was also lower in AD patients (1.38 f 0.6 vs. 1.7 f 0.85 c m - piO.01). Spontaneous food intake was only moderately lower in AD patients than in VD, however, the difference was statistically significant (9899 f 2844 vs. 10877 f 2383 Id/day - piO.05). MNA correlated significantly with food intake both in AD group (piO.01) as well as in VD group (piO.01). Conclusions: It can be concluded from 0~1’study that patients with AD xe more frequently malnourished than patients with VD. MNA is a good method for prediction of malnutrition in elderly patients with AD.
024-P. BIOCHEMICAL PARAMETERS FOR THE ASSESSMENT O F MALNUTRITION AND FOR MONITORING NUTRITION INTERVENTION IN ANOREXIA NERVOSA M. Nardi, A. Lion, L. Di Pascoli, A. Favxo, P. Santonastaso, D. Milazzo, E. Zola, R. Crecca, L. Caregaro Centre for Eating Disorders, University of Padua, Padua, Italy Rationale: The study aimed to individuate the most useful biochemical parameters for nutritional assessment and for monitoring nutritional changes during refeeding in anorexia nervosa (AN). Method: At baseline and at the end of the ezuiy phase of refeeding (26flO days), we evaluated clinical and biochemical parameters in 24 AN patients who consecutively entered an inpatient refeeding program. Mean age was 24.2f8.2 y, duration of illness 40.3f43.8 months, and BMI 13.7f1.9. Biochemical evaluation included: s-albumin, prealbumin, transferrin, retinolbinding protein (RBP), IGF-1, lymphocyte count, and thyroid hormones. BMI, zmn muscle area (AMA) and zmn fat xea (AFA) were also measured. Results: At baseline, IGF-1 z score was s-1 in all patients, while prealbumin was lower than normal in 4.8%, RBP in 12.5%, albumin in 14.3%, transferrin in 33.3%, lymphocyte count in 20.8%, and ff3 in 50% of them. AFA was 55th percentile in all, and AMA in 71.4%. At the end of the early phase of refeeding mean BMI was 14.7f1.8 (p=O.OOOcompxed to baseline). AMA and AFA significantly increased (p=O.OOO),as well as prealbumin (p=O.Ol), transferrin (p=O.OOl), and IGF-1 (p=O.O02). The percentage increase of IGF-1 averaged 56%. Other parameters did not vxy significantly. Conclusions: Protein malnutrition, as evidenced by low values of serum proteins, is not uncommon in severely malnourished patients with AN. The reduction of IGF-1 and transferrin is the most frequent biochemical abnormality. IGF-1 is the most sensitive index of nutrition repletion, but s-transferrin and s-prealbumin may also be useful for monitoring nutritional changes during refeeding.
025-P. IS BODY MASS INDEX AN APPROPRIATE MEASURE O F NUTRITIONAL STATUS IN PATIENTS W ITH HEART FAILURE OR DILATED CARDIOMYOPATHY? S.A. Hood Nutrition and Dietetics, St George’s Healthcare NHS Trust, London, UK Rationale: Body mass index (BMI) is routinely calculated in the nutritional assessmentof patients with heart failure and dilated cxdiomyopathy, however undernutrition may be masked by the presence of obesity. Method: Fifty-five patients attending a heart failure/dilated cxdiomyopathy clinic wele recruited to a prospective cohort study. Weight, height, BMI, mid-upper zum circumference (MUAC), nutritional status and cxdisc cachexia were assessed. Nutritional status was assessed using Subjective Global Assessment and patients classified as well nourished (WN), moderately malnourished (MM) and severely malnourished (SM). Cardiac cachexia was assessedusing Anker’s criteria of a weight loss of >7.5% over >6 months. Results: Despite 9 patients being classified as moderately or severely malnourished, no patient had a BMI 120. Of the four patients who were classified as cachectic using Anker’s criteria, one was classified as WN, two as M M and one as SN. Anker’s criteria failed to detect one patient who was subjectively classified as S M with a MUAC of 55th centile. However, one patient with weight loss due to a change in social circumstances was identified as cachectic. A comparison
Nomal
of SGA
weight
Overweight
(BMI
(BMI
Obese I (BMI Obese II (BMI
20-24.9)
25-29.9)
30-34.9) 35-39.9)
Obese III (BMI>40)
and BMI Well
Moderately
nourished
malnourished
Severely malnourished
7
3
2
1x
3
0
13
1
0
6
0
0
2
0
0
Conclusions: BMI is unable to accurately detect undernutrition in this patient group. A variety of methods should be used to investigate undemutrition and be interpreted in light of a clinical history.
