Assessment Of Protein-calorie Malnutrition Research Articles

Outcomes of continuous process improvement of a nutritional care program incorporating TTR measurement.

Early assessment of protein calorie malnutrition (PCM) can improve the outcome for hospitalized patients by allowing the initiation of nutrition support if required. In addition, monitoring nutritional status during the hospital stay can identify a decline in or improvement of PCM so that alterations to treatment regimens can be made if needed. The visceral protein albumin is the traditional laboratory indicator of PCM. In the past decade another protein has been lauded as a superior marker that can be used in conjunction. We undertook several studies to test the effectiveness of TTR as an aid in nutritional assessment. We found TTR to be a sensitive measure of nutritional status, allowing for earlier assessment and intervention, thus reducing length of stay and other hospital associated costs. Based on these findings, our hospital generated and implemented a multidisciplinary nutrition care program. Transthyretin is an integral portion of this program; levels are determined on admission and repeated twice weekly until discharge.

Biochemical markers in the assessment of protein-calorie malnutrition in premature neonates.

We studied 135 premature newborns of 26 to 36 weeks gestation, divided into three groups: the control group, 66 premature infants with uncomplicated course; 51 premature neonates with appropriate birth weight for gestational age (AGA), who suffered from clinical problems that delayed oral feeding; and 18 premature infants with small birth weight for gestational age (SGA). When neonates of the same postnatal age were compared, prealbumin concentrations were the lowest in the SGA group at the third and fourth postnatal week. Although the AGA group had the most infants with serious illnesses and the lowest protein-calorie intakes, their prealbumin concentrations did not differ significantly from those of the control group. But when the infants of each group were subdivided on the basis of intakes and weight gain regardless of postnatal age, those with greater intakes showed significantly higher prealbumin values; however, in all groups, the infants with higher intakes were also significantly older. Total proteins and albumin showed similar changes in all groups. Prealbumin concentrations showed great interindividual variability in infants of the same postnatal age. We conclude that prealbumin, albumin, and serum total proteins are not sufficiently sensitive biochemical markers to assess alterations of the nutritional status of premature infants.

Assessment of protein-calorie malnutrition.

We critically review the various methods for assessing protein--calorie malnutrition. These tests are lacking in sensitivity and specificity, and currently no single one can be used as a reliable indicator of malnutrition. However, a combination of several of them can be used as prognostic indicators and are of help in selecting patients who may benefit from nutritional support. Body-composition analyses and functional tests hold the promise of greater applicability in the future. Newer and more nearly accurate tests for use in diagnosis of protein-calorie malnutrition as well as for objectively monitoring short-term changes in response to nutritional repletion are badly needed. Despite a lack of consensus on the desirability of objective nutritional assessment, we expect the use of these procedures in hospitals to increase.

Weight/height ratio in assessment of protein calorie malnutrition.

Weight/height ratio in assessment of protein calorie malnutrition.

Assessment of protein-calorie malnutrition in surgical patients from plasma proteins and anthropometric measurements

Six plasma proteins, two anthropometric measurements, hemoglobin and total lymphocytes were determined in 54 surgical patients and 19 normal individuals. Preoperative patients had low mean values for prealbumin, retinol binding protein, and arm muscle circumference. In postoperative patients, plasma transferrin, albumin, hemoglobin, total lymphocytes and body weight were also low and complement C3 was higher than normal. A correlation matrix for 10 variables showed interrelationships between the biochemical and anthropometric data. Prealbumin and transferrin were highly correlated with most of the variables. The effects of protein-calorie malnutrition were analyzed from the data ranked and grouped according to the plasma prealbumin or transferrin concentration. Those groups with low mean values for these proteins also had low values for most of the other variables. Protein-calorie malnutrition in surgical patients may be conveniently assessed from plasma prealbumin, transferrin, arm muscle circumference, percentage weight loss, and hemoglobin.

Mid-arm/head circumference ratio in the assessment of protein calorie malnutrition amongst the under fives.

Mid-arm/head circumference ratio in the assessment of protein calorie malnutrition amongst the under fives.

An evaluation of the use of changes in hair root morphology in the assessment of protein-calorie malnutrition

A study was carried out to evaluate the use of changes in hair root morphology in the assessment of protein-calorie malnutrition (PCM) among a group of black West Indian children. The following five hair root characteristics were measured: percentage of anagen (the growing phase), percentage of telogen (the resting phase), percentage of atrophy, diameter of anagen bulbs, and shaft diameter. Significant differences in shaft diameter, percentage of anagen, and percentage of telogen were found only between well-nourished and severely malnourished children. Significant correlation coefficients were obtained between both bulb diameter and percentage of atrophy and muscle circumference. No significant differences in any of the hair root characteristics were obtained between children with nutritional marasmus and those with kwashiorkor. The method was found to be time-consuming; it can be used for differentiating well-nourished children only from those with severe PCM; and it is unsuitable for determining the prevalence of the three degrees of PCM. For these reasons, the method is not recommended for use in the field assessment of protein-calorie malnutrition.

The efficacy of arm circumference as a substitute for weight in assessment of protein-calorie malnutrition.

The efficacy of arm circumference in identifying children suffering from different degrees of undernutrition was studied on 605 rural pre-school children, using standards for height, weight and arm circumference obtained on a group of well-to-do healthy children. The results indicated that there existed 57 per cent and 73 per cent agreement in the assessment using arm circumference on one hand, and weight and weight for height respectively on the other. Some children, who were severely undernourished on the basis of weight for age, weight for height and muscle circumference were classified as normal based on arm circumference.

The Use Of Changes In Hair Root Morphology In The Assessment Of Protein-Calorie Malnutrition

A study was carried out to evaluate the use of changes in hair root morphology in the assessment of protein-calorie malnutrition (PCM) among a group of Black West Indian children. Significant differences in mean shaft diameter, mean % anagen, and mean % telogen were found only between the well-nourished and the severely malnourished groups. No significant differences in mean % atrophy, and in mean diameter of anagen bulbs were found among well-nourished children, children with mild-moderate PCM, severely malnourished children, and children hospitalized for conditions with a secondary effect on nutritional status. The method was found to be time consuming; it can be used only for differentiating well-nourished from severely malnourished children; and it cannot be used for determining the prevalence of the different degrees of PCM. For these reasons, the method is not recommended for use in the field assessment of PCM.

The arm/head ratio in the assessment of protein-calorie malnutrition in Baghdad.

The arm/head ratio in the assessment of protein-calorie malnutrition in Baghdad.