Use Of Nutritional Assessment Research Articles

Validation of Skeletal Muscle Volume as a Nutritional Assessment in Patients With Gastric or Colorectal Cancer Before Radical Surgery.

BackgroundRecently, some studies have reported the importance of sarcopenia as a prognostic factor in patients with gastrointestinal cancer who have undergone surgery. We aimed to examine skeletal muscle volume for use in nutritional assessment of preoperative patients, and to compare the results with those of other conventional methods of nutritional assessment, such as biochemical or body composition values.MethodsThis was an open cohort study which examined skeletal muscle volume for use in nutritional assessment of preoperative patients. A total of 121 patients with gastrointestinal cancer who underwent radical surgery were enrolled in this study between June 1, 2008 and December 31, 2012. There were 39 and 82 patients with gastric and colorectal cancer, respectively. The primary outcome of this study was postoperative overall survival. The secondary outcomes were postoperative survival from cancer-related deaths, recurrences of cancer after surgery, postoperative complications, and postoperative hospital inpatient stay (measured in days). Univariate and multivariate analyses were used to identify the relevant factors for postoperative outcomes mentioned above.ResultsSkeletal muscle volume was a significant (hazard ratio (HR): 3.34, 95% confidence interval (CI): 1.21 - 9.17, P = 0.020) independent prognostic factor for cancer-related deaths in patients with gastric or colorectal cancer who had undergone surgery, and a marginally independent (HR: 2.48, 95% CI: 0.91 - 6.81, P = 0.077) factor that negatively contributed to overall survival in these patients. In contrast, the preoperative skeletal muscle volume was not correlated with the recurrence of cancer, and was not significantly correlated with the occurrence of severe complications after surgery or prolongation of hospitalization.ConclusionsThe preoperative skeletal muscle volume was a significant prognostic factor in patients with gastric or colorectal cancers. Therefore, the estimation of skeletal muscle volume may be important for stable, long-term nutritional assessment in patients with gastrointestinal cancers.

Study Body Composition of Adolescent Girls

Nutritional status of individuals or populations and measurements of food and nutrient intake and evaluation of nutrition-related health indicators is aspect of study nutritional anthropometry. The use of nutritional assessment has increased importance in recent years because of our greater knowledge of the nutritional status and health. It refers not only to inadequate dietary intake or undernutrition but also to over- nutrition characterized by obesity and its associated co-morbidities such as diabetes mellitus, cardiovascular disease, hypertension and stroke, osteoporosis, and some form of cancer as well. Malnutrition is a “pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients”. Sample size: For this study 1009 adolescent’s girls are chosen as subjects for this study. Weight is measured in weighing scale and height is measured by anthropometre rod, skinfolds are measured by Harpenden caliper. Results: Fat Mass is 9.35 kg (2.01) mean Fat free Mass is 34.22 kg (4.35). Mean FMI and FFMI of Adolescent girls are 4.08 kg/m2 and 14.98 kg/m2 (1.61). Age wise changes of different variable which significantly vary with age. fat mass increase 4.03 kg from 10 to 19 years.

Mini Nutritional Assessment as a Useful Method of Predicting the Development of Pressure Ulcers in Elderly Inpatients

To determine the usefulness of the Mini Nutritional Assessment (MNA) and plasma amino acid analysis in predicting the formation of pressure ulcers (PUs) in inpatients. Prospective, observational cohort study with a mean observation period of 62.2 ± 86.4 days. Intermediate and acute care wards of a hospital in rural Japan. Inpatients with an average age of 85.0 ± 7.6 (N = 422). Mini Nutritional Assessment, Subjective Global Assessment (SGA), Braden Scale (PU prognostic score), PU formation, and biochemical analysis including plasma amino acid concentrations. PUs developed in 7.1% of participants. A MNA score of less than 8 was more sensitive than a rating of moderate or severe malnourishment on the SGA combined with a Braden Scale score of less than 15 in predicting future PUs. The area under the receiver operating characteristic curve (AUC) of the MNA was superior to that of the Braden Scale. The Braden Scale nutrition subscore had the lowest AUC of the six Braden Scale subscores. Individuals who developed PUs had significantly lower plasma arginine concentrations than those who did not. Mini Nutritional Assessment was able to predict the development of PUs. A MNA score of less than 8 performed better than the SGA, Braden Scale, and plasma arginine levels in predicting PU development. Although lower plasma arginine concentration at time of admission was associated with PU development, the AUC for arginine was not significantly different from 0.50. The findings from this prospective study support the use of nutritional assessment in inpatients to predict PU risk and target appropriate interventions.

