Nutritional Assessment Parameters Research Articles

Clinical Outcomes Associated With Malnutrition Diagnosed by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition: A Systematic Review of Content Validity and Meta-Analysis of Predictive Validity

BackgroundThe Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition (AAIM) is a tool that uses nutrition assessment parameters to diagnose patients with malnutrition. Evaluation of the content validity of AAIM relative to the Subjective Global Assessment (SGA) or Patient Generated-Subjective Global Assessment (PG-SGA) is needed. Predictive validity of malnutrition diagnosed by AAIM for clinical outcomes in hospitalized adults is also important. ObjectiveThe purpose of this systematic review of the published literature was to evaluate the content validity of the AAIM approach relative to SGA/PG-SGA and to determine whether malnutrition diagnosed by AAIM at or near hospital admission is associated with increased mortality, length of stay, hospitalization cost, or readmissions. MethodsObservational studies of hospitalized adult patients published in English during 5/1/2012-6/1/2023 were identified using Pubmed, CINAHL, EMBASE or Cochrane Library. The risk of bias of outcome studies was evaluated by the National Institutes of Health quality assessment tool for observational studies. Effect sizes from three or more studies were combined into forest plots using Review Manager 5.0 to produce effect sizes expressed as odds ratios or mean differences with 95% confidence intervals (CI) using the inverse variance method with a random effects model, and computation of the I2 statistic to indicate heterogeneity. Visual examination of funnel plots was used to assess likelihood of publication bias. ResultsEighteen studies with data from 14,794 patients were included. In the nine studies that provided content validation data, five did not measure hand grip strength. Nonetheless, AAIM demonstrated 89% sensitivity, 84% specificity, and substantial agreement with the SGA/PG-SGA. Sixteen studies reported clinical outcomes. Malnutrition diagnosed by AAIM was associated with greater OR (95% CI) hospital mortality of 2.37(1.58 to 3.55) and increased OR (95% CI) 30-day readmissions of 2.26 (1.97 to 2.58) than patients without malnutrition. While a specific effect size was not established due to study heterogeneity, longer length of stay was confirmed in five adjusted models. Two studies reported significantly increased costs of hospitalization in patients with malnutrition. ConclusionsThe AAIM criteria are valid in content relative to SGA/PG-SGA. Malnutrition diagnosed by AAIM identifies patients with greater odds of hospital mortality, and 30-day readmissions as well as longer hospital length of stay.

Effect of probiotics on nutritional status, biochemical parameters, and disease severity in cirrhotic patients referred for liver transplantation–A randomised double blind, placebo-controlled trial

Probiotics have been shown to be effective in many diseases. However, their effects on the nutritional status in patients with cirrhosis is uncertain. We aimed to study the effect of probiotics on nutritional status, biochemical parameters, and liver disease severity in patients with cirrhosis referred for liver transplantation. A randomised, double-blind, placebo-controlled study was conducted from July 2021-October 2022. A total of 215 patients with cirrhosis referred for liver transplantation were enrolled and randomised to two groups to receive either probiotics (VSL#3, Sun Pharma, India, 112.5 billion colony-forming units (cfu) containing eight strains of bacteria) or placebo (corn starch filled capsules), two capsules/day for six weeks. Nutritional assessment was done, and biochemical parameters were measured before and after the intervention. Nutritional assessment parameters like body mass index (p=0.001), triceps skin fold thickness (p=0.011), muscle strength (p=0.007) and subjective global assessment scores (p<0.000) showed a positive trend in the probiotic group. Probiotic intake also significantly downregulated direct bilirubin levels (p=0.043) and increased albumin levels compared to baseline, but other biochemical parameters remained unchanged. Child Turcotte Pugh score also decreased significantly compared to pre therapy (p=0.0001). These changes were not observed in the placebo group. Moreover, probiotic VSL#3 supplementation was safe and well-tolerable without any adverse events in patients with cirrhosis. Probiotic VSL#3 supplementation improved the nutritional status, reduced the severity of liver disease and was safe and tolerable in patients with cirrhosis. www.ctri.nic.in (CTRI/2021/07/034917).