026-P. IS PHYSICAL ACTIVITY MEASURED BY ACCELEROMETER USEFUL AS A PARAMETER O F NUTRITIONAL ASSESSMENT? T. Kimma’, Y. Inoue’, S. Fujita’, M. Yoshikawa’, T. Ito’, H. Matsuda’ ‘Department of Surgery, Osaka University Graduate School of Medicine, Suita City, 2Department of Surgery, Nissay Hospital, Osaka City, Japan Rationale: Physical function is important as a parameter of nutritional assessment, but only skeletal muscle function, such as grip strength or the force of isometric contractions of the adductor pollicis muscle, is used. There is no parameter for integral physical activity. Accelerometer is a device that measures the gravitational acceleration of body movement, and hence permits quantitative evaluation of physical function. The purpose of this study is to investigate the possibility of physical activity as a parameter of nutritional assessment. Method: 130 patients were classified into 3 groups according to SGA; Group A (well nourished, n=85), Group B (moderately malnourished, n=32), Group C (severely malnourished, n=13). A portable accelerometer (1OOg)was attached to patient’s waist, and gravitational acceleration of body movement was measured continuously for 3 days. Cumulative acceleration for three days was calculated into the value for 24 hours and defined 24-hour physical activity. Compz&on of %IBW, %UBW, %TSF, %AMC, serum protein values and 24-hour physical activity were canied out among three groups. Results: There were significant differences of %IBW, %UBW, %TSF, %AMC, albumin, prealbumin and retinal-binding protein value among 3 groups. The 24-horn physical activity shows a consistent tendency to decrease as the severity of malnutrition developed and was significantly different among 3 groups; group A: lO.lf3.2G, group B: S.Sf3.1G, group C: 6.5f2.7G (piO.05).
AND
NUTRITIONAL
Sl
ASSESSMENT
tecting 82% of grade C malnourished patients. Such screening tool could be systematically perfomed by the nurse or dietitian on the day of admission.
023-P. THE MINI NUTRITIONAL ASSESSMENT IS EFFECTIVE IN THE GROUP O F ELDERLY PATIENTS SUFFERING F R O M ALZHEIMER DISEASE L. Sobotka t , M. Navratilova’, R. Hyspler t , Z. Zadak’ ‘Department of Metabolic Care and Gerontology, Faculty of Medicine, Charles University, Hradec Kralove, 2Department of Psychiatry, Faculty Hospital, Brno, Czech Republic Rationale: The Mini Nutritional Assessment (MNA) is valuable method for early recognition of malnutrition in elderly persons. Weight loss is a common problem in patients with Alzheimer’s Disease, however the efficacy of MNA in this group of patient is not fully known. The aim of present study was to assessthe ability of MNA to predict the risk of malnutrition in elderly patients with dementia of AD origin or vasculzu dementia (VD). Method: The study was provided on 149 institutionalized elderly subjects. The patients weight and height was recorded; skinfold thickness was measured above left triceps muscle. Spontaneous nutritional intake was measured during three working days and one weekend day. Data were compxed by t-test and regression analysis. Results: 97 patients suffered from AD and 52 patients from VD. BMI lower than 22 kg.m-2 was recorded in 43.3% of AD patients and in 25% of VD patients. BMI was significantly lover in AD patients than in patients with VD (25.5 f 5.0 vs. 23.0 f 3.6 kg.m-2- piO.001). Triceps skinfold thickness was also lower in AD patients (1.38 f 0.6 vs. 1.7 f 0.85 c m - piO.01). Spontaneous food intake was only moderately lower in AD patients than in VD, however, the difference was statistically significant (9899 f 2844 vs. 10877 f 2383 Id/day - piO.05). MNA correlated significantly with food intake both in AD group (piO.01) as well as in VD group (piO.01). Conclusions: It can be concluded from 0~1’study that patients with AD xe more frequently malnourished than patients with VD. MNA is a good method for prediction of malnutrition in elderly patients with AD.
