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Apparent low frequency of undernutrition in Dublin hospital in-patients: should we review the anthropometric thresholds for clinical practice?

Published online by Cambridge University Press:  09 March 2007

Clare A. Corish ,
P. Flood ,
S. Mulligan  and
N. P. Kennedy
Clare A. Corish*
Affiliation:
Unit of Nutrition and Dietetic Studies, Department of Clinical Medicine, Trinity Centre for Health Sciences, James's St, Dublin 8, Republic of Ireland
P. Flood
Affiliation:
Unit of Nutrition and Dietetic Studies, Department of Clinical Medicine, Trinity Centre for Health Sciences, James's St, Dublin 8, Republic of Ireland
S. Mulligan
Affiliation:
Unit of Nutrition and Dietetic Studies, Department of Clinical Medicine, Trinity Centre for Health Sciences, James's St, Dublin 8, Republic of Ireland
N. P. Kennedy
Affiliation:
Unit of Nutrition and Dietetic Studies, Department of Clinical Medicine, Trinity Centre for Health Sciences, James's St, Dublin 8, Republic of Ireland
*
*Corresponding author: Mrs C. Corish, fax +353 1 454 2043, email tc@clubi.ie
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Abstract

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Protein–energy undernutrition, or the possibility of its development, has been documented to occur frequently in patients on admission to hospital. Deterioration in nutritional status is known to occur in hospital. In a prospective study of 594 sequential hospital admissions, we aimed to assess the prevalence of undernutrition among patients on admission to two acute teaching hospitals in Dublin, Republic of Ireland using the widely-accepted anthropometric criteria applied in a large study from Dundee, Scotland, UK () and to determine changes in nutritional status in hospital. The mean prevalence of undernutrition (11 %) was considerably lower than was reported from Dundee (40 %). Unintentional weight loss before admission and functional impairment on admission occurred to a similar extent in both centres. Weight loss in hospital occurred in the same proportion of patients, but less frequently among those undernourished on admission to hospital, in Dublin compared with Dundee. The patients found to be undernourished on admission in this study had a mortality rate in hospital (6·5 %) over three times that of the adequately nourished group (2 %). The magnitude of the difference in prevalence of undernutrition between the two centres cannot be explained by ethnicity, case-mix or age distribution. With the secular increase in BMI in the population, the thresholds for classifying patients as undernourished or at risk of nutritional deterioration may need to be reviewed. For clinical use, recent weight loss and functional status may be more appropriate variables to use in the evaluation of nutritional status on admission to hospital.

Keywords

UndernutritionAnthropometryReference data
Type
Research Article
Information
British Journal of Nutrition , Volume 84 , Issue 3 , September 2000 , pp. 325 - 335
Copyright
Copyright © The Nutrition Society 2000

