Clinical Assessment Of Nutritional Status Research Articles

Dynamics of biophysical characteristics of albumin in patients on programmed hemodialysis

Background. One of the components of the metabolome that performs multifaceted functions in homeostasis is blood albumin. The albumin molecule has a pronounced hydrophilicity, due to which it plays an important role in maintaining oncotic blood pressure. Thus, the expansion of knowledge about the interrelationships of traditional biochemical information about the concentration of albumin and the biophysical properties of its derivatives complements the idea of the pharmacological effect of albumin transfusions. THE AIM: to study of the biophysical properties of albumin in patients with chronic kidney disease on programmed hemodialysis.Patients and Methods. The study included 29 patients with chronic renal failure treated with programmed bicarbonate hemodialysis for an average of 110 months. To assess the condition of patients, a complex of laboratory studies was used, including hematological examination on Beckman Coulter analyzers; clinical assessment of nutritional status based on data from the analysis of medical histories; assessment of colloidal osmotic blood pressure by calculation, as well as by direct measurement on a BMT 923 oncometer; measurement of particle size in blood plasma by dynamic light scattering on a Photocor Compact spectrometer- Z. Statistical analysis of the material was performed using the Statistica for Windows v.6.0 software package. The null statistical hypothesis of the absence of differences and connections was rejected at p<0.05. RESULTS. The average correlation coefficient of oncotic pressure was 0.94 for total protein and 0.90 for albumin. Measurement of colloidal osmotic pressure showed a significant increase in pressure in each of the postdialysis samples. The hydrodynamic radius of the albumin peak for the predialysis sample is significantly higher, which may indicate a change in the sorption properties of the albumin surface. CONCLUSION. The calculation of oncotic pressure by the concentration of total protein, as a rule, provides clinical needs, however, with a significant concentration of toxins, clinical situations are possible in which a moderate decrease in the concentration of the "total protein" of the blood is detected, hence the main oncotic component – albumin is noted but there is a development pronounced edematous syndrome due to a significant decrease in oncotic pressure as a result of a conformational change in albumin molecules. In such situations, it is necessary to directly determine the oncotic pressure of the blood. Keywords: albumin, oncotic pressure, hydrodynamic radius, dialysis>˂0.05.Results. The average correlation coefficient of oncotic pressure was 0.94 for total protein and 0.90 for albumin. Measurement of colloidal osmotic pressure showed a significant increase in pressure in each of the postdialysis samples. The hydrodynamic radius of the albumin peak for the predialysis sample is significantly higher, which may indicate a change in the sorption properties of the albumin surface.Conclusion. The calculation of oncotic pressure by the concentration of total protein, as a rule, provides clinical needs, however, with a significant concentration of toxins, clinical situations are possible in which a moderate decrease in the concentration of the "total protein" of the blood is detected, hence the main oncotic component – albumin is noted but there is a development pronounced edematous syndrome due to a significant decrease in oncotic pressure as a result of a conformational change in albumin molecules. In such situations, it is necessary to directly determine the oncotic pressure of the blood.

Fetal Malnutrition and Associated Factors among Term Newborn Babies at Birth in South Gondar Zone Hospitals, Northwest Ethiopia.

