Biochemical Nutritional Indices Research Articles

Comparison of Different Hemodialysis Frequencies per Week on Adequacy Parameters Including Electrolytes in Patients on Chronic Hemodialysis

Introduction: Due to the limitations in finding the right donor, the majority of patients with renal failure (chronic kidney disease stage 5) are treated with hemodialysis. In literature, we have extensive evidence of different hemodialysis prescriptions based on different frequencies per week and duration of each session. We tried to assess the impact of different hemodialysis frequencies on the adequacy of dialysis based on nutritional parameters, electrolyte imbalances and quality of life (QoL) parameters. Material and Methods: It was a single center, prospective, observational study conducted over three consecutive months on patients on hemodialysis and their biochemical, and QoL parameters were recorded. We could enroll 29 patients for this study. The objective was to assess the effect of different hemodialysis frequencies per week on hemodialysis adequacy parameters and QoL indices. Results: The baseline characteristics were uniform with respect to age (p=0.761) and commonly associated co-morbidities like obesity (BMI p=0.971), hypertension (p=0.927), diabetes mellitus (p=0.822). The serum albumin was observed to be similar in patients receiving either thrice weekly or twice weekly hemodialysis (p=0.736). The URR and kt/v were marginally higher in patients receiving thrice weekly dialysis but with no statistical significance (p=0.938 for URR & p=0.615 for kt/v). Discussion and Conclusions: The biochemical indices of nutrition along with electrolyte imbalance and quality of life parameters observed with different frequencies of hemodialysis per week were identical over three consecutive months.

Nutritional Assessment in Patients with Inflammatory Bowel Disease

Abstract Background Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract, which clinically contains Crohn’s disease, ulcerative colitis, and other conditions. The inflammation of the intestinal mucosa in IBD is characterized by episodes of abdominal pain, diarrhea, bloody stools, weight loss, and the influx of neutrophils and macrophages that produce cytokines, proteolytic enzymes, and free radicals that result in inflammation and ulceration. Aim of the Work The aims of our study is to assess the nutrient status of individuals with CD and UC in relation to the recommended nutrient intake values, anthropometric measures, and biochemical indices of nutrition, and to determine the extent to which reduced food and nutrient intake contributes to the nutrition deficiencies in this population. Materials and Methods This was across-sectional study was conducted on patients with IBD, including Crohńs disease (CD), ulcerative colitis (UC)and undtermined colitis, who attended to the outpatient clinic for IBD of the Department of Internal Medicine, University Hospital of Ain Shams University, between january 2020 to july 2020. 90 patients with IBD (65 UC patients, 22 CD patients and 3 UD colitis) were included in the study. Results Our study show that The majority of our IBD patients showed a normal BMI indicating that malnutrition, especially underweight, is not as common a described in former studies with up to 85% in IBD patients. Our study show that majority of patients are suffering from GI upset following certain meals, all of them are suffering from flatulance, some of them suffering from nausea, vomiting, heart burn and 79(87.7%) patients are suffering from diarrhea, most of patients with crohns disease are suffering from constipation, and some of them are suffering from intestinal colick. So Many patients with IBD suppose that the diet influences the courseof their disease or even cause a relapse Our study groups showed an unfavorable ratio of essential fatty acids (FA) compared to the recent guidelines. Whereas the ratio of the n-6 fatty acid linolic acid (LA) to the n-3 fatty acid α-linolenic acid (ALA) should be 5:1, the actual ratio was more than in all participants because of the high incidence of margarine ingestion. Conclusion The worldwide rising incidence of IBD is paralleled by a ―Westernization‖ of dietary habits in developing countries. It is therefore obvious that, in addition to a genetic influence, environmental factors, especially diet, undoubtedly play a major role in the development of IBD. Impairment of nutritional status in BID patients has a multifactorial etiology. Main reasons include suboptimal energy intake, malabsorption, enteric nutrient loss, increased basal energy expenditure, and medications.