024-P. BIOCHEMICAL PARAMETERS FOR THE ASSESSMENT O F MALNUTRITION AND FOR MONITORING NUTRITION INTERVENTION IN ANOREXIA NERVOSA M. Nardi, A. Lion, L. Di Pascoli, A. Favxo, P. Santonastaso, D. Milazzo, E. Zola, R. Crecca, L. Caregaro Centre for Eating Disorders, University of Padua, Padua, Italy Rationale: The study aimed to individuate the most useful biochemical parameters for nutritional assessment and for monitoring nutritional changes during refeeding in anorexia nervosa (AN). Method: At baseline and at the end of the ezuiy phase of refeeding (26flO days), we evaluated clinical and biochemical parameters in 24 AN patients who consecutively entered an inpatient refeeding program. Mean age was 24.2f8.2 y, duration of illness 40.3f43.8 months, and BMI 13.7f1.9. Biochemical evaluation included: s-albumin, prealbumin, transferrin, retinolbinding protein (RBP), IGF-1, lymphocyte count, and thyroid hormones. BMI, zmn muscle area (AMA) and zmn fat xea (AFA) were also measured. Results: At baseline, IGF-1 z score was s-1 in all patients, while prealbumin was lower than normal in 4.8%, RBP in 12.5%, albumin in 14.3%, transferrin in 33.3%, lymphocyte count in 20.8%, and ff3 in 50% of them. AFA was 55th percentile in all, and AMA in 71.4%. At the end of the early phase of refeeding mean BMI was 14.7f1.8 (p=O.OOOcompxed to baseline). AMA and AFA significantly increased (p=O.OOO),as well as prealbumin (p=O.Ol), transferrin (p=O.OOl), and IGF-1 (p=O.O02). The percentage increase of IGF-1 averaged 56%. Other parameters did not vxy significantly. Conclusions: Protein malnutrition, as evidenced by low values of serum proteins, is not uncommon in severely malnourished patients with AN. The reduction of IGF-1 and transferrin is the most frequent biochemical abnormality. IGF-1 is the most sensitive index of nutrition repletion, but s-transferrin and s-prealbumin may also be useful for monitoring nutritional changes during refeeding.
025-P. IS BODY MASS INDEX AN APPROPRIATE MEASURE O F NUTRITIONAL STATUS IN PATIENTS W ITH HEART FAILURE OR DILATED CARDIOMYOPATHY? S.A. Hood Nutrition and Dietetics, St George’s Healthcare NHS Trust, London, UK Rationale: Body mass index (BMI) is routinely calculated in the nutritional assessmentof patients with heart failure and dilated cxdiomyopathy, however undernutrition may be masked by the presence of obesity. Method: Fifty-five patients attending a heart failure/dilated cxdiomyopathy clinic wele recruited to a prospective cohort study. Weight, height, BMI, mid-upper zum circumference (MUAC), nutritional status and cxdisc cachexia were assessed. Nutritional status was assessed using Subjective Global Assessment and patients classified as well nourished (WN), moderately malnourished (MM) and severely malnourished (SM). Cardiac cachexia was assessedusing Anker’s criteria of a weight loss of >7.5% over >6 months. Results: Despite 9 patients being classified as moderately or severely malnourished, no patient had a BMI 120. Of the four patients who were classified as cachectic using Anker’s criteria, one was classified as WN, two as M M and one as SN. Anker’s criteria failed to detect one patient who was subjectively classified as S M with a MUAC of 55th centile. However, one patient with weight loss due to a change in social circumstances was identified as cachectic. A comparison
Nomal
of SGA
weight
Overweight
(BMI
(BMI
Obese I (BMI Obese II (BMI
20-24.9)
25-29.9)
30-34.9) 35-39.9)
Obese III (BMI>40)
and BMI Well
Moderately
nourished
malnourished
Severely malnourished
7
3
2
1x
3
0
13
1
0
6
0
0
2
0
0
Conclusions: BMI is unable to accurately detect undernutrition in this patient group. A variety of methods should be used to investigate undemutrition and be interpreted in light of a clinical history.
026-P. IS PHYSICAL ACTIVITY MEASURED BY ACCELEROMETER USEFUL AS A PARAMETER O F NUTRITIONAL ASSESSMENT? T. Kimma’, Y. Inoue’, S. Fujita’, M. Yoshikawa’, T. Ito’, H. Matsuda’ ‘Department of Surgery, Osaka University Graduate School of Medicine, Suita City, 2Department of Surgery, Nissay Hospital, Osaka City, Japan Rationale: Physical function is important as a parameter of nutritional assessment, but only skeletal muscle function, such as grip strength or the force of isometric contractions of the adductor pollicis muscle, is used. There is no parameter for integral physical activity. Accelerometer is a device that measures the gravitational acceleration of body movement, and hence permits quantitative evaluation of physical function. The purpose of this study is to investigate the possibility of physical activity as a parameter of nutritional assessment. Method: 130 patients were classified into 3 groups according to SGA; Group A (well nourished, n=85), Group B (moderately malnourished, n=32), Group C (severely malnourished, n=13). A portable accelerometer (1OOg)was attached to patient’s waist, and gravitational acceleration of body movement was measured continuously for 3 days. Cumulative acceleration for three days was calculated into the value for 24 hours and defined 24-hour physical activity. Compz&on of %IBW, %UBW, %TSF, %AMC, serum protein values and 24-hour physical activity were canied out among three groups. Results: There were significant differences of %IBW, %UBW, %TSF, %AMC, albumin, prealbumin and retinal-binding protein value among 3 groups. The 24-horn physical activity shows a consistent tendency to decrease as the severity of malnutrition developed and was significantly different among 3 groups; group A: lO.lf3.2G, group B: S.Sf3.1G, group C: 6.5f2.7G (piO.05).