Nutritional Status of People with a Coexisting Chronic Wound and Extended Assessment Using Bioelectrical Impedance.

The diagnosis of malnutrition should be one of the pillars of comprehensive patient care, especially in the case of patients with large wounds, prolonged healing, or comorbidities. The condition for a reliable and accurate nutritional diagnosis is to link it with the parameters of nutritional status assessment at the basic level (anthropometric measurements and clinical assessment) and in depth (biochemical tests and bioelectrical impedance). A prospective study included a sample of 60 patients with coexisting chronic wounds (venous ulcers, diabetic foot syndrome, pressure injury) treated at the Wound Treatment Clinic of Fr. B. Markiewicz Podkarpackie Oncology Center (Poland). The method of estimation and diagnostic survey was used; the research tool was a scientific research protocol consisting of four parts. Self-care capacity was assessed based on the Barthel scale, nutritional status using blood biochemical parameters, and electrical bioimpedance. Wounds were classified according to the extent, depth of tissue structures, and potential infection. Subjects with pressure ulcers had statistically significantly lower fat-free mass component indices compared to those with diabetic foot syndrome and venous ulceration. The subjects with pressure ulcers had significantly lower values of body composition components compared to those with diabetic foot syndrome and venous ulcers. In the group of patients with pressure ulcers, the lowest values of albumin (3.20 g/dL), hemoglobin (10.81 g/dL), and nutritional risk index (NRI) (88.13 pts.) scores were confirmed. Subjects with pressure ulcers with limited self-care presented a non-physiological nutritional status, indicating a risk of malnutrition. Local actions related to wound treatment should be preceded by a general examination, considering the state of augmented nutrition with the use of electrical bioimpedance.

#5742 MID-ARM CIRCUMFERENCE AS A CORRELATE TO DIFFERENT: ASPECT NEUROCOGNITIVE IMPAIRMENT IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Malnutrition is associated with poor cognitive function (CI) in Hemodialysis (HD) patients. Both have multiple ways of assessment scaled from simple bedside screening tests to more sophisticated time- and cost-consuming measures. This work aims to define the best nutritive assessment measure that correlates to the degree of CI. Method A cross-sectional study was carried out on 116 patients in 4 different HD units from Delta Nile, Egypt. The nutritional status was examined after the dialysis session in euvolemic patients using (1) anthropometric measurements, including body mass index (BMI), mid-arm circumference (MAC), skin fold thickness (SFT), and mid-arm muscle circumference (MAMC); (2) bioelectrical impedance analysis for assessment of skeletal muscle mass (SMM), skeletal muscle index (SMI), free fat mass (FFM), body fat mass (BFM), and total body water (TBW); (3) Hand grip strength was used to assess muscle power. The assessment of cognition was made using (1) a mini-mental state examination (MMSE) for orientation, registration, attention, recall, language, and copying; (2) Saint Louis University Mental Status Exam (SLUMS) for early CI and executive functioning; (3) Arabic version of Penn Web-Based Computerized Neurocognitive Battery (WebCNP) for those who scored no CI in the previous two tests. Results The results of MMSE and SLUMS tests showed that 34.5% of our cohort (n = 40) had no CI, 34.5% (n = 40) had mild to moderate degrees of CI, and 31% (n = 36) had a severe form of CI. Comparing the nutritional assessment parameters between the categories of cognitive scores revealed that there were no significant differences except in significantly lower median values of MAC (P 0.01), SMI in bioelectrical impedance analysis (P0.01), and hand grip strength (P 0.002) in severe CI group than the normal to patients without CI. In correlation statistics, MAC and hand grip strength were negatively correlated to the degree of CI (r = -0.3, P 0.006 and r = -0.26, P 0.009, respectively). MAC was the only parameter correlated with attention, emotional recognition, and differentiation functioning in the forty patients with no CI who underwent computerized neurocognitive assessment. The highest reported positive correlations reported were between the MAC and response time of both emotion recognition (r = 0.57, P &amp;lt;0.001) and differentiation (r = 0.55, P &amp;lt;0.001). Conclusion Of the different parameters of nutritional state assessment, MAC, the simple bedside measurement, was the best correlate with the degree of cognitive impairment in HD patients, even in its mild primitive forms.