NUTRITIONAL EVALUATION OF PATIENTS CANDIDATES FOR HOME ENTERAL NUTRITION (HEN)

Various nutritional evaluation tools have been proposed over the years. A good tool should involve simple and easy-to-detect measures and should be applicable to a large number of patients. In the home setting it is even more difficult to collect useful data for nutritional evaluation. Our unit carries out the evaluations and prescriptions for the HEN in patients discharged from the same presidium and for patients discharged from other structures but afferent to the territory of the AUSL. During the 1st evaluation, the anthropometric parameters (height weight or, where not available, arm and calf circumference plus ulna lenght) and nutritional indices are required. A clinical-laboratory follow-up is provided at fixed intervals. From January 2018 to August 2018, 50 patients initiated HEN (19 M and 31 F, average age 76 ± 22 years). 20 patients were carriers of PEG and 30 of SNG. At the 1st evaluation the average weight was 59 kg and the average BMI was 22.5 ± 4.2, not indicative of malnutrition, but the mean values of Albumin (2.6 ± 0.6 g/L) Prealbumin (12 ± 8 mg/dl) Total Protein (5.6 ± 1.1 g/dl) Transferrin (141 ± 75 mg/dl) and Lymphocytes (1312 ± 640) were all indicative of moderate malnutrition. Follow-up data collection is in progress. Our results show that weight and BMI in HEN setting are not really indicative of the nutritional status of patients, but it is necessary to use more specific tools such as the dosage of biochemical nutritional indices.

PS-137 Low Biochemical Nutritional Indices Predict Clinical Outcomes In Children Undergoing Cardiac Surgery

Aim To determine whether biochemical nutritional indices predict clinical outcomes in children undergoing cardiac surgery. Methods Retrospective single centre study between July 2012 and June 2013. Biochemical nutritional indices included serum albumin and total lymphocyte count (TLC) which was used to calculate Onodera’s prognostic nutritional index (PNI) [10 x serum albumin (g/dL) + 0.005 x TLC (/mL)]. Severity of illness assessed using Paediatric Risk of Mortality (PRISM) III score. Surgery categorised using the risk adjusted classification for congenital heart surgery (RACHS-1) score. Outcomes included hospital mortality, paediatric intensive care unit (PICU) length of stay (LOS) and duration of mechanical ventilation (MV). Results Total of 31 patients identified. Median age was 2.0 (0.7–41.0) months. Median PRISM III score was 8.0 (5.0–13.0). 14 (45%) underwent RACHS-1 category 2 surgery and 6 (20%) had ventricular septal defects. Median albumin and TLC were 3.2 (2.6–4.2) g/dL and 4280 (2810–5100)/uL respectively. Median PNI score was 52.7 (41.2–69.7). There was no hospital mortality. Median PICU LOS was 5.0 (3.0–8.0) days. Hypoalbuminaemia ≤3.0 g/dL associated with longer median PICU LOS (7.0 vs. 4.0 days, p = 0.016) and duration of MV (156 vs. 33 h, p = 0.007). PNI ≤ 58 associated with longer median PICU LOS (6.0 vs. 3.0 days, p = 0.041). Adjusting for age and RACHS-1 score, for every 1 g/dL drop in albumin, PICU LOS increased by 0.5 days (p = 0.006). Conclusions Hypoalbuminaemia and PNI ≤ 58 were associated with adverse postoperative outcomes. Future studies to study effect of perioperative aggressive nutrition care on biochemical indices and clinical outcomes.

Nutrition education for care staff and possible effects on nutritional status in residents of sheltered accomodation

