Prevalence Of Protein-calorie Malnutrition Research Articles

Risk Factors and Outcomes of Protein-Calorie Malnutrition in Chronic Heart Failure Patients Undergoing Elective Cardiac Surgery.

Chronic heart failure (CHF) patients are often malnourished. Our aim was to determine the effect of protein-calorie malnutrition (PCM) on in-hospital outcomes in CHF patients following elective cardiac surgery and to identify risk factors for PCM in this patient population. A retrospective analysis of the National Inpatient Sample (NIS) database was conducted from2016 to 2018. In-hospital outcomes in adult patients with CHF undergoing elective coronary artery bypass graft (CABG) with cardiopulmonary bypass-assist or cardiac valve replacement surgeries were analyzed. Propensity-score matching was used to match CHF patients with and without PCM and followed by logistic regression analysis. A multivariate logistic regression model was used to identify the risk factors associated with PCM in this population. In total 25,940 CHF patients were identified, of which 6,271 underwent elective CABG and 19,669 underwent valve replacement surgeries. The prevalence of PCM in CHF patients undergoing CABG and valve replacement was 3.9% and 2.9%, respectively. CHF patients with PCM had significantly higher risk of in-hospital mortality, post-operative cardiac and gastrointestinal complications compared to CHF patients without PCM. The mean hospital length of stay was twice as high in the PCM group (mean days: 18.6 vs 9.9). Female gender, Black race (vsWhite race), a high Charlson Comorbidity Index, Medicare/Medicaid insurance status (vsprivate insurance), and CHF (systolic and combined systolic and diastolic) were independently associated with significantly higher risk of PCM diagnosis. CHF patients with PCM who undergo elective CABG or valve replacement surgeries are at a significantly higher risk of mortality, post-operative cardiac and gastrointestinal complications, and increased duration of hospital stay compared to those without PCM. Future prospective studies should assess the CHF patients who are at a higher risk of PCM and whether correcting pre-operative nutrition in this surgical population can improve outcomes following cardiac surgery.

Malnutrition screening and diagnosis tools: Implications for practice.

Despite the prevalence of protein-calorie malnutrition (PCM) in acute-care hospitals and long-term care centers, a national and global consensus on nutrition screening and malnutrition diagnosis is lacking. PCM is associated with various acute and chronic complications, such as impaired wound healing, increased risk for infection, debility, and increased risk for rehospitalization. The consequences of PCM are also incredibly costly to both the patient and the healthcare facility. The purpose of this paper is to identify nutrition screening tools and malnutrition diagnosis tools currently being utilized in acute-care healthcare centers across the United States.

Nutritional status of CAPD patients at three years.

A nutritional assessment was carried out in 63 patients starting treatment from April 1990 up to December 1993. Anthropometric measurements were performed showing a prevalence of protein-calorie malnutrition (PCM) of 21% in a total of 142 clinical surveys carried out in the above-mentioned sample. A steady state of albumin levels in plasma was verified during a three-year follow-up period at a lower level than that of the control group. The patients' lymphocytic profile throughout the study was characterized by lymphopenia and decreased B and T8 lymphocytes. During the first two years of continuous ambulatory peritoneal dialysis (CAPD), a high percentage of patients met the "adequacy" dialysis criteria as residual renal function plays an important role as regards treatment.

Identifying Geriatric Malnutrition in Nursing Practice: The Mini Nutritional Assessment (MNA®)—An Evidence-Based Screening Tool

Protein calorie malnutrition (PCM) is common and often undiagnosed in older adults. Left untreated, PCM carries both clinical and financial risks, including decreased quality of life, declining functionality, the inability to live independently, and increased health care costs. The prevalence of PCM in older adults calls for a systematic and standardized approach to nutrition screening that includes the use of a validated screening tool. Recommended by international organizations, the Mini Nutritional Assessment® (MNA) is highly specific and reliable and the most well-validated nutrition screening tool for adults 65 and older. Simple, noninvasive, inexpensive, and easy for nurses and other clinicians to use, the newest MNA-short form (MNA-SF) can quickly and easily identify older adults who are at risk for malnutrition or malnourished. Nurses are key players in successful malnutrition screening in hospitals, long-term care, home care, and community settings. It is strongly recommended that nurses incorporate the newest MNA-SF into all practice settings where older adults receive care.