References

Bannerman, E, Reilly, JJ, MacLennon, WJ, Kirk, T and Pender, F (1997) Evaluation of validity of British anthropometric data for assessing nutritional state of elderly people in Edinburgh: cross sectional study.British Medical Journal 315, 338–341.CrossRefGoogle ScholarPubMed
Bastow, MD, Rawlings, J and Allison, SP (1983) Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial.British Medical Journal 287, 1589–1592.CrossRefGoogle ScholarPubMed
Beattie, AH, Baxter, JP, Prach, AT and Pennington, CR (1999) An evaluation of the use of enteral nutritional supplements post operatively in malnourished surgical patients.Proceedings of the Nutrition Society 58, 112A.Google Scholar
Bishop, CW, Bowen, PE and Ritchley, SI (1981) Norms for nutritional assessment of American adults by upper arm anthropometry.American Journal of Clinical Nutrition 34, 2530–2539.CrossRefGoogle ScholarPubMed
Bistrian, BR, Blackburn, GL, Vitale, J, Cochran, D and Naylor, J (1976) Prevalence of malnutrition in general medical patients.Journal of the American Medical Association 253, 1567–1570.CrossRefGoogle Scholar
Burr, ML and Phillips, KM (1984) Anthropometric norms in the elderly.British Journal of Nutrition 51, 165–169.CrossRefGoogle ScholarPubMed
Busby, GP, Mullen, JL, Mathews, DC, Hobbs, CL and Rosato, EF (1980) Prognostic nutritional index in gastrointestinal surgery.American Journal of Surgery 139, 160–167.CrossRefGoogle Scholar
Butterworth, CE (1974) The skeleton in the hospital closet.Nutrition Today 9, 4–8.CrossRefGoogle Scholar
Chumlea, WC, Roche, AF and Steinbaugh, ML (1985) Estimating stature from knee height for persons 60–90 years of age.Journal of the American Geriatric Society 33, 116–120.CrossRefGoogle Scholar
Chumlea, WCRoche, AF & Mukherjee, D (1987) Nutritional Assessment of the Elderly through Anthropometry. Columbus, OH: Ross Laboratories.Google Scholar
Coats, KG, Morgan, SL, Bartolucci, AA and Weinsier, RL (1993) Hospital-associated malnutrition: a re-evaluation 12 years later.Journal of the American Dietetic Association 93, 27–33.CrossRefGoogle Scholar
Corish, C, Flood, P and Kennedy, NP (2000) Anthropometric data of healthy elderly Irish subjects.Proceedings of the Nutrition Society.(In the Press)Google Scholar
Delarue, J, Constans, T, Malvy, D, Pradignac, A, Court, C and Lamas, F (1994) Anthropometric values in an elderly French population.British Journal of Nutrition 71, 295–302.CrossRefGoogle Scholar
Delmi, M, Rapin, C-H, Bengoa, J-M, Delmas, PD, Vasey, H and Bonjour, J-P (1990) Dietary supplementation in elderly patients with fractured neck of femur.Lancet 335, 1013–1016.CrossRefGoogle Scholar
Edington, J, Kon, P and Martyn, CN (1996) Prevalence of malnutrition in general practice.Clinical Nutrition 15, 60–63.CrossRefGoogle ScholarPubMed
Edington, J, Kon, P and Martyn, CN (1997) Prevalence of malnutrition after major surgery.Journal of Human Nutrition and Dietetics 10, 111–116.CrossRefGoogle Scholar
Ferro-Luzzi, A and James, WPT (1996) Adult malnutrition: simple assessment techniques for use in emergencies.British Journal of Nutrition 75, 3–10.CrossRefGoogle ScholarPubMed
Finch, SDoyle, WLowe, CBates, CJPrentice, ASmithers, G & Clarke, PC (1998) National Diet and Nutrition Survey: People Aged 65 Years and Over. Volume 1: Report of the Diet and Nutrition Survey. London: The Stationery Office.Google Scholar
Flegal, KM, Carroll, MD, Kuczmarski, RJ and Johnson, CL (1998) Overweight and obesity in the United States: prevalence and trends, 1960–1994.International Journal of Obesity Related Metabolic Disorders 22, 39–47.CrossRefGoogle ScholarPubMed
Frisancho, AR (1981) New norms of upper limb fat and muscle areas for assessment of nutritional status.American Journal of Clinical Nutrition 34, 2540–2545.CrossRefGoogle ScholarPubMed
Gallagher-Allred, CR, Coble Voss, C, Finn, SC and McCamish MA (1996) Malnutrition and clinical outcomes: the case for medical nutrition therapy.Journal of the American Dietetic Association 96, 369–366.CrossRefGoogle ScholarPubMed
Galuska, DA, Serdula, M, Pamuk, E, Siegel, PZ and Byers, T (1996) Trends in overweight among US adults from 1987 to 1993: a multistate telephone survey.American Journal of Public Health 86, 1729–1735.CrossRefGoogle ScholarPubMed
Gariballa, SE, Parker, SG, Taub, N and Castleden, M (1998) Nutritional status of hospitalized acute stroke patients.British Journal of Nutrition 79, 481–487.CrossRefGoogle ScholarPubMed
Giner, M, Laviano, A, Meguid, MM and Gleason, JR (1996) In 1995 a correlation between malnutrition and poor outcome still exists.Nutrition 12, 23–29.CrossRefGoogle ScholarPubMed
Gregory, JFoster, KTyler, H & Wiseman, M (1990) The Dietary and Nutritional Survey of British Adults. London: The Stationery Office.Google Scholar