Gambaran Asupan Zat Gizi Makro dan Status Gizi Remaja SMA di Kota Surakarta

Food intake is a direct factor that can affect the nutritional status of adolescents. Imbalance of food intake will cause nutritional problems in adolescents. The survey results from two senior high schools showed that 16.46% of adolescents were overweight. This study aims to determine the description of macronutrient intake with nutritional status of high school adolescents in the city of Surakarta. This type of research uses observational research with a cross-sectional approach. The population in this study were teenagers in class XI and XII as many as 943 students. Sampling by simple random sampling method with a sample of 88 students. Food intake data was obtained by food recall 3x24 hours, namely 2 weekdays and 1 weekend with the method of 1 day direct interview and 2 days via whatsapp, food intake data was processed using NutriSurvei 2007 software. Nutritional status data was obtained based on anthropometric measurements, namely weight weighing using digital weight scales and measurement of height with microtoice, nutritional status assessment parameters using Body Mass Index according to Age (BMI/U). The results showed that most of the intake of carbohydrates (73.9%), fat (64.8%) and protein (52.3%) of adolescents were included in the category of weight deficit. As many as 14.8% of adolescents have abnormal nutritional status. Respondents with poor intake of protein, fat and carbohydrates showed more abnormal nutritional status. Adolescents must pay attention to the adequacy of fat intake so that it is balanced with daily needs.

Comparison of Tools for Nutritional Assessment and Screening of Hospitalized Patients: A study on Surgical Patients.

To compare the Simple Nutrition Screening Tool (SNST) with other nutritional screening tools [Nutrition Risk Screening 2002 (NRS-2002), Nutrition Risk index (NRI)], nutritional assessment parameters, and the Subjective Global Assessment (SGA) in surgical patients. A comparative observational study with a total of 122 surgical patients. Patients were assessed during the first 24 h of admission in the ward from January to July 2022 using the NRI, NRS-2002, SNST, body mass index (BMI), mid-upper arm circumferences (MUAC), albumin serum, hemoglobin level, total lymphocyte count (TLC), and SGA. Sensitivity, specificity and predictive values were calculated to evaluate NRI, NRS-2002, SNST, BMI, MUAC, albumin, hemoglobin, TLC compared to SGA. The screening tools identified a high nutritional risk in surgical patients from 58.2%-72.1%. Meanwhile, about 29.5% to 71.3% was affected by malnutrition based on nutritional assessment tools. There were significant associations between the type of disease, the screening tools, the anthropometric parameters, albumin, TLC as well and SGA (p<0.05). The SNST has a good category among the nutritional screening tools with sensitivity and specificity >80%, as well as area under the curve >0.8. There were significant associations for screening (NRS-2002, SNST) and nutritional assessment tools (BMI, MUAC, albumin) compared with SGA. Both these tools can be used to determine the risk of malnutrition in surgical patients.

Selected parameters of nutritional status assessment as biomarkers of short and long-term prognosis in patients undergoing surgery due to colorectal cancer

Selected parameters of nutritional status assessment as biomarkers of short and long-term prognosis in patients undergoing surgery due to colorectal cancer

Prediction of Prognosis in Geriatric Palliative Care Patients with Diagnosed Malnutrition: A Comparison of Nutritional Assessment Parameters.

Malnutrition is very commonly encountered in palliative care centers (PCC), especially in geriatric patients. It is known that development of malnutrition increases morbidity and mortality. In this study, we aimed to investigate the effectiveness of commonly used nutritional assessment parameters in predicting prognosis in geriatric patients diagnosed in PCC with malnutrition. Our study included 1451 patients aged ≥65 years, who were diagnosed with malnutrition in PCC between 2016-2020 and did not yet start receiving nutritional support. Demographic data, comorbidities, The Nutritional Risk Screening 2002 (NRS-2002), body mass index (BMI), albumin, prealbumin and C-reactive protein (CRP) values of the patients were recorded. Prognostic course was evaluated by dividing the patients into 3 groups, namely mortal patients during PCC follow-up, patients transferred from PCC to Intensive Care (ICU) and patients discharged to home from PCC. Logistic Regression analysis showed that low albumin levels affected transfer to ICU (P<0.05). Elevated NRS-2002 and low albumin and prealbumin levels were found to be factors affecting mortality (P<0.05). Areas under the ROC Curve were calculated to attain patients' differential diagnosis. The area under the ROC Curve of low albumin in patients transferred to ICU was found to be significant (P<0.05). In the differential diagnosis of patients with mortal course, the area under the ROC Curve of low albumin and prealbumin and high CRP was found to be significant (P<0.05). We found that BMI had no prognostic predictive effects in geriatric PCC patients with malnutrition. We concluded that NRS-2002 and high CRP and low albumin and prealbumin can be used to predict mortality. In addition, we found that low albumin indicates a poor prognosis and predicts patients to be transferred to ICU.