Background Undernutrition contributes to almost half of all under-five deaths. Fetal malnutrition (FM) has been implicated in both short- and long-term consequences among fetal, neonatal, and adult life. Currently, Ethiopia lacks information on the prevalence of fetal malnutrition and its associated factors. This study, therefore, is aimed at assessing the prevalence of FM at birth and its associated factors in South Gondar zone hospitals, northwest Ethiopia. Methods A cross-sectional study was carried out from November 1, 2019, to April 30, 2020, among four hospitals of South Gondar zone. All women with their live newborns who met the eligibility criteria were included. Clinical assessment of nutritional status including other anthropometric measurements was done immediately after delivery. The newborn was declared as fetal malnourished if the clinical assessment of nutritional status cut-off point is less than 25. Data were collected by trained clinical midwives. Besides bivariate regression analysis, a multivariable logistic regression analysis was done to identify associations. Results A total of 1592 mothers with their live newborns participated in this study. The prevalence of fetal malnutrition was 21.7% (95% CI: 19.7-23.9). Intimate partner violence (AOR: 1.97, 95% CI: 1.52-2.56), placental weight less than 512 grams (AOR: 2.76, 95% CI: 2.13-3.57), and small for gestational age (AOR: 1.96, 95% CI: 1.46-2.62) were significantly associated with fetal malnutrition. Conclusions The prevalence of fetal malnutrition was a public health problem in this study. Intimate partner violence, placental weight, and small for gestational age were found the most significant variables. To avert fetal malnutrition, positive family relation and additional or balanced nutritional supplementation during pregnancy are critical. We recommend researchers do clinical follow-up research which comprises a detailed investigation of placental, maternal, and fetal factors including genes.

Growth patterns in children with spinal muscular atrophy

BackgroundSpinal muscular atrophy (SMA) is a neuromuscular disorder characterized by muscle atrophy and weakness. SMA type 1 (SMA1) is the most severe form: affected infants are unable to sit unaided; SMA type 2 (SMA2) children can sit, but are not able to walk independently. The Standards of Care has improved quality of life and the increasing availability of disease-modifying treatments is progressively changing the natural history; so, the clinical assessment of nutritional status has become even more crucial. Aims of this multicenter study were to present the growth pattern of treatment-naïve SMA1 and SMA2, and to compare it with the general growth standards.ResultsBody Weight (BW, kg) and Supine Length (SL, cm) were collected using a published standardized procedure. SMA-specific growth percentiles curves were developed and compared to the WHO reference data. We recruited 133 SMA1 and 82 SMA2 (48.8% females). Mean ages were 0.6 (0.4–1.6) and 4.1 (2.1–6.7) years, respectively. We present here a set of disease-specific percentiles curves of BW, SL, and BMI-for-age for girls and boys with SMA1 and SMA2. These curves show that BW is significantly lower in SMA than healthy peers, while SL is more variable. BMI is also typically lower in both sexes and at all ages.ConclusionsThese data on treatment-naïve patients point toward a better understanding of growth in SMA and could be useful to improve the clinical management and to assess the efficacy of the available and forthcoming therapies not only on motor function, but also on growth.

Clinical assessment of nutritional status using the modified quantified subjective global assessment and anthropometric and biochemical parameters in patients undergoing hemodialysis in Macao

ObjectiveMalnutrition is widespread among patients undergoing hemodialysis and is linked to high morbidity and mortality rates. We evaluated the nutritional status and malnutrition markers in patients undergoing hemodialysis in Macao.MethodsWe performed a cross-sectional analysis of 360 patients in a hemodialysis center. The modified quantitative subjective global assessment (MQSGA), anthropometric indices and related biochemical test data were used to evaluate nutritional status.ResultsThe sample's mean age was 63.47 ± 13.95 years. There were 210 well-nourished (58.3%), 139 mild-to-moderately malnourished (38.6%) and 11 severely malnourished (3.1%) patients. Older patients had a higher incidence of severe malnutrition, but there were no significant differences between diabetic and non-diabetic patients. Mid-arm circumference (MAC); mid-arm muscle circumference; body mass index; triceps skin fold thickness; serum albumin, creatinine and urea; and hemoglobin were all valid for assessing nutritional status. MAC and the serum albumin and creatinine concentrations significantly negatively correlated with MQSGA.ConclusionsMalnutrition is commonplace in patients undergoing hemodialysis in Macao, but their nutritional status is not affected by diabetes. Serum creatinine, serum albumin and MAC, and especially pre-dialysis creatinine concentration, represent effective, readily available, and easily remembered screening measures of nutritional status for patients undergoing maintenance dialysis.