Should Household Consumption and Expenditures Surveys (HCES) be Used for Nutritional Assessment and Planning?

Household Consumption and Expenditures Surveys (HCES) are routinely conducted in several countries on nationally representative samples, often on a regular basis. The HCES have been considered as a potential alternative to more expensive surveys of individuals'food intakes for use in nutritional assessment and in planning programs such as food fortification. HCES gather information on household food availability (purchased, produced, or received as gifts) and use over a given period of time, often the past week or month. To discuss the potential usefulness of HCES consumption data for nutritional assessment and planning for populations of households and individuals within the households. There are several limitations to the HCES, most notably the difficulty of estimating the intrahousehold allocation of foods and therefore of quantifying the actual food intake of individual household members. Another concern is the lack of information on the variability of consumption over time, making it difficult to estimate the distribution of usual consumption, and thus the prevalence of nutrient inadequacies or excesses. Other potential limitations might be addressed by improvements to the HCES questionnaires, such as including information on foods that are available but not consumed and those that are consumed outside the home. Research is needed to better understand both the strengths and the weaknesses of the HCES data when used to assess and plan intakes at the household and individual levels.

An exploratory case study of cancer nurses’ understanding and use of nutritional screening in patients diagnosed with cancer

Background: Cancer is often associated with malnutrition and therefore nutritional support should be considered a major component of treatment and used in adjunct with anti‐neoplastic therapies (Read et al., 2006). Successful nutritional support depends on thorough nutritional assessment (Mercadante, 1996). The literature suggests that systematic screening through the use of a tool enables practitioners to provide relevant nutritional support but this does not occur in practice due to a lack of formal education and gaps in knowledge (Savage & Scott, 2005). This gap in the evidence appears to relate to the nurses’ own perceptions of the importance of nutritional assessment and its’ application in practice. The aim of this study was to explore nurses’ understanding and use of nutritional assessment in patients diagnosed with cancer.Methods: Case study methodology was used to understand the culture of the ward. Sampling was defined by the methodology as the case was chosen to facilitate exploration of the phenomenon. Non‐random sampling was employed as it allowed for the richest possible source of information (O’Leary, 2004). A letter of invitation and information sheet was sent to all eligible nurses. Data from two nursing staff focus groups (n = 7, n = 11), a survey of patient documentation (n = 27) and field observations were used to elicit influences of nursing practice on nutritional risk screening. A tentative focus group question guide was used to ensure that the process had as few interruptions as possible and a moderator facilitated this. The focus groups were audio tape‐recorded and were transcribed verbatim. The data was analyzed using triangulation, looking for phrases and themes that related to the propositions. A mind map was used to explore connections between the themes and propositions along with my own perceptions ensuring transparency of analysis. The case was reported using a reflexive narrative enabling the causal links between the data and propositions to be explored. Study propositions were: did nurses play a critical role in identifying patients at nutritional risk? What were the nurses’ understanding and use of nutritional assessment? Was the nurse's commitment to nutrition inconsistent with their actions and documentation?Results: Nurses’ felt they played a critical role in nutritional risk assessment; ‘it's everyone's responsibility but mainly the nurses and makes a difference in the success of treatment”, this was not reflected in the survey. Their understanding of nutritional risk assessment was apparent ‘you need to get their weight history and what they can eat’but they blamed lack of time and increasing pressures of medicalised tasks, for example drug administration to justify the assessment being observational and ad hoc. The survey of patients’ documentation supported this, 81% of patients had incomplete documentation of their nutritional risk.Discussion: Pressures of workload and conflicting primary tasks influence nurses’ behaviour around nutritional support. The survey of documentation showed that NICE (2006) guidelines have had little impact in practice. Nurses’ are involved in multiple tasks and due to pressures on time and resources have become reactive and not proactive; nutritional assessment is a proactive activity.Conclusions: Lack of recognition the impact ward and organizational culture had on individual behaviour may have been the pivotal factor that led to the inconsistency in understanding and use of nutritional risk assessment. The relationship between nurses’ attitude to nutritional assessment, knowledge of nutrition and practice was complex. The priority of nutrition needs to increase in both the organisation and ward culture in order for nutritional support to be successfully implemented.References Mercadante, S. (1996) Nutrition in cancer patients. Support. Care Cancer 4, 10–20.National Institute for Clinical Excellence. (2006) Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. London: Department of Health.O’Leary Z. (2004) The Essential Guide to doing Research. London: Sage.Read, J.A. et al. (2006) An evaluation of the prevalence of malnutrition in cancer patients’ attending the oncology outpatient oncology clinic. Asia‐Pacific J. Clin.Oncol.2, 80–86.Savage, J. & Scott, C. (2005) Patients’ nutritional care in hospital: an ethnographic study of nurses’ role and patients’ experience. London: RCN.