Evaluation of Nutritional Characteristics Reveals Similar Prevalence of Malnutrition in Patients with Ulcerative Colitis and Crohn's Disease.

Inflammatory bowel disease (IBD) is associated with an increased risk of malnutrition and sarcopenia. To evaluate the nutritional status of patients with IBD and determine the threshold values of different parameters of nutritional assessment to identify malnutrition. This was a single-centre cross-sectional analysis of adult patients with IBD [ulcerative colitis (UC) and Crohn's disease (CD)] who underwent anthropometry [body mass index (BMI), mid upper arm circumference (MUAC) and triceps-fold thickness (TSF)], body composition analysis and assessment for sarcopenia [hand-grip strength and skeletal muscle index (SMI) at L3 vertebral level)]. Age- and gender-matched healthy adults served as controls. Malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. A total of 406 patients [336 (82.76%) UC and 70 (17.24%) CD; mean age 40.56 ± 13.67years; 215 (52.95%) males] with IBD and 100 healthy controls (mean age 38.69 ± 10.90years; 56 (56%) males) were enrolled. The mean BMI, MUAC, TSF thickness, fat and lean mass, hand-grip strength, and SMI at L3 vertebral level were lower in patients with IBD compared to controls. The prevalence of malnutrition was similar in UC and CD [24.40% (n = 82) and 28.57% (n = 20), respectively (p = 0.46)]. Thresholds for fat mass in females (15.8kg) and visceral fat index in males (0.26) were both sensitive and specific to detect malnutrition. The cutoff values of MUAC and TSF thickness to identify malnutrition were 23.25cm and 25.25cm, and 16.50mm and 8.50mm, in females and males, respectively. Malnutrition and sarcopenia were common in patients with IBD, with the prevalence being similar in patients with both UC and CD.

POS-641 DEPRESSION DETERMINANTS IN EGYPTIAN HEMODIALYSIS PATIENTS

Depression is common in hemodialysis patients. There are many risk factors for depression among ESRD patients. Additionally, nutrition is likely to influence patients’ morbidity, especially, those who suffered from malnutrition. The correlations between depressions together with nutritional assessment among HD patients have been understudied in Egypt to the best of our knowledge hence; we aimed to evaluate the relations between depression and different variables including parameters of nutritional assessment in hemodialysis patients.

Homemade blenderized Ryles tube formula is equally efficient as commercial formula in terms of anthropometric and biochemical measurements in tertiary care neurologic intensive care unit: A single center study

Objectives: In Indian intensive care units (ICUs), malnutrition is a leading cause of death and morbidity. There is a scarcity of information on the state of malnutrition in India and the efficacy of homemade Ryle’s tube formula in neurologic cases as compared to commercial formula feed. The goals of the present study were to evaluate the nutritional status of neurological disorder patients, to prepare a home-based feed using locally available cereal and pulse combinations, and to investigate the impact of two different Ryes tube formulas on nutritional status. Material and Methods: A prospective, randomized comparative study was conducted in the neurological ICU of a tertiary care medical college hospital located in rural Telangana. Group A was given commercial formula, while Group B was given homemade Ryle’s tube formula, which was calorically equivalent to commercial formula. The Harris-Benedict equation was used to determine the patients’ caloric requirements. During hospital stay, both groups received a comparable amount of Ryle’s tube feeding. The impact of two different formulations was evaluated using quantitative indices including weight, body mass index, triceps skinfold thickness, and serum albumin over a period of 2 weeks. The standard deviation and mean were determined. The researchers used a paired t-test with a two-tailed distribution. If the P &lt; 0.05, it was considered significant. For data processing, open-source software open Epi 2007 was used. Results: In both classes, thirty patients were enrolled. On admission, the demographic profiles of both groups were identical, as evidenced by non-significant P-values. According to the sample parameters, there was no substantial difference between the two formulas at the end of the study period. Both formulas were equally efficacious for the nutritional assessment parameters during the study period. Conclusion: On initial admission, malnutrition was uncommon in the neurologic ICU. In terms of study parameters, both formulas were equally efficient. The homemade blenderized formula was 50% less expensive than commercial formula, making it an important nutritional supplementation option for the deprived strata of the population.