Fetal malnutrition assessment program

Objective To study the application of ponderal index (PI), body mass index (BMI), mid-arm circumference/head circumference (MAC/HC), and Clinical Assessment of Nutritional Status (CANS) score in assessing the nutritional status of neonates at birth, and to find a simple and reliable scheme for the assessment of fetal nutritional status. Methods PI, BMI, MAC/HC, and CANS were used to assess the nutritional status of full-term infants and preterm infants shortly after birth. The assessment results of these methods were analyzed. Results Among the 678 full-term infants, 61, 102, 47, and 131 were diagnosed with malnutrition by PI, BMI, MAC/HC, and CANS respectively. Among the 140 preterm infants, 30, 87, 9, and 112 were diagnosed with malnutrition by PI, BMI, MAC/HC, and CANS respectively. The combination of BMI and CANS had a detection rate of 99.3% in full-term infants and 100% in preterm infants. Compared with the single method, the combination significantly improved the detection rate of malnutrition (P 0.05). Conclusions The combination of BMI+CANS can reduce the rate of missed diagnosis of fetal malnutrition. It is therefore a simple and reliable method for the assessment of fetal malnutrition.

Study of the prevalence of small for gestational age newborns using clinical assessment of nutritional status of newborn baby at birth (CAN score)

Background: Small for gestational age infants are classically defined as having a birth weight that is more than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight vs. gestational age plot. IUGR is defined as a rate of fetal growth that is less than normal for the population and for the growth potential of a specific infant. IUGR therefore produces infants who are SGA. The choice of intrauterine growth charts for classification of babies is also not agreed upon. Effect of gender, order of birth, birth weight of previously born babies, maternal factors are also one of the determinants of IUGR in the detection and classification of true Small for gestational age babies. CAN score (clinical assessment of nutritional status at birth in newborn babies), independent of these factors can be used for international comparison of Small for gestational age babies. The objective of the present study was to evaluate the prevalence of Small for Gestational Age newborns using Clinical Assessment of Nutritional status of newborn baby at birth (CAN score).Methods: This study was carried out on 400 consecutive term neonates delivered at the Department of Obstetrics and Gynaecology, Tirunelveli Medical College Hospital, Tirunelveli during June-July 2015. Clinical assessment of nutritional status was done within 48 hours on the basis of the superficial readily detectable signs of malnutrition in the newborn as described by Metcoff. Maximum score of 4 is awarded to each parameter with no evidence of malnutrition and lowest of 1 is awarded to parameter with the worse evidence of malnutrition. Statistics were done using SPSS 16.Results: The study identified 110 (27.5%) babies as IUGR babies using CAN score. This included 56 male babies and 54 female babies. Thus, from the present study, the prevalence of Small for Gestational Age using CAN score was 27.5%.Conclusions: CAN score is the best measure for identifying the IUGR among the neonates.

Study of thyroid profile in malnourished children (6 months - 5 years) admitted in the nutritional rehabilitation centre and paediatric ward NSCB Medical College Jabalpur, India

Background: Globally, PEM continues to be a major health problem in developing countries and the most important risk factor for illnesses and death especially among young children. The research was conducted to study the effect of thyroid profile in malnourished children (6 month-5 years) admitted in tertiary care center in Central India.Methods: A cross sectional hospital based observational study was carried out in tertiary care hospital NSCB MCH Jabalpur. 80 malnourished children were included in the study. The cases were categorized into moderate and severe malnutrition as per WHO classification. Detailed clinical assessment of nutritional status followed by anthropometric measurement (weight for height) was recorded in predesigned proforma. Triiodothyronine (T3), Thyroxine (T4), thyroid stimulating hormone (TSH), serum total protein and serum albumin were estimated. The parameters were compared among SAM and MAM groups using appropriate tool.Results: Mean serum protein, serum albumin, T3, T4 were significantly low in SAM group, when compared to the MAM group (p <0.001). while level of TSH was not found significant among SAM and MAM groups.Conclusions: Malnutrition is associated with decrease level of thyroid hormone levels and were positively correlated with serum total protein and albumin levels. The decrease level of thyroid hormone may have a contributory role in retarded growth and development.