We investigated the nutritional, cognitive and functional status in residents of two service-flat (SF) complexes and the effects of a nutrition education programme for care staff. Controlled nonrandomised study. Two SF complexes, that is community-assisted accommodation. Of 115 eligible SF residents, 80 subjects participated (age 83+/-7 y, 70% women). The nutritional status was assessed using body mass index (BMI, kg/m(2)), subjective global assessment (SGA), serum concentrations of albumin, insulin-like growth factor-I (IGF-I) and vitamin B(12). Cognitive and functional status were evaluated using the Mini Mental State Examination (MMSE, 0-30 points, <24 points indicates impaired cognition) and the Katz activities of daily living (ADL) index, respectively. Two assessments were made with a 5-month interval. At the start, a 12-h education programme was given to the staff at one of the SF complexes. At baseline, the means of BMI and the biochemical nutritional indices were normal, whereas one-third had BMI <22 kg/m(2) and one-fourth had lost > or =10% of previous weight. According to SGA, 30% demonstrated possible or serious malnutrition. The median MMSE was 23 points (19.5-26.5, 25-75th percentile). Nearly 70% were ADL-independent. At the 5-month follow-up there were no differences in the nutritional and cognitive status of the residents. The nutritional knowledge of the staff improved slightly (P<0.05) at both SF complexes (NS between groups). Around one-third of SF residents appeared to be at nutritional risk. Five months after a 12-h staff nutrition education programme, no objective changes were seen in the nutritional status of the SF residents.

Diet, smoking and cardiovascular risk in people with schizophrenia

BackgroundPhysical health of people with schizophrenia is poor and they die early from cardiovascular disease.AimsTo describe the lifestyle of people with schizophrenia through diet, smoking habits, weight and exercise, and to report risk of coronary heart disease (CHD).MethodDietary habits of 102 community-dwelling people with schizophrenia were assessed by the Scottish Health Survey Questionnaire. Also assessed were smoking habits, physical activity biochemical indices of nutrition and future risk of CHD.ResultsFewer males, compared with the general population, reached acceptable levels for consumption of fruit, vegetables, milk, potatoes and pulses. Fewer females reached the levels for consumption of milk and potatoes. Mean number of fruit and vegetable portions consumed per week was 16 (s.d.=14); 71 (70%) were smokers; 25 (86%) females and 50 (70%) males were overweight or obese; 59 (59%) considered themselves physically active; 46 (53%) had a raised cholesterol: high-density lipoprotein ratio, and 64 (74%) a low α-tocopherol: cholesterol ratio. Mean 10-year risk of CHD in males was 10.5% (s.d.=8) and in females 7% (s.d.=6).ConclusionsThe lifestyle of people with schizophrenia must give cause for concern in relation to CHD Care from secondary care services must address physical as well as mental health.

Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study.

Physical health of people with schizophrenia is poor and they die early from cardiovascular disease. To describe the lifestyle of people with schizophrenia through diet, smoking habits, weight and exercise, and to report risk of coronary heart disease (CHD). Dietary habits of 102 community-dwelling people with schizophrenia were assessed by the Scottish Health Survey Questionnaire. Also assessed were smoking habits, physical activity, biochemical indices of nutrition and future risk of CHD. Fewer males, compared with the general population, reached acceptable levels for consumption of fruit, vegetables, milk, potatoes and pulses. Fewer females reached the levels for consumption of milk and potatoes. Mean number of fruit and vegetable portions consumed per week was 16 (s.d.=14); 71 (70%) were smokers; 25 (86%) females and 50 (70%) males were over weight or obese; 59 (59%) considered themselves physically active; 46 (53%) had a raised cholesterol: high-density lipoprotein ratio, and 64 (74%) a low alpha-tocopherol: cholesterol ratio. Mean 10-year risk of CHD in males was 10.5% (s.d.=8) and in females 7% (s.d.=6). The lifestyle of people with schizophrenia must give cause for concern in relation to CHD. Care from concern in relation to secondary care services must address physical as well as mental health.