Homemade blenderized Ryles tube formula is equally efficient as commercial formula in terms of anthropometric and biochemical measurements in tertiary care neurologic intensive care unit: A single center study

OBJECTIVES:In Indian intensive care units (ICUs), malnutrition is a leading cause of death and morbidity. There is a scarcity of information on the state of malnutrition in India and the efficacy of homemade Ryle’s tube formula in neurologic cases as compared to commercial formula feed. The goals of the present study were to evaluate the nutritional status of neurological disorder patients, to prepare a home-based feed using locally available cereal and pulse combinations, and to investigate the impact of two different Ryes tube formulas on nutritional status.MATERIAL AND METHODS:A prospective, randomized comparative study was conducted in the neurological ICU of a tertiary care medical college hospital located in rural Telangana. Group A was given commercial formula, while Group B was given homemade Ryle’s tube formula, which was calorically equivalent to commercial formula. The Harris-Benedict equation was used to determine the patients’ caloric requirements. During hospital stay, both groups received a comparable amount of Ryle’s tube feeding. The impact of two different formulations was evaluated using quantitative indices including weight, body mass index, triceps skinfold thickness, and serum albumin over a period of 2 weeks. The standard deviation and mean were determined. The researchers used a paired t-test with a two-tailed distribution. If the P &lt; 0.05, it was considered significant. For data processing, open-source software open Epi 2007 was used.RESULTS:In both classes, thirty patients were enrolled. On admission, the demographic profiles of both groups were identical, as evidenced by non-significant P-values. According to the sample parameters, there was no substantial difference between the two formulas at the end of the study period. Both formulas were equally efficacious for the nutritional assessment parameters during the study period.CONCLUSION:On initial admission, malnutrition was uncommon in the neurologic ICU. In terms of study parameters, both formulas were equally efficient. The homemade blenderized formula was 50% less expensive than commercial formula, making it an important nutritional supplementation option for the deprived strata of the population.

Role of the nutrition-focused physical examination in identifying malnutrition and its effectiveness.

It has long been recognized that malnutrition changes physical appearance, as evidenced by muscle wasting, losses of fat stores, signs of vitamin and mineral deficiencies, and reduced physical activity. Malnutrition is associated with poor clinical outcomes and quality of life. Various nutrition assessment parameters have been used to determine the presence and degree of malnutrition, including use of anthropometric measurements and laboratory values. In the mid-1980s, the Subjective Global Assessment (SGA) tool was developed in acknowledgement of the physical features of malnutrition; an evaluation of muscle mass, fat stores, edema, and functional capacity was a major component of the SGA. SGA became a gold standard for nutrition assessment. Since then, nutrition assessment evolved from anthropometric tools and laboratory values to one based on the nutrition-focused physical examination (NFPE). NFPE uses a head-to-toe approach to evaluate muscle mass, fat stores, fluid retention, micronutrient deficiencies, and functional capacity. In 2012, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (AND/ASPEN) developed a standardized definition for malnutrition diagnoses for coding and reimbursement; the AND/ASPEN malnutrition diagnosis is derived from the SGA. A few studies demonstrated good agreement between SGA and AND/ASPEN malnutrition criteria in diagnosing malnutrition, and some studies have shown malnutrition, as diagnosed by AND/ASPEN criteria, is associated with poor clinical outcomes. More research is needed to validate the AND/ASPEN malnutrition diagnosis criteria.