Comparison of clinical assessment of nutritional status (CAN) score with other methods in the assessment of fetal malnutrition

Background: Assessment of nutritional status of new born has been a major concern to many clinicians because of the potentially serious sequelae of malnutrition on multiple organ system and future health. Various methods have been used to identify malnourished babies as early as possible. The objective of the study was to assess the nutritional status of new born at birth using CAN score and to compare the utility of CAN score with other commonly used measures for defining nutritional status of new borns like weight for gestational age, Ponderal index and Kanawati index.Methods: The present study is a hospital based cross sectional study consisting of 250 singleton full term with no major congenital malformations. Clinical assessment of nutritional status was done on the basis of CAN score and compared with other methods like weight for gestational age, Ponderal index and Kanawati index.Results: Out of 250 babies, CAN score detected 171 (68.4%) babies as malnourished, weight for gestational age at birth detected 150 (60%) babies as AGA and 100 (40%) babies as SGA. Based on Ponderal index and Kanawati index, 154 (61.6%) babies and 140 (56%) babies were malnourished respectively. Using CAN score as the gold standard for identifying fetal malnutrition, the sensitivity and specificity of weight for gestational age at birth were 51% and 21.5%, the sensitivity and specificity of Ponderal index were 69.5% and 55.6% and the sensitivity and specificity of MAC/HC (Kanawati index) were 77.7% and 91.1%.Conclusions: CAN score is a simple, systemic method of identifying fetal malnutrition. This method does not require any sophisticated equipments or laborious calculations and is a good indicator in comparison with other methods of determining fetal malnutrition.

Thyroid hormone status in children with protein energy malnutrition a hospital based case control study

Background: WHO estimates that about half of all deaths, occurring among children aged less than five years in the developing countries, can be attributed to malnutrition. In malnourished children various endocrinal changes are noted. There is reduced synthesis of plasma proteins that affects secretion and metabolism of thyroid hormone. The present study has been conducted to study the effect of protein energy malnutrition (PEM) on thyroid hormone and plasma protein levels; and to find correlation between thyroid hormones and plasma protein levels in PEM children.Methods: A cross sectional hospital based case-control study was carried out in tertiary care hospital of Northern India. 50 children with PEM, and equal number of age and sex matched healthy controls (1-5 years) were included in the study. Detailed clinical assessment of nutritional status followed by anthropometric measurement was recorded in a predesigned performa. The cases were categorized into moderate and severe malnutrition as per WHO classification (weight for height). Free Triiodothyronine (fT3), free Thyroxine (fT4), thyroid stimulating hormone (TSH), serum total protein and serum albumin were estimated. The parameters were compared among cases and controls using appropriate statistical tool. Results: Mean hemoglobin, serum protein, serum albumin, fT3, fT4 and TSH levels were significantly low in case group, when compared to the control group (p <0.001).The levels of biochemical variables, decreases as the severity of malnutrition increases. The difference within the cases (moderate and severe malnutrition) was also found to be statistically significant (p <0.001).Conclusions: PEM is associated with decrease level of thyroid hormone levels and were positively correlated with serum total protein and albumin levels. The decrease level of thyroid hormone may have a contributory role in retarded growth and development.

Growth reference for Saudi school-age children and adolescents: LMS parameters and percentiles.

BACKGROUNDInformation on LMS parameters and percentiles reference for Saudi children and adolescents is not available.OBJECTIVETo report the L, M, and S parameters and percentile reference graphs for growth.DESIGNField survey of a population-based sample of Saudi school-age children and adolescents (5–18 years of age).SETTINGA stratified listing of the Saudi population.SUBJECTS AND METHODSData from the national study of healthy children were reanalyzed using the Lamba-Mu-Sigma (LMS) methodology. The LMS parameters of percentiles for weight, height, and body mass index for age were calculated for children and adolescents from 5 to 18 years of age.MAIN OUTCOME MEASUREThe main outcomes were the LMS parameters and percentiles of growth.RESULTSThere were 19 299 and 9827 (50.9%) were boys. The data for weight, height, and BMI for age for boys and girls are reported for the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles including LMS parameters for each percentile and age. Figures corresponding to each table are color coded (blue for boys and pink for girls).CONCLUSIONSThis report provides a reference for growth and nutrition of Saudi school-age children and adolescents. The detailed LMS and percentile tables and graphs provide essential information for clinical assessment of nutritional status and growth in various clinical conditions and for research.LIMITATIONSThis report does not reflect regional variations in growth.