Identifying Geriatric Malnutrition in Nursing Practice: The Mini Nutritional Assessment (MNA®)—An Evidence-Based Screening Tool

Protein calorie malnutrition (PCM) is common and often undiagnosed in older adults. Left untreated, PCM carries both clinical and financial risks, including decreased quality of life, declining functionality, the inability to live independently, and increased health care costs. The prevalence of PCM in older adults calls for a systematic and standardized approach to nutrition screening that includes the use of a validated screening tool. Recommended by international organizations, the Mini Nutritional Assessment® (MNA) is highly specific and reliable and the most well-validated nutrition screening tool for adults 65 and older. Simple, noninvasive, inexpensive, and easy for nurses and other clinicians to use, the newest MNA-short form (MNA-SF) can quickly and easily identify older adults who are at risk for malnutrition or malnourished. Nurses are key players in successful malnutrition screening in hospitals, long-term care, home care, and community settings. It is strongly recommended that nurses incorporate the newest MNA-SF into all practice settings where older adults receive care.

Factors associated with nutritional status in liver transplant patients who survived the first year after transplantation

Most studies published focus on the evaluation of the impact of nutritional status on the morbidity and mortality during the immediate postoperative period or on the short-term evolution of liver transplant patients. The aim of the study was to evaluate long-term trends in nutritional status. Seventy patients consecutively submitted to liver transplantation were studied. Nutritional assessment was performed the day before transplantation and the 45, 90, 180 and 365 days after transplantation, consisting of determination of dietary intake, anthropometric and biochemical analysis. Sixty-nine percent of the patients presented with malnutrition on the day before liver transplantation, decreasing to 44% at end of the first year. The prevalence of protein-calorie malnutrition (PCM) was 63% at 90 days post-transplant. A significant difference of PCM was observed between patients with cirrhosis and non-cirrhotic disease (53.6% x 100%) at 90 days post-transplant. The pre-transplant nutritional diagnosis and 90-day calorie intake were identified as variables independently associated with nutritional status at 90 days post-transplant. The variables independently associated with nutritional status in the 1-year assessment were pre-transplant PCM and 365-day calorie requirements. No influence on nutritional status was observed for peri- or postoperative factors after 3 or 12 months of follow up. As expected, dietary factors, especially adequate calorie intake, were always associated with nutritional status during all periods analyzed.

Protein–calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension

We conducted a nationwide analysis of the prevalence of protein-calorie malnutrition (PCM) in patients with cirrhosis and portal hypertension (PHTN) and to determine its mortality and economic impact. We used the Nationwide Inpatient Sample (NIS) to identify admissions throughout the US with cirrhosis and PHTN between 1998 and 2005 using the International Classification of Diseases, 9th Revision diagnostic codes. Prevalence of PCM in this group of patients with cirrhosis was compared with that of general medical inpatients. The impact of PCM on in-hospital mortality was quantified using multiple logistic regression analysis. There were 114 703 admissions with cirrhosis and PHTN in the NIS between 1998 and 2005. The prevalence of PCM was substantially higher among patients with cirrhosis and PHTN compared with general medical inpatients (6.1 vs. 1.9%, P<0.0001), with an adjusted odds ratio of 1.55 (95% CI: 1.4-1.7). There was greater prevalence of ascites (64.6 vs. 47.8%, P<0.0001) and hepatorenal syndrome (5.1 vs. 2.8%, P<0.0001) among those with PCM and cirrhosis. In-hospital mortality was two-fold higher among patients with cirrhosis and PCM (14.1 vs. 7.5%, P<0.0001), with an adjusted mortality of 1.76 (95% CI: 1.59-1.94). PCM was associated with greater length of stay (8.7 vs. 5.7 days, P<0.0001) and hospital charges (US$36 818 vs. US$22 673; P<0.0001) among patients with cirrhosis. PCM is more common among patients with cirrhosis and PHTN than the general medical population, and is associated with higher in-hospital mortality and resource utilization. PCM may be an indicator of greater disease severity and should be routinely assessed on admission.

