Body Mass Index (BMI) and Serum Albumin Changes Prior to DeathinChronic Life-Limiting Illness (S714)

Abstract

1.Understand the uses and limitations of body mass index and albumin as screening tools for nutritional intervention in chronic illness.2.Future applications of BMI and albumin measurements. Evaluation of the nutritional status inpatients with chronic disease is potentially time consuming and resource intensive. Identifying patients that are likely to need nutritional intervention and symptom management by using routine weight measurements or inexpensive biomarkers would be useful screening tools. However, the benefit ofthese measurements may vary depending on the type of disease. Describethe differences in BMI, rate of weight loss, and serum albumin in decedents with chronic life-limiting illness. We purchased and linked Social Security Death Index data to our health system's electronic medical records system. This analysis focused on 4,782 adult patients with one of 7 chronic, life-limiting diseases who used our health system in the final 12 months before death. Patients' height, weight, and albumin were extracted and analyzed relative to date of death. Body mass index was computed for each date on which a weight was taken. Underweightwas defined per the National Institutes of Health as a BMI<18.5. 12 months before death, 8% of the chronic disease patients were underweight, increasing to 16% in their final month. Patients with cancer, HIV, and kidney disease had a mean percentage weight loss of >2% from baselineby 8 months before death, while this occurred 3 months later for cirrhosis and congestive heart failure (CHF). A decrease in mean serum albumin <3.5 g/dL occurred at baseline for cirrhosis and at 4 months for cancer and CHF decedents. The pattern of changes in BMI and serum albumin prior to death may bedifferent within a disease group and between groupsdepending on the type of disease.