Assessment of foetal nutrition status at birth using the CANS score

Abstract Introduction Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study was to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. Patients and methods Retrospective population of term infants was studied between 2003 and 2014 (n = 14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score Results Using the CANS score, 7.6% (n = 1101) of the population showed FM, 50.3% (n = 538) of SGA, 76.2% (n = 193) subgroup 24 in 49% with PI Conclusions It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age.

Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score

IntroductionFoetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. Patients and methodsRetrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI <2.2g/cm3. ResultsUsing the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n=538) of SGA, 76.2% (n=193) subgroup <p3, and 4.67% (n=559) of AGA. The CANS score was <25 in 7.26% (n=1,043) of newborns with PI ≥2.2g/cm3 (n=14.356), and the CANS score was >24 in 49% with PI <2.2g/cm3 (n=109) ConclusionsIt is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term.CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age.

English

INTRODUCTION: India has higher incidence of low birth weight as compared to any other developed country in the world. Also the sequelae of low birth weight like morbidity and mortality due to lack of early identification and treatment is a major problem throughout India. Hence, this study was conducted in Mysore Medical College & Research Institute, Mysore with objective of assessing the fetal malnutrition (FM) in term newborns using Clinical assessment of nutritional status (CANS) and comparing with other available methods. MATERIALS AND METHODS: A cross-sectional study was conducted using 225 full-term neonates delivered at MMC & RI, Mysore, over one month period of June 2013. Birth weight, length, mid arm circumference (MAC) and head circumference (HC) were recorded in the newborns. Ponderal index (PI), wt/GA, MAC: HC ratio and MAC were calculated. Clinical assessment of nutritional status was done on the basis of CAN score and compared with other methods. RESULTS: Total 225 neonates studied with male: female ratio of 1.1:1. CANS found 45.7% (103) neonates with FM. Wt/GA was more sensitive (98.06%) and correlating statistically (p=0.000) with FM detected by CANS. FM detected by PI, MAC: HC ratio and MAC were less correlating and less sensitive to that of CANS (sensitivities=86.40%, 51.45%, and 50.48% respectively). CONCLUSION: Clinical assessment of nutritional status (CANS) being a simple clinical-tool, can detect fetal-malnutrition (FM) without aid of any sophisticated-equipment in term- neonates which are missed by other methods. CANS can be used as a screening-tool in resource- limited settings of India effectively.

The usefulness of anthropometric measures

Based on EWGSOP guidelines, muscle mass should be evaluated using the DEXA or bioelectrical impedance analysis (BIA) [1]. In our study, it was not possible to assess all participants using DEXA or BIA. Therefore, muscle mass was estimated using the measurement of the mid-arm muscle circumference (MAMC) [2]. Indeed, anthropometric measures are generally considered poor markers of muscle mass, and their role in the assessment of sarcopenia is debatable [3]. For example, Faisy et al. [4] suggested that BIA might be superior to MAMC in predicting malnutrition and negative outcomes among patients with chronic obstructive pulmonary disease and acute respiratory failure. However, as previously demonstrated, MAMC provides a simple measure of body composition. Moreover, muscle mass as assessed by MAMC was shown to be independently associated with mortality in elderly subjects [5, 6]. MAMC estimates performed by expert personnel have shown excellent reliability [7]. Mid-arm muscle circumference estimation could be a practical and useful tool for the assessment of nutritional status and sarcopenia in older adults. In fact, it is simple, quick, inexpensive, noninvasive, and easy to use, valuable especially in those settings where DEXA and BIA are not available (i.e., nursing homes and long-term care settings). It is essential to recognize the relevance of the clinical assessment of sarcopenia and to reach a large and consolidated consensus on the recommended tools to measure body composition when DEXA and BIA are not accessible. Anthropometric measures (MAMC and/or calf circumference) could represent a simple and reliable instrument for the clinical assessment of nutritional status and sarcopenia.