Sensibilidade no diagnóstico da desnutrição protéico-calórica realizado pelas equipes de saúde por meio do SIAB e de busca ativa de casos

É atribuição da Atenção Primária á Saúde e da Estratégia de Saúde da Família (ESF) atuar na promoção e na manutenção do estado de saúde da população infantil por meio do atendimento e acompanhamento integrais. Para a atuação das equipes de saúde é fundamental a análise de saúde das populações cobertas. Para esse fim o Sistema de Informação da Atenção Básica (SIAB) é instrumento de valor inestimável. O objetivo deste estudo foi demonstrar a sensibilidade no diagnóstico da desnutrição protéico-calórica realizado pelas equipes de Saúde da Família, quando são utilizados apenas dados primários como instrumentos de busca da adequação e posterior informação destes, via SIAB, e por meio da busca ativa de crianças de 0 a 23 meses e 29 dias e obtenção de seus dados antropométricos delas. Trata-se de estudo seccional, realizado no município de Patos de Minas (MG), de janeiro a abril de 2005. As prevalências de desnutrição protéico-calórica informadas no SIAB foram 2,35% e 2,5%, nas equipes A e B, respectivamente. As prevalências de desnutrição encontradas a partir da busca ativa, dos dados antropométricos e do cálculo dos índices peso-idade foram 14,12% e 13,75% nas equipes A e B, respectivamente. Essas foram superiores à prevalência descrita pela Pesquisa Nacional de Demografia e Saúde, cuja prevalência foi 5,7%. As prevalências de desnutrição protéico-calórica com base no índice peso-idade, mediante exclusivamente a utilização do SIAB como fonte de dados, levam ao subdiagnóstico do problema. Tratando-se o SIAB de um sistema de informação “territorializado”, cujos dados possibilitam a construção de indicadores populacionais referentes a áreas de abrangência bem-delimitadas, propomos a avaliação crítica e constante desses dados.

Insuficiencia cardíaca, malnutrición e inflamación. Prevalencia y aspectos relevantes en su valoración

Heart failure is associated to alterations in the nutritional status that contributes to a worse prognosis of the disease. To study protein-calorie malnutrition (PEM) prevalence, micronutrient deficits and increase of inflammatory parameters in patients with cardiac failure (CF). Cross-sectional, observational study in 98 heart failure patients of Internal Medicine Service have been evaluated. We have analyzed biomedical, anthropometric variables (weight, size, BMI, tricipital fold), search of treatments, echocardiogram valuation and determination of albumin, pre-albumin, A and E group vitamins, ESR and C-reactive protein. We have defined protein malnutrition (PN) as albumin values Average age was 76.6 +/- 7.5. A total of 77.7% showed a functional class II-III/IV. Prevalence of PEM was 40%. Low albumin and prealbumin was found in 12.8% and 38.3% respectively (p < 0.05). Using BMI, 5.3% of patients had malnutrition. Nevertheless, if tricipital fold is used, EM was found in the 25.3% of the cases (p < 0.05). Iron iron, vitamin A and C-reactive protein levels were different in heart failure patients with PM (p < 0.05). The percentage of protein malnutrition in patients with LVEF < 45% was 16.4% versus 5.5% in diastolic dysfunction (p = 0.01). Treatment with ACE-inhibitors was 42.2%; in this group the malnutrition for any criterion was 13% vs 26% in the group of patients without ACE-inhibitors (p = 0.08). There is a high prevalence of nutritional and inflammatory disturbances (low in diastolic dysfunction) in patients with moderate status of heart failure. Treatment with an ACE-inhibitor improves the nutritional parameters.