Nutritional effects of oral zinc supplementation in cirrhosis

Poor zinc status is common in cirrhosis. Experimental studies proved that zinc supplementation produces metabolic effects, and trends towards improved liver function and nutritional status have previously been reported. We measured liver function by means of dynamic, quantitative tests and biochemical indices of nutrition in response to zinc treatment in patients with cirrhosis. Fifteen patients with advanced cirrhosis were studied before and after long-term oral zinc-sulfate supplementation (200 mg t.i.d. for 2–3 months). Liver function was measured by routine biochemistry, galactose elimination capacity and antipyrine clearance; nutritional assessment included the measurement of daily urinary creatinine excretion, and albumin, prealbumin, retinol-binding protein and insulin-like growth factor-1 (IGF-1) serum or plasma concentrations. In 10 patients data were correlated with the parameters of glucose metabolism obtained during a frequently-sampled i.v. glucose tolerance test. At baseline, serum zinc was low normal or reduced, and returned to normal range in all patients after supplementation. Liver function improved significantly. All nutritional indices improved as well, but remained on average below normal. IGF-1 increased on average by 30%, but was in the normal range in only 2 cases. Changes in IGF-1 correlated with improved glucose tolerance after i.v. glucose load, namely with the increased non-insulin-mediated glucose uptake. The study confirms that oral zinc produces metabolic effects in zinc-deficient patients with cirrhosis. Improved liver function and nutritional status may increase glucose disposal via increased IGF-1, responsible for the non-insulin-dependent fraction of glucose disappearance.

Changes in growth and metabolism in very low birthweight infants fed with fortified breast milk

Human milk is often inadequate nutritionally for preterm infants. We investigated the effect of adding a commercially prepared milk fortifier to human (maternal or bank) milk and measured changes in lower leg length velocity (LLLvel) using knemometry, weight gain and biochemical indices of nutrition. Babies were allocated to one of three feed groups, in a semi‐randomized fashion, to receive human milk alone (group I), fortified human milk (group II) or a preterm formula (group III). The birthweights (median and R) and birth gestations (median and R) of the three groups were as follows: group I 1099 g (654‐1248 g) and 28 wk (26‐32 wk); group II 838 g (742‐1340 g) and 31 wk (28‐36); group III 1136g (624‐1552 g) and 32 wk (27–36 wk). All babies who received fortified milk either showed significant (p = 0. 0004) acceleration in LLLvel during the period studied, or maintained their pre‐study period velocity. This increase in LLLvel was comparable to that achieved by a group of babies given a standard preterm infant formula (p&lt;0.001). By comparison, the control group's change in LLLvel was more modest (p= 0.04). Babies who received human milk with the fortifier added had the lowest serum levels of alkaline phosphatase at the end of the study period when compared to the other two groups. Other biochemical indices were similar in the three feed groups. No adverse clinical events were encountered which could be attributed to the use of the breast milk fortifier.

Nutrition, tissue oxygenation, and healing of venous leg ulcers

The purpose of the prospective study described in this article was to explore nutrition, tissue oxygenation, and healing in venous ulcer patients. Nutritional risk, anthropometric measures, biochemical indices, two 3-day dietary records, and transcutaneous tissue oxygen levels were obtained. Wound surface area was evaluated 2 times, 4 weeks apart. A convenience sample of 25 English-speaking persons with 1 or more venous ulcers participated (mean age 59.8 years, 60% men, 48% white). Moderate or high nutritional risk existed in 84% of the persons in the sample. Based on body mass index, more than 50% of the persons in the samle were obese. Nonetheless, 17 of 25 persons in the sample had 1 or more abnormal biochemical nutritional indices. In addition, caloric intake (17 of 20), protein intake (15 of 20), and zinc intake (17 of 20) were inadequate to meet the needs for healing. No statistically significant relationships were found between biochemical nutritional indices, tissue oxygenation, and healing. The women in the sample were more likely to heal than were the men (P < .05). This study begins to document the problems of overnutrition and undernutrition in the venous ulcer population. Future studies need to explore the effects of obesity and inadequate intake on the healing of venous ulcers. Additional examination of the differences between men and women also is warranted to identify predictors of venous ulcer healing.