English

OBJECTIVE: clinical assessment of nutritional status of neonate using CAN score and comparison with other method of assessing intrauterine growth. DESIGN: cross sectional study. SETTING: tertiary care hospital. SUBJECTS: 314 liveborn singleton newborns with known gestational age and no major anomalies. METHODS: birth weight, length was recorded and ponderal index was calculated. Clinical assessment of nutritional status was done on the basis of CAN score and compared with Ponderal index. RESULTS: CAN score of <24 separated 60 % of the babies as well nourished and 40% as malnourished. Weight for age and Ponderal Index both classified around 87% as well nourished and 13% as malnourished. Conclusion: CAN scoring along with other anthropometric parameters like birth weight will be giving more accurate information regarding intrauterine malnutrition in newborn babies.

Placental findings in malnourished term neonates

The aim of the present study was to investigate placental pathologies in malnourished term neonates. A group of term newborns was evaluated at birth for fetal malnutrition (FM) using the Clinical Assessment of Nutritional Status (CANS) score. The study group consisted of 37 malnourished neonates and 13 well-nourished newborns, including their placentas. Infants with FM were subdivided into two groups: appropriate for gestational age (AGA) and small for gestational age (SGA). The proportion of subjects having antepartum complications was 18.9% in the FM group, whereas none was found in the control group. Similarly, a significant portion, 83.8% of the study group, had gross placental abnormalities, while the control group had none. The placental microscopic findings in the study group included perivillous fibrin deposition, calcification, necrosis, retroplacental hematoma, and infarction. In contrast, the control group had only perivillous fibrin deposition and calcification. Placental histopathological findings between FM term AGA and SGA neonates were also compared, and no statistically significant differences were found (P < 0.05). Placental findings in malnourished term AGA neonates are not different from findings documented in malnourished SGA cases, but they are different from those in well-nourished term AGA newborns.

Fetal malnutrition in infants of smokers and passive smokers assessed by clinical assessment of nutritional status scoring

Aim: Studies have shown that maternal smoking during pregnancy is associated with low birth weight, height and head circumference in newborns. In the present study, along with these anthropometric measures we aimed to determine fetal malnutrition (FM), which is a less known outcome of antenatal tobacco exposure. Materials and methods: Two hundred and sixty-six term singletons without anomalies were evaluated for their birth weight, height, and head circumference and for FM using the Clinical Assessment of Nutritional Status (CANS) scoring. A CANS score equal to or less than 24 is accepted as FM. Results: Smokers' (n = 84) and passive smokers' (n =110) babies showed a birthweight deficit of -220.6 g (95% CI:-403.2 to -37.9) and -160.22 g (95% CI:-364.3 to -43.9), a birth height deficit of -0.42 cm (95% CI:-1.38 to -0.55) and -0.94 cm (95% CI:-2.03 to -0.16) and a head circumference deficit of -1.38 cm (95% CI:-1.91 to -0.86) and -0.89 cm (95% CI:-1.46 to -0.32) respectively, compared to nonsmokers' babies (n = 72). Smokers and passive smokers' babies also revealed decreases in CANS scorings, which were 22.7 (3.9) (P < 0.001) and 24.3 (4.3) respectively, compared to nonsmokers' babies who showed a CANS score of 27.6 (4.4). Babies whose mothers smoked more than 10 cigarettes/day had a much lower CANS score, which was 21 (3.97) (P = 0.013). Conclusion: Our findings suggest that screening for fetal malnutrition is indicated in smoking women's and passive smokers' babies.