Fat Indices in High and Low Altitude Populations in Southwestern Saudi Arabia

The present study was undertaken to determine the fat indices in high and low altitude populations in Southwestern Saudi Arabia. Measurement of weight, height, mid-upper arm circumference, mid-upper arm muscle area, and skinfold thickness over the triceps region in 261 males living at high altitude (3150 meters above sea level) and 237 males living at low altitude (500 meters above sea level) in Southern Saudi Arabia are reported. The assessment of fatness by calculation of percent body weight is supported by correlation of triceps skinfold thickness with body mass index (BMI). In both high- and lowlanders the triceps skinfold thickness has significant correlation with BMI (P<0.001 for both). BMI also showed significant correlations with body weight, mid-upper arm circumference and mid-upper arm muscle area (P<0.001 for all). The findings show that the use of skinfold thickness in the prediction of degree of fatness in both groups seems to be a practical and useful method. However, it appears that there is a need for densitometric studies among Saudi populations to enable the derivation of valid regression equations for the calculation of body fat from skinfold thickness measurements. In the absence of skinfold measurements the BMI appeared to be a reliable indicator for assessment of body fat in Saudi high- and lowlanders.

Nutritional status in the elderly patient with uraemia

An increasing number of elderly patients with uraemia are treated by dialysis therapy. Virtually every published study on nutritional status of patients undergoing maintenance haemodialysis treatment or continuous ambulatory peritoneal dialysis (CAPD) has indicated that a substantial proportion of patients undergoing regular dialysis treatment have protein calorie malnutrition. Problems of undernutrition increase significantly with age; a combination of socioeconomic, psychological, and biochemical problems interfering with acquiring and assimilating a balanced diet are responsible for nutritional deficiencies in older people. We assessed the prevalence of protein calorie malnutrition in 183 regular dialysis patients aged 65 years or older treated with haemodialysis or CAPD. This group of patients was compared to two other groups aged 18-40 years (62 patients) and 41-64 years (239 patients). Presence of malnutrition was assessed by selected serum chemistries, anthropometry and Subjective Global Nutritional Assessment. Adequacy of dialysis, protein nitrogen appearance, as an index of protein intake, and residual renal function were measured. The results indicate that protein calorie malnutrition occurs commonly in regular dialysis patients, with a higher prevalence of malnutrition in the elderly; 51% of patients of the elderly group were classified as malnourished, and no difference was found with the two dialytic modalities.

Prevalence of malnutrition and vitamin A deficiency in the Diourbel, Fatick, and Kaolack regions of Senegal: epidemiological study

The purpose of our study was to determine the prevalence of protein-calorie malnutrition (PCM), ocular diseases, and vitamin A deficiency in preschool children selected at random in a rural zone of the groundnut belt of Senegal. The prevalence of PCM was 37.1% (95% CI 33.8-40.2%) according to the Waterlow classification, with a majority of stunting, and prevalence of hypovitaminosis A was estimated to be 11.4% (95% CI 9.3-13.5%) by using impression cytology. Furthermore, 19.4% (95% CI 15.8-22.0%) of the children might be defined at risk of deficiency. The prevalence of Bitot's spots was equal to 0.2% (95% CI 0.03-0.9%). A problem of PCM associated with a health-endangering vitamin A deficiency existed.

Determinants of nutritional status in hospital patients in Italy.

The prevalence of protein-calorie malnutrition (PCM) and micronutrient deficiency (MND) at the time of admission and discharge from hospital was evaluated in 91 patients consecutively admitted to the Surgery Clinic of the University Hospital of Rome. Anthropometric parameters and circulating levels of vitamins (A, E, C, B1, and B2) and visceral proteins [retinol-binding protein (RBP, prealbumin (PA), and transferrin] were measured. Twenty-one patients (23%) had moderate to severe PCM, and 70 patients (77%) had normal nutritional status (NNS) at admission. Two patients with PCM died in the hospital. At discharge, the prevalence of PCM was unchanged in the remaining 19 patients. Single or multiple MND was observed initially in 71% of patients with PCM and in 36% with apparently normal nutritional status. Despite vitamin supplementation, MND was present at the time of discharge in 73% of patients with PCM and 44% with NNS. Nutritional status at the time of admission was assessed in hospitals in six different Italian cities. The criterion for admission to the study was the diagnosis of chronic (greater than 1 yr duration) illness (excluding cancer and multiple organ disorders). Two hundred eighty-four patients (145 males, 139 females), ages 25-88 yr, were selected. The findings indicated a high prevalence of MND (64%). Also, in disorders that usually do not have significant alterations of digestion or absorption, such as uncomplicated cardiorespiratory disease, the prevalence of MND was high (9-38%). The prevalence of MND was not related to body mass index (BMI). PCM was more common among patients with chronic gastrointestinal disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional evaluation of hemodialysis patients with and without spinal cord injury.