Effects of increasing dialysis dose on serum albumin and mortality in hemodialysis patients

Dialysis dose and malnutrition have a great impact on the clinical outcome of chronic hemodialysis patients. The interrelationships between them, however, remain undefined. Thus, we performed a study to determine the effects of increasing the dialysis dose on serum albumin concentrations and mortality in hemodialysis patients. We examined urea kinetic modeling, biochemical nutritional indices, comorbid conditions, patient survival time, and annual mortality rate. Dialysis dose, measured by Kt/V, significantly increased from 1.3 ± 0.3 in 1987 to 1.5 ± 0.4 in 1990 and to 1.7 ± 0.4 in 1993. Serum albumin level also increased, from 3.8 ± 0.4 g/dL in 1987 to 4.0 ±0.4 g/dL in 1990 and to 4.3 ± 0.3 g/dL in 1993. In 1993, 76% of patients had Kt/V ≥1.50 compared with 45% in 1990 and 28% in 1987, whereas 82% of patients had a serum albumin level ≥4.0 g/dL in 1993 compared with 58% in 1990 and 29% in 1987. Protein catabolic rate and hematocrit also increased from 1987 to 1993, but not serum cholesterol or triglyceride. The annual mortality rate decline from 16.1% in 1987 to 13.2% in 1990 and to 8.0% in 1993. The decrease in mortality appeared to be unrelated to differences in patient selection or comorbid conditions. Serum albumin levels, hematocrit, Kt/V, and protein catabolic rate were significantly related to patient survival after age, sex, and diabetic status had been adjusted. Furthermore, there was a positive correlation between Kt/Vs and serum albumin concentrations ( r = 0.216, P <0.001). Thus, it appears that increasing the dose of dialysis improves serum albumin levels and perhaps survival rate in hemodialysis patients as well.

Spontaneous dietary protein intake during progression of chronic renal failure.

Malnutrition at the initiation of dialysis is a strong predictor of subsequent increased mortality on dialysis. Few studies have documented the relationship between the progression of renal failure and spontaneous dietary protein intake (DPI) and other indices of malnutrition. In this prospective study, renal function was sequentially measured by creatinine clearance (CrCl) and DPI by 24-h urine collection; simultaneously, multiple sequential biochemical nutritional indices, including serum albumin, transferrin, prealbumin, and insulin-like growth factor-I (IGF-I) concentrations, were measured. The study involved 90 patients (46 men and 44 women) with chronic renal failure (CRF) of various causes monitored in an outpatient clinic. Dietary interventions were minimal. The mean duration of follow-up was 16.5 +/- 11.8 months. The results show that the mean (+/- SD) DPI was 1.01 +/- 0.21 g/kg per day for patients with CrCl over 50 mL/min and decreased to 0.85 +/- 0.23 g/kg per day for patients with CrCl between 25 and 50 mL/min. The DPI further decreased to a level of 0.70 +/- 0.17 g/kg per day for patients with CrCl between 10 and 25 mL/min and was 0.54 +/- 0.16 g/kg per day for patients with CrCl below 10 mL/min. This trend was statistically significant (P < 0.001). A similar statistically significant trend was observed for serum cholesterol, transferrin, and total creatinine excretion (all P < 0.01). A mixed model analysis indicated that for each 10 mL/min decrease in CrCl, DPI decreased by 0.064 +/- 0.007 g/kg per day, transferrin decreased by 16.7 +/- 4.1 mg/dL, weight decreased by 0.38 +/- 0.13% of initial weight, and IGF-I decreased by 6.2 +/- 1.9 ng/mL. It was concluded that the progression of renal failure is associated with a spontaneous decrease in DPI, especially below a CrCl of 25 mL/min, and that most nutritional indices in CRF patients worsen as CrCl and DPI decrease. Dietary protein restriction should be used cautiously in CRF patients when CrCl falls below 25 mL/min.