2 Assessment of nutritional status in clinical practice

As most diseases can have nutritional consequences, the assessment of nutritional status may help to detect an underlying disease, to identify nutritional disorders related to a given disease, and to quantify the impact of nutritional therapy. The aims and methods used for nutritional assessment depend on the circumstances in which nutritional assessment is performed. Whatever the context or aim, nutritional status is assessed through a simple, mainly clinical approach, based on the past history, dietary intake, auxological analysis, anthropometric measurements, body compartment and biological parameters. Accurate techniques for measuring body compartments are available in children such as dual-energy X-ray absorptiometry to assess fat body mass or bioelectrical impedance analysis for body water and lean body mass. Measuring energy expenditure allows for a more accurate monitoring of the patient's energy needs and decreases the risks associated with underfeeding or overfeeding. In clinical practice, the analysis should be longitudinal and take into account situations carrying a risk of malnutrition. Preventive use of nutritional assessment allows nutritional support to be introduced in a timely fashion, thereby avoiding morbidity/mortality and limiting the long-term impact of malnutrition on growth and development.

Anthropometric indices in normal elderly subjects.

Anthropometric data (triceps skinfold thickness, mid-arm circumference and arm muscle circumference) have been obtained from 114 normal elderly individuals and are presented as a suitable reference range for use in nutritional assessment of the elderly. In males the results did not differ significantly from existing standards for younger men but in females there was a significant difference from similar standards for younger women. These findings suggest that there is an increase in fat and a decrease in lean body mass with advancing age in females but not in males. This difference is discussed.

Comparison of Derived and Actual Transferrin

A prospective study was undertaken to evaluate the utility of calculating transferrin from total iron-binding capacity in the nutritional assessment of burned patients. Regression analysis was used to compare total iron-binding capacity with radial immunodiffusion transferrin determinations. The method used for calculating transferrin (0.8 TIBC - 43) is a frequently published conversion formula for deriving transferrin. One hundred twenty-five data sets were obtained from 45 burned patients. Values for derived transferrin ranged from 39 to 235 mg/dl, averaging 121 mg/dl. Actual transferrin averaged 162 mg/dl, ranging from 41 to 320 mg/dl. Forty-eight actual serum transferrin samples were normal (greater than 172 mg/dl) whereas only 17 derived transferrin values were normal. While there is a correlation between total iron-binding capacity and serum transferrin (r = 0.85), to calculate transferrin according to the formula above would have resulted in significant error in the clinical assessment of the patients' nutritional status (p less than 0.001). From our studies, the formula for conversion of total iron-binding capacity to transferrin was found to be (0.68 TIBC + 21). These results suggest that the development of a universal conversion factor is not feasible. Modification of the formula may be necessary at each institution for clinically useful evaluations of serum transferrins are to be derived from iron-binding capacity for use in nutritional assessment.

The insertion tape: a new circumference tape for use in nutritional assessment

Certain body circumferences, such as the mid-upper arm circumference, are regarded as useful indicators of the nutritional status of children. The insertion tape is designed to reduce errors of measurement, prone to occur with the present tapes. At the widened origin of the new tape is a narrow slot perpendicular to the tape's long axis. The measurer threads the distal end of the tape though this slot, tightens to the required tension around the circumference and reads from an open window near the slot. Modifications of the basic tape for specific uses of measurement, screening and survey, are described.