Both end stage renal disease (ESRD) and spinal cord injury (SCI) represent major disabling conditions that may be associated with protein-calorie malnutrition (PCM). The prevalence of PCM in ESRD, however, remains unknown, and virtually no data exist regarding the status of PCM in patients with both SCI and ESRD. In this study we evaluated 23 ambulatory-ESRD patients and 11 SCI-ESRD patients utilizing a range of parameters recommended for assessing nutritional status in ESRD. Based on these parameters, our results show evidence for PCM in a substantial proportion of both groups. When the two groups were compared, however, the frequency and severity of PCM were significantly greater in the SCI-ESRD patients. Important factors felt to adversely influence nutritional status in the SCI-ESRD patients were intercurrent infection and amyloidosis that were found to frequently complicate this setting. It is also probable that the combined effects of PCM and ESRD significantly predispose these patients to further infection, establishing a vicious cycle.

Nutritional status of nursing home patients.

Nutritional surveys were conducted on all 115 patients of a Medicare-approved nursing home. The techniques of nutritional assessment used included anthropometric measurements (weight/height, triceps skinfold, arm-muscle and arm circumference), biochemical and hematologic tests (serum albumin, serum transferrin, total lymphocyte count, hemoglobin, and hematocrit), and an intradermal skin test for cell mediated immunity. The prevalence of protein-calorie malnutrition (PCM) of moderate to severe degree was very high by currently used standards (weight/height, 43%; triceps skinfold, 37%; arm-muscle circumference, 85%; serum albumin, 32%; serum transferrin, 38%; and total lymphocyte counts, 22%). Anemia was found in 52% of the men and 14% of the women by normal adult standards; in addition, 19% of the patients had negative cell-mediated immunity (CMI) tests. The mortality rate during the 6 months after surveying was 13% for the immunocompetent (CMI-positive) patients and 48% for the anergic (CMI-negative). These findings confirm that PCM is prevalent in 85% of nursing home patients according to currently accepted nutritional assessment standards. In this nursing home population, 485 had marasmus, 35% had marasmus-kwashiorkor mixed syndrome, and 2% had kwashiorkor. Perhaps new standards need to be derived for such specific age groups as the elderly.

Assessment of nutritional status in adult hospitalized patients.

140 adult hospitalized Thai patients were assessed for their nutritional status. The prevalence of protein-calorie malnutrition in these patients based on various parameters was as follows: 73.2% according to weight-height, 80.0% accroding to triceps skinfold thickness, 60.7% according to upper arm muscle circumference, 50.4% according to hair root morphology and 66.2% according to serum albumin level. These data reflected the disproportionate loss of the patients' body tissues. Severity of protein-calorie malnutrition was also detected by physical signs. Anemia and vitamin deficiencies were present in some of the patients. This study signifies that intensive nutritional management should be done to combat hospital malnutrition.

Prevalence of Malnutrition in General Medical Patients

Three, single-day nutritional surveys at weekly intervals were conducted in the general medical wards of an urban municipal teaching hospital. The techniques of nutritional assessment included anthropometric measures (weight/height, triceps skin fold, arm-muscle circumference, serum albumin, and hematocrit). The prevalence of protein-calorie malnutrition was 44% or greater by these criteria (weight/height, 45%; triceps skin fold, 76%; arm-muscle circumference, 55%; serum albumin, 44%; and hematocrit, 48%). These results were reproducible without significant variation between surveys. In 34% of patients, a lymphopenia of 1,200 cells/cu mm or less was found, a level likely to be associated with diminished cell-mediated immunity. Compared with a similar survey among surgical patients, the medical patients were more depleted calorically (weight/height, triceps skin fold) but had better protein status (arm-muscle circumference, serum albumin). Significant protein-calorie malnutrition occurs commonly in municipal hospitals in both medical and surgical services.