Clinical nutrition survey administered to general surgery residents

Nutrition care services are an integral part of patient care services at Harborview Medical Center (HMC). Based on the assumption that the quality of nutrition care provided to patients is impacted positively when physicians are knowledgeable about nutrition, an examination was designed to survey the nutritional knowledge of residents. A total of 38 general surgery residents were tested, all of whom were in a general surgery training program First year residents (R1) totaled 14, second year residents (R2) totaled 11, and third, fourth and fifth year residents (R3,4,5) combined to total 13. The exam focused on topics thought to be important to the nutritional care of the patients at HMC, as determined by the department of clinical nutrition and a committee of health care personnel including two Registered Dietitians, a pharmacist, and two general surgeons. Topics included biochemical nutritional indices, enterostomies, early enteral nutrition support, enteral feeding complications, drug-nutrient interactions, nutrition and immunity, and assessment of caloric requirements. The exam consisted of 48 multiple choice questions and 2 true/false questions. Overall mean score was 31 correct out of 50 questions (62% correct). Mean for R1 =28 (56%). R2=30 (60%), and R3,4,5=33 (66%). Individual scores among the three groups were compared using the Kruskal-Wallis test. No significant differences were found between scores of different levels of residency. And as many as 93% of examinees incorrectly answered questions regarding nitrogen losses. post-operative feeding, and drug-nutrient interactions. The Department of Nutrition and Foodservices at HMC is interested in providing nutrition information to residents in an effort to maximize the quality of nutrition care. The results of this survey helped identify areas of nutrition on which to focus our educational efforts for residents during on-site training. One method that is used to provide information to residents is a newsletter. Articles in the newsletter will be focused on areas of concern as identified in the survey. The survey also helped strengthen lines of communication and improve visibility with the medical staff.

Prediction of mortality in patients in acute medical wards using basic laboratory and anthropometric data.

The value of anthropometric and biochemical indices in predicting short-term mortality among patients in general medical wards was assessed in 294 patients admitted consecutively to a district hospital over a one month period. Using a stepwise logistic regression model and supported by the linear discriminant analysis method, mortality within 3 months could be predicted with sensitivity of 83% and specificity of 84% using the following variables: sex, functional ability, urea, total protein, alkaline phosphatase and albumin-adjusted calcium. Addition of anthropometric values and biochemical nutritional indices did little to improve the accuracy of the prediction, contrary to previous findings among surgical patients and elderly residents of long-term care institutions.

Nutritional assessment of infants with cystic fibrosis diagnosed through screening

Presymptomatic infants diagnosed through neonatal screening for cystic fibrosis can have biochemical evidence of malnutrition. With aggressive dietary management and treatment with pancreatic enzymes, normal biochemical indices of nutrition can be achieved at 12 months of life in most cases. Males with cystic fibrosis appear to be more at risk than females for abnormal growth and biochemical indices of nutrition in the first year of life. This may be related to the observed decrease in fat intake when compared to females. Males, especially, should be carefully observed for development of nutritional abnormalities based on this data. Careful attention should be paid to vitamin E and essential fatty acid status in all CF infants. The numbers in this study are small and the long-term consequences of early nutritional intervention await the conclusion of the randomized, controlled study on-going in Wisconsin.

The relationship between insulin-like growth factor-I, adiposity, and aging

Aging is associated with both a relative accumulation of body fat and a reduction in growth hormone (GH) secretion. This study was devised to investigate the relationship between plasma insulin-like growth factor-I (IGF-I), an index of GH secretion, and anthropometric indices of body fat in normal subjects of various ages. Somatic and biochemical indices of nutrition were assessed in 107 subjects between the ages of 17 and 83 years who attended an outpatient clinic for general health supervision. Plasma IGF-I correlated negatively with age in both males ( r = −.44, P = .001) and females ( r = −.40, P = .005). In addition, plasma IGF-I correlated negatively with body mass index (BMI) ( r = .35, P = .006), percentage of standard triceps skinfold (TSF) ( r = −.26, P = .05), and percentage of standard weight ( r = −.35, P = .006) in males, but not in females. Multiple regression analysis indicated that in males, BMI and percentage of standard weight correlated with plasma IGF-I independent of the effect of age. We conclude that adiposity and aging are independently associated with decreased plasma IGF-I concentrations. The negative correlations between indices of adiposity and IGF-I were observed only in males, whereas the age-associated decline in IGF-I was present in both males and females. We speculate that sex differences in the gonadal steroid milieu, combined with declining GH secretion in both sexes, may contribute to the age-associated development of obesity in males.