Dietary intake and characteristics in persons with multiple sclerosis

BackgroundDespite growing interest in diet and dietary interventions in persons with multiple sclerosis (PwMS), few studies have examined dietary intake and characteristics within this population. The objectives of this study were to prospectively describe and compare nutrition assessment parameters related to the diet, including daily food intake, nutrient intake, eating behaviours, and other dietary characteristics (i.e., specific diets, food preparation, and food security) between PwMS and controls without multiple sclerosis (MS). MethodsThis study used a cross-sectional design in 60 PwMS and 60 matched controls. All participants completed a 3-day food intake record and questionnaires. Dietary intake was analysed with and without supplements using ESHA Food Processor SQL. Differences in dietary intake by group and supplement intake were examined using mixed-model ANOVAs. ResultsThere were differences in average daily micronutrient intake between groups for vitamins D, B12, and C, omega 3 fatty acids, and phosphorous. Through supplement use, PwMS consumed significantly more vitamin D, omega 3 fatty acids, vitamin B12, vitamin C, magnesium, manganese, and zinc than controls. There was no difference in dietary behaviours or other dietary characteristics between groups. ConclusionsResults suggest that dietary intake was similar in persons with and without MS. The few differences in dietary intake between groups were mostly accounted for by supplement intake in PwMS. Further studies are needed to continue exploring dietary intake in PwMS.

Nutrition Essentials: Pressure Injury Prevention and Healing for Adults.

Nutrition factors associated with the development of pressure injuries include unintended weight loss, undernutrition, increased nutrient needs, malnutrition, dehydration, low body mass index, inadequate food and fluid intake, and an inability to feed oneself.1 For individuals with compromised nutrition status, time is of the essence. Interprofessional teams must ensure efforts to identify the risk or presence of malnutrition and implement a timely, individualized plan of care. The Table identifies basic nutrition assessment parameters and interventions for adults. Table - NUTRITION-RELATED PRESSURE INJURY (PI) PREVENTION AND HEALING Component Method Procedure Intervention/Recommendation Screen • Use a validated screening tool to identify malnutrition (risk) • Facility should select a screening tool validated for patient age/setting1,2 • Screen at admission, readmission, and/or condition change1 • Unvalidated screening tools are not recommended2,3 • Determine who will be trained to administer the screening process • Notify registered dietitian nutritionist (RDN) of results1,2 • Perform nutrition screening per facility policy • Validated nutrition screening tools for adults: Malnutrition Screening Tool,2 Mini Nutritional Assessment,3 Malnutrition Universal Screening Tool,4 Nutrition Risk Screening 2002,2 Short Nutrition Assessment Questionnaire,2 Canadian Nutrition Screening Tool5 Assessment2 Nutrition status assessment by RDN includes review and evaluation of: Assessment to identify malnutrition is defined as presence of two or more characteristics:6 Laboratory values: • Validated screening tool • Insufficient energy intake • Albumin and prealbumin are acute phase reactants decreased by inflammatory conditions that affect the liver • Food/fluid history and intake • Unintended weight loss • Approximately 5% of the body’s albumin is produced in the liver daily, so intake has little impact on protein levels • Anthropometric measurements • Loss of muscle mass • Research indicates albumin/prealbumin are NOT markers of malnutrition6–8 • Weight history • Loss of subcutaneous fat Nutrition-focused physical examination:2 • Biochemical data, medical tests, and procedures • Localized or generalized edema • The RDN is responsible for this essential step malnutrition diagnosis • Ability to eat independently • Diminished functional status as measured by handgrip strength • The RDN is trained to identify conditions such as edema, loss of muscle mass/subcutaneous fat, and micronutrient deficiencies (current standard) • Nutrition-focused physical examination • A decrease in subcutaneous fat and muscle mass is a marker of malnutrition6 Interventions • Provide adequate calories per assessed need to spare protein for PI healing1,7 PI risk: optimize energy intake per assessed need1,7 For individuals with PI and malnutrition or at risk of malnutrition:1,9 • Fortify favorite foods • Provide 30–35 kcal/kg • Offer high-calorie/high-protein supplement between meals • Provide 1.25–1.5 g/protein/kg • Offer modular protein (whey, soy, or hydrolyzed collagen) • Offer high-calorie/high-protein supplement fortified with arginine, zinc, and antioxidant between meals for PI stage ≥2 Fluids • Aids in wound site hydration and oxygen perfusion • Evaluate current daily intake • Provide and encourage adequate hydration for individuals with or at risk for PI (considering goals of care and individual condition)1,9 • Solvent for minerals, vitamins, amino acids, glucose, and other small molecules • Monitor for dehydration including weight changes, skin turgor, urine output, elevated serum sodium, and/or calculated serum osmolality1,9 • Consider 30 mL/kg for healthy individuals or 1 mL/kcal/d1,9 • Transports nutrients through the body and removes waste from cells • Individuals with congestive heart failure and/or chronic kidney disease may not tolerate high fluid intake • Offer hydration during wound/patient care and with each medication pass • Offer choice of beverages at meals and snacks • Offer added fluids for individuals with dehydration, draining wounds, fever, profuse sweating, nausea, or diarrhea1,9 Vitamins/minerals Micronutrients (such as vitamins A, B, and C and zinc) required in trace amounts as part of a healthy diet Observe: • Mega doses of vitamin or minerals are NOT recommended1,9 • Meals/snacks intake • Provide vitamin/mineral supplement daily if meal intake is poor (usually defined as <50% of food served/provided on plate)1,9 • Type of food/beverages • Check the label: oral supplements and fortified foods contain vitamins and minerals • Amount of oral nutrition supplement consumed, if applicable