The pattern of malnutrition in early childhood in Southern Trinidad

Summary An investigation of malnutrition in early childhood was undertaken in South Trinidad in March, 1959. Analysis of admissions to San Fernando General Hospital showed that 70 children had been admitted in 1958 with a primary diagnosis of malnutrition. None were over 3 years of age, only 10 per cent fell in the “classical” 1 to 3 year period, and the majority (86 per cent) were between 1 and 12 months of age. All were classified as having “protein-calorie malnutrition”. Eighteen were suffering from kwashiorkor and of these 15 (83 per cent) were infants. Their dietary history, when available, showed that all had had what was in Trinidad “nutritionally unsatisfactory” breast feeding together with small amounts of various milk preparations and carbohydrate gruels, especially arrowroot. The peculiar clinical picture of infantile kwashiorkor is described. Analysis of admissions with diarrhea also showed that the majority occurred below 2 years of age—69 per cent in the first semester of life. Dietary histories showed what can be termed in Trinidad as “bacteriologically dangerous” infant feeding in 93 per cent of infants. The prevalence of protein-calorie malnutrition in the community at large was estimated by examining the total child population aged between birth and 4 years in 15 villages and 2 slum areas in the County of Victoria. Assessment was attempted by syndromes and by the use of certain nutritional indicators. Results showed relatively little protein-calorie malnutrition in the community at the time of the survey, the preschool edema index being nil. Factors are considered which may be responsible for the change in age incidence of protein-calorie malnutrition from the classical 1 to 3 year period to infancy and of the increasing occurrence of diarrhea in early childhood. Unsatisfactory infant feeding associated with a decline in breast feeding and a lack of knowledge of correct methods by mothers appear to be of major importance.

The pattern of malnutrition in early childhood in southern Trinidad

Summary An investigation of malnutrition in early childhood was undertaken in South Trinidad in March, 1959. Analysis of admissions to San Fernando General Hospital showed that 70 children had been admitted in 1958 with a primary diagnosis of malnutrition. None were over 3 years of age, only 10 per cent fell in the “classical” 1 to 3 year period, and the majority (86 per cent) were between 1 and 12 months of age. All were classified as having “protein-calorie malnutrition”. Eighteen were suffering from kwashiorkor and of these 15 (83 per cent) were infants. Their dietary history, when available, showed that all had had what was in Trinidad “nutritionally unsatisfactory” breast feeding together with small amounts of various milk preparations and carbohydrate gruels, especially arrowroot. The peculiar clinical picture of infantile kwashiorkor is described. Analysis of admissions with diarrhea also showed that the majority occurred below 2 years of age—69 per cent in the first semester of life. Dietary histories showed what can be termed in Trinidad as “bacteriologically dangerous” infant feeding in 93 per cent of infants. The prevalence of protein-calorie malnutrition in the community at large was estimated by examining the total child population aged between birth and 4 years in 15 villages and 2 slum areas in the County of Victoria. Assessment was attempted by syndromes and by the use of certain nutritional indicators. Results showed relatively little protein-calorie malnutrition in the community at the time of the survey, the preschool edema index being nil. Factors are considered which may be responsible for the change in age incidence of protein-calorie malnutrition from the classical 1 to 3 year period to infancy and of the increasing occurrence of diarrhea in early childhood. Unsatisfactory infant feeding associated with a decline in breast feeding and a lack of knowledge of correct methods by mothers appear to be of major importance.

Prevalence of proteincalorie malnutrition in Haitian preschool children.

Prevalence of proteincalorie malnutrition in Haitian preschool children.