Nutritional Status is Associated With Disease Progression in Very Mild Alzheimer Disease

The objective of this study is to identify, in a sample of very mild Alzheimer disease (AD) patients, factors associated with disease progression. The authors followed 160 AD patients from a multicenter cohort with a Clinical Dementia Rating (CDR) of 0.5, corresponding to very mild AD but with impairment insufficient to be classified as dementia. Patients with disease progression were defined as those with CDR> or =1 at 1 year; those with no progression (stable) remained at CDR 0.5. The baseline characteristics of these 2 groups of patients were compared in search of predictors of progression. After a 1-year follow-up, 84 (52.5%) of the patients remained stable, CDR 0.5; 76 (47.5%) progressed to a CDR score > or =1. A baseline lower nutritional status assessed by the Mini Nutritional Assessment [odds ratio 0.80, 95% confidence interval (0.68-0.94), P=0.007] and a lower cognitive performance on the Alzheimer Disease Assessment Scale [odds ratio 1.22, 95% confidence interval (1.07-1.39), P=0.003] were found as predictors of progression. The results suggest that clinical assessment of nutritional status, along with cognitive data, may help detect patients at risk of progression in very early AD. Nutritional assessment should therefore form part of clinical evaluation of patients with AD at an early stage of the disease.

Application of subjective global assessment as a screening tool for malnutrition in surgical patients in Vietnam

In most hospitals in Vietnam, clinical assessment of nutritional status has yet to become part of the routine clinical history taking and physical examination. It is the aim of this study to apply subjective global assessment (SGA) of nutritional status in surgical patients in the Mekong Delta, Vietnam, to determine the incidence of malnutrition according to SGA and to know whether there was an association between SGA class and infectious complications. A prospective, cross-sectional study design was used. SGA of nutritional status was applied. Patients were rated as well nourished (A), moderately malnourished (B) or severely malnourished (C). Infectious complications (wound infection, intra-abdominal abscesses, anastomotic leakage) were recorded. Of the 438 patients assessed, 194 (44.3%) were classified as A, 126 patients (28.8%) were classified as B and 118 patients (26.9%) were classified as C. Of the 274 patients who underwent major abdominal surgery assessed, 61 patients (22.3%) were classified as A, 97 patients (35.4%) were classified as B and 116 patients (42.3%) were classified as C. Weight loss and percent weight loss, muscle wasting, loss of subcutaneous fat, functional capacity and significant gastrointestinal symptoms correlate significantly with the severity of SGA class (P<0.001). The rate of postoperative infectious complications was higher in patients classified as SGA class C (33.6%) than as class A (6%) and B (11%). A high rate of malnutrition was found, applying SGA of nutritional state in surgical patients in Vietnam. Malnutrition was associated with an increase in infectious complications. Special attention should be paid to weight loss, muscle wasting, loss of subcutaneous fat, functional capacity and gastrointestinal symptoms.

An algorithm for the clinical assessment of nutritional status in hospitalized patients.

Upon admission to hospital, 30-50 % of patients either are or become malnourished. There is no generally accepted definition of malnutrition or guidelines on the best way to establish nutritional status. We consider it self-evident that the nursing staff have an important role in screening patients at risk of malnutrition on admission and thereafter at regular times. This is why we developed the nursing nutritional screening form (NNSF). The NNSF was tested by nurses, dietitians and clinicians, in pairs, to establish the extent of agreement in two phases on sixty-nine and forty patients. Later, the form was used in practice by nursing staff on five wards (334 patients). Based on the results of the NNSF, patients were referred to a dietitian. The dietitian established whether the patient was indeed at risk, or was actually malnourished, using a complete nutritional history. The degree of concurrence within pairs was reasonable to good. The same applied to the concurrence between nursing staff and dietitians, but concurrence between clinicians and nursing staff was less. In total, 334 patients were screened and sixty-nine of them were referred to the dietitian. It was established that 86 % of the referred patients were potentially at risk of malnutrition or were malnourished. Without the NNSF, 39 % (n 27) of the patients referred to the dietitian would not have been referred, or would have been referred much later. The NNSF makes it possible for nurses to detect malnourished patients or patients at risk of malnutrition at an early stage of their hospitalization.