Body composition among patients undergoing surgery for colorectal cancer.

IntroductionNutritional status assessment is an important part of preoperative patient evaluation, but the standard anthropometric parameters do not appear to be adequate.AimTo determine the changes in the values of bioelectrical impedance analysis (BIA) parameters in patients 3 months after undergoing surgery for colorectal cancer (CRC).Material and methodsBIA and nutritional status assessment parameters were determined in 80 patients prior to undergoing surgery for CRC. The results 3 months after surgery for 64 of those patients were then compared with their initial assessments.ResultsAccording to standard WHO ranges, 54% of the patients were diagnosed as being overweight and 29% as obese. The percentage of patients categorized as obese amounted to 56% when this was defined as high fat mass. Moderate sarcopaenia, defined as a low skeletal muscle index (SMI) or low percentage of skeletal muscle mass, was diagnosed in 21% and 29% of patients, respectively. Patients with postoperative weakness that made it impossible for them to attend the control visit had a lower preoperative skeletal muscle mass (p = 0.01) and SMI value (p = 0.001). Parameters of BIA did not discriminate patients with postoperative complications, which occurred in 23% of individuals enrolled.ConclusionsA significant proportion of the patients undergoing surgery for CRC were overweight or obese, which could mask the sarcopaenia that presented in 21–29% of them. Sarcopaenia was the only parameter predictive of a postoperative decrease in performance status.

Study on the role of nutritional assessment parameters in predicting chemotherapy Induced thrombocytopenia (CIT) with oxaliplatin based regimens in colorectal cancer

Rationale: The incidence of CIT caused by oxaliplatin based regimen is about 24% in colorectal cancer patients, which often cause chemotherapy delay, reduction, or even termination, and then affect the efficacy of chemotherapy. This study will focus on finding predictive nutritional assessment parameters on CIT caused by oxaliplatin based chemotherapy to find high risk CIT population.

Relation between parameters of body composition and echocardiography in patients with nonvalvular atrial fibrillation

