Percutaneous endoscopic gastrostomy (PEG) tube feeding of nursing home residents is not associated with improved body composition parameters.

Abstract

To study differences in nutritional status and body composition, by feeding modality, among disabled nursing home residents. A retrospective chart-review study. A nursing wing of a public urban geriatric center. Three groups of patients: non-dysphagic, orally-fed dysphagic and percutaneous endoscopic gastrostomy -fed dysphagic patients. Standard nursing care. Basal metabolic rate, total energy expenditure and nitrogen balance under oral or percutaneous endoscopic gastrostomy feeding. Dietary intake was assessed during a 3-days period by daily-food intake protocols and a 24-hours urinary creatinine excretion to detect nitrogen balance and calculate body composition parameters. Data of 117 patients (55.5% females), mean age 84.6±7.5 (range 66-98 years) was analyzed. Dysphagic patients (60) differed from non-dysphagic patients (57) by lower body mass index (p=0.020), fat mass index (p=0.017), daily protein intake (p<0.0001), daily energy intake (p<0.001), protein related energy intake (p<0.001) and a negative nitrogen balance (p<0.001). In regression analyses, dysphagia was associated with increased risk of having a body mass index lower than 22.0kg/m2 (OR=2.60, 95% CI 1.135-5.943), a negative nitrogen balance (OR=2.33, 95% CI 1.063-4.669), a low fat mass index (OR=2.53, 95% CI 1.066-6.007), and low daily protein and energy intakes per body weight (OR=2.87, 95% CI 1.316-6.268 and OR=2.99, 95% CI 1.297-6.880). Compared with orally-fed dysphagic patients (21pts.), percutaneous endoscopic gastrostomy -fed patients (39pts.) received an additional mean energy intake of 30.5% kcal per day and mean protein intake of 26.0%. This additional intake was not associated with improved body composition parameters (such as fat free mass, skeletal mass or body mass index). Dysphagic nursing home residents are characterized by worse nutritional, metabolic and body composition parameters, compared with non-dysphagic residents. Body composition parameters did not differ between orally-fed and percutaneous endoscopic gastrostomy-fed dysphagic patients, despite significantly better nutritional and metabolic parameters in PEG-fed patients. Other approaches (perhaps physical training, pharmacological etc.) should be sought to improve body composition of such patients.