Formula omitted

The purpose of the prospective study described in this article was to explore nutrition, tissue oxygenation, and healing in venous ulcer patients. Nutritional risk, anthropometric measures, biochemical indices, two 3-day dietary records, and transcutaneous tissue oxygen levels were obtained. Wound surface area was evaluated 2 times, 4 weeks apart. A convenience sample of 25 English-speaking persons with 1 or more venous ulcers participated (mean age 59.8 years, 60% men, 48% white). Moderate or high nutritional risk existed in 84% of the persons in the sample. Based on body mass index, more than 50% of the persons in the samle were obese. Nonetheless, 17 of 25 persons in the sample had 1 or more abnormal biochemical nutritional indices. In addition, caloric intake (17 of 20), protein intake (15 of 20), and zinc intake (17 of 20) were inadequate to meet the needs for healing. No statistically significant relationships were found between biochemical nutritional indices, tissue oxygenation, and healing. The women in the sample were more likely to heal than were the men (P < .05). This study begins to document the problems of overnutrition and undernutrition in the venous ulcer population. Future studies need to explore the effects of obesity and inadequate intake on the healing of venous ulcers. Additional examination of the differences between men and women also is warranted to identify predictors of venous ulcer healing.

Hypercapnic-hypoxemic chronic obstructive pulmonary disease (COPD): influence of severity of COPD on nutritional status

In 90 patients with hypercapnic-hypoxemic chronic obstructive pulmonary disease (COPD), noninvasive anthropometric and biochemical nutritional indices were measured to assess the prevalence and features of malnutrition in COPD and to analyze the relationship between nutritional depletion and the severity of the disease. A significant inverse relationship was found between PaCO2 and body weight; a parallel decrease of both somatic proteins and body-energy stores of fat appears to be paired with decreasing body weight. Deterioration of nutritional status occurred in the COPD patients considered despite seemingly adequate calorie and protein intakes, although in patients with more severe impairment of pulmonary gas exchange, calorie intake was significantly lower compared with basal energy expenditure. In the course of hypercapnic-hypoxemic COPD malnutrition is common, it is related to the severity of the disease as judged by the need for hospitalization and degree of impairment of gas exchange, and it may be present despite apparently adequate nutrient intake.

Why are Alzheimer patients thin?

Nutritional assessments were performed in three groups of hospitalized elderly women comparable in age and mobility: a group with Alzheimer's disease (ALZ), a multi-infarct dementia group (MID) and a nondemented group (ND). We have shown that: ALZ patients lose weight and on average weigh 21% less than ND patients and 14% less than MID patients. This weight loss is not accounted for by any obvious deficit in food intake, or by malabsorption. Biochemical indices of nutrition are little different in the three groups. The reason for weight loss in ALZ remains uncertain.

The effect of starvation on skeletal muscle function in man

Measuring skeletal muscle function may be a diagnostic aid to detect malnutrition. To evaluate this hypothesis 11 lean women were studied before and after 5 days of total starvation. Skeletal muscle function was assessed as hand grip strength and as adductor pollicis muscle function after electrical stimulation of the ulnar nerve. The muscle function variables were force of contraction at 5, 10, 20 and 50 Hz stimulation, relaxation rate and endurance. In addition some currently used anthropometric and biochemical nutritional indices were serially determined. Hand grip strength was decreased (p < 0.05) and the function of the adductor pollicis muscle was altered with a higher contraction force at 10 Hz (p < 0.01), a slower relaxation rate (p < 0.05) and a reduced endurance (p < 0.05). These changes were all within the normal ranges. Triceps skin fold and arm muscle circumference were not changed after a mean weight loss of 3.3 kg (p < 0.05). However blood glucose, insulin and triiodothyronine all decreased (p < 0.01) indicating a metabolic adaptation to starvation. Prealbumin (p < 0.05) and fibronectin (p < 0.01) were also lowered. In conclusion, skeletal muscle function was significantly altered after five days of total starvation. However, to identify short term nutritional depletion in clinical practice the changes in muscle function were too small to be diagnostically useful.