Purpose: Both nutritional status and echocardiographic parameters are associated with the risk of atrial fibrillation (AF). The aim of this study was to determine the relationships between parameters of transthoracic echocardiography and nutritional status assessment as risk factors for AF. Methods: This cross-sectional study considered 120 consecutive patients hospitalized due to AF and 240 inpatients admitted due to exacerbation of cardiovascular conditions. Echocardiographic parameters and parameters of nutritional status were determined for each patient. Results: Patients in the lowest body mass index (BMI) quartile and without visceral adiposity had the lowest standard echocardiographic parameters; however, the majority of these differences disappeared after the parameters were indexed to BSA. In logistic regression analysis, echocardiographic parameters were associated with slightly higher or similar AF risk comparing with parameters of nutritional status assessment. When the comparison was made in relation to cut-off values obtained in ROC analysis, then having a visceral adipose tissue (VAT) score ≥ 12 was associated with a lower increase in AF risk (odds ratio [OR]; 95% confidence interval [CI]: 3.09; 1.85–5.15) than the risk increase associated with e.g. left atrium diameter greater than 45mm ([OR; 95% CI] 10.483; 6.308–17.421). Conclusions: The unitary values of echocardiographic and body composition parameters only slightly differed in relation to the risk of AF occurrence, however, the use of cut-off values significantly increases an impact of echocardiography on the prediction of AF. The U-shaped relationships between a patient’s nutritional status and AF occurrence cannot be explained by the effect of body mass on cardiac structure and size.

661 Dietitian Order-writing in a Burn Intensive Care Unit

Abstract Introduction Recent changes in Center for Medicare &amp; Medicaid Services guidelines recommend that Registered Dietitians (RD) write nutrition-related orders for hospitalized patients. The goal is to improve patient care and assist other clinical providers. Permitted orders may include diets, enteral nutrition and monitoring along with referrals per hospital policies. RD order-writing started in our intensive care units (ICU) the past year. This study reviewed the type and number of orders written by the RD. Methods The ICU RD prospectively (January 17, 2019 – August 31, 2019) tallied RD orders including: diet and supplement changes, enteral nutrition, calorimetry, nitrogen balance and intake orders (calorie count). Orders that could have been completed by the RD but were completed by a doctor or physician assistant (PA) were also noted. Data was analyzed using descriptive statistics and results reported as percent of patient days and type of order completed. Results Results were collected on a total of 1775 patient day. The majority (1519 = 85.5%) did not require changes in nutritional intervention or monitoring (see Table). Of the 446 nutrition related orders written, the RD completed 347 (77.8%) with 99 (22.2%) completed by the PA. Changes to enteral nutrition, calorie counts and nutrition-related tests (calorimetry and nitrogen balance) the most common. The majority of changes occurred during team rounds. Conclusions Most patients did not require changes in diets, nutrition support or nutritional assessment parameters. The most common changes were stopping/starting calorie counts and adjusting enteral nutrition or nutritional monitoring. RD order-writing decreased the number of orders the MD or PA completed. Applicability of Research to Practice Order-writing protocols can assist the burn medical team with workflow and allow for more timely nutritional interventions when needed.

Nutritional status and outcomes of superficial femoral artery stenting due to intermittent claudication

The pathogenesis of in-stent restenosis is still not clear. The aim of this study was to determine the nutritional status of patients with lower limb ischemia and the risk of target lesion revascularization (TLR) after superficial femoral artery (SFA) stenting. Numerous parameters of nutritional status assessment were compared between 70 patients undergoing SFA endovascular intervention with a self-expandable plane stent due to life-limiting intermittent claudication and 40 patients undergoing carotid artery stenting (CAS). All subjects were followed up for at least 1 year in relation to outcomes such as clinically driven TLR occurrence. Patients undergoing SFA stenting had a lower prevalence of overweight and obesity than those who underwent CAS (51.43% vs. 72.50%; P=0.031). An increase in Ankle-Brachial Index of >0.15 after SFA stenting (early end-point) was positively associated with greater handgrip strength (HGS), fat-free mass, skeletal muscle mass and waist-to-hip ratio. Freedom from TLR (late end-point) was significantly related to a higher waist-to-height ratio (WHtR), HGS and Geriatric Nutritional Risk Index (GNRI) Score. The 1-year risk of TLR for patients with a WHtR of ≥61.39 amounted to odds ratio; 95% confidence interval: 0.21; 0.05-0.25; P=0.021. Parameters of nutritional status assessment were associated with early and late outcomes of SFA stenting in patients with intermittent claudication. Abdominal fat distribution and higher HGS and GNRI scores lowered the 1-year risk of TLR. Further study is needed to determine the pathomechanism of the obesity paradox, sarcopenia and undernutrition in relation to outcomes of endovascular interventions.