Haydock, DA and Hill, GL (1986) Impaired wound healing in surgical patients with varying degrees of malnutrition.Journal of Parenteral and Enteral Nutrition 10, 550–554.CrossRefGoogle ScholarPubMed
Heslin, MJ, Latkany, L, Leung, D, Brooks, AD, Hochwald, SN, Pisters, PWT, Shike, M and Brennan, MF (1997) A prospective randomised trial of early enteral feeding after resection of upper gastrointestinal malignancy.Annals of Surgery 226, 567–580.CrossRefGoogle ScholarPubMed
Hill, GL, Blackett, RL, Pickford, I, Birkenshaw, L, Young, GA, Warren, JB, Schorah, CG and Morgan, DB (1977) Malnutrition in surgical patients: an unrecognised problem.Lancet i, 689–692.CrossRefGoogle Scholar
Jebb, SA (1999) Obesity: from molecules to man.Proceedings of the Nutrition Society 58, 1–14.CrossRefGoogle ScholarPubMed
Kilkenny Health Project (1992) A Pilot Programme for Coronary Heart Disease Prevention in Ireland 1985–1990. Kilkenny: Kilkenny Health Project.Google Scholar
Klidjian, AM, Foster, KJ, Kammerling, RM, Cooper, A and Karran, SJ (1980) Relation of anthropometric and dynamometric variables to serious postoperative complications.British Medical Journal 281, 899–901.CrossRefGoogle ScholarPubMed
Landi, F, Zuccala, G, Gambassi, G, Incalzi, RA, Manigrasso, L, Pagano, F, Carbonin, P and Bernabei, R (1999) Body mass index and mortality among older people living in the community.Journal of the American Geriatric Society 47, 1072–1076.CrossRefGoogle ScholarPubMed
Launer, LJ and Harris, T (1996) Weight, height and body mass index distributions in geographically and ethnically diverse samples of older persons.Age and Ageing 25, 300–306.CrossRefGoogle ScholarPubMed
Lee, P & Cunningham, K (1990) Irish National Nutrition Survey. Dublin: Irish Nutrition and Dietetic Institute.Google Scholar
Lennard-Jones, JE (1992) A Positive Approach to Nutrition as a Treatment. London: Kings Fund Centre.Google Scholar
Lumbers, M, Driver, LT, Howland, RJ, Older, MWJ and Williams, CM (1996) Nutritional status and clinical outcome in elderly female surgical orthopaedic patients.Clinical Nutrition 15, 101–107.CrossRefGoogle ScholarPubMed
McWhirter, JP and Pennington, CR (1994) Incidence and recognition of malnutrition in hospital.British Medical Journal 308, 945–948.CrossRefGoogle ScholarPubMed
Mazolewski, P, Turner, JF, Baker, M, Kurtz, T and Little, AG (1999) The impact of nutritional status on the outcome of lung volume reduction surgery: a prospective study.Chest 116, 693–696.CrossRefGoogle ScholarPubMed
Meguid, MM, Campos, ACL, Meguid, V, Debonis, D and Terz, JJ (1988) IONIP, a criterion of surgical outcome and patient selection for perioperative nutrition support.British Journal of Clinical Practice 63, 8–14.Google Scholar
Naber, THJ, Schermer, T, de Bree, A, Nusteling, K, Eggink, L, Kruimel, JW, Bakkeren, J, van Heereveld, H and Katan, MB (1997) Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications.American Journal of Clinical Nutrition 66, 1232–1239.CrossRefGoogle ScholarPubMed
Norgan, NG (1994) Population differences in body composition in relation to the body mass index.European Journal of Clinical Nutrition 48, 10S–25S.Google ScholarPubMed
Paul, AA, Cole, TJ, Ahmed, EA and Whitehead, RG (1998) The need for revised standards for skinfold thickness in infancy.Archives of Disease in Childhood 78, 354–358.CrossRefGoogle ScholarPubMed
Prentice, AM and Jebb, SA (1995) Obesity in Britain: gluttony or sloth?.British Medical Journal 311, 437–439.CrossRefGoogle ScholarPubMed
Rea, IM, Gillen, S and Clarke, E (1997) Anthropometric measurements from a cross-sectional survey of community dwelling subjects aged over 90 years of age.European Journal of Clinical Nutrition 51, 102–106.CrossRefGoogle ScholarPubMed
Reilly, JJ, Hull, SF, Albert, N, Waller, A and Bringardener, S (1988) Economic impact of malnutrition: a model system for hospitalised patients.Journal of Parenteral and Enteral Nutrition 12, 371–376.CrossRefGoogle Scholar
Reilly, HM, Martineau, JK, Moran, A and Kennedy, H (1995) Nutritional screening-evaluation and implementation of a simple nutrition risk score.Clinical Nutrition 14, 269–273.CrossRefGoogle ScholarPubMed
Savage, SAH, Reilly, JJ, Edwards, CA and Durnin, JVGA (1999) Adequacy of standards for assessment of growth and nutritional status in infancy and early childhood.Archives of Disease in Childhood 80, 121–124.CrossRefGoogle ScholarPubMed
Shaw-Stiffel, TA, Zarney, LA, Pleban, WE, Rosman, DD, Rudolf, RA and Bernstein, LH (1993) Effect of nutrition status and other factors on length of hospital stay after major gastrointestinal surgery.Nutrition 9, 140–145.Google ScholarPubMed
Stack, JA, Babineau, TJ and Bistrian, BR (1996) Assessment of nutritional status in clinical practice.The Gastroenterologist 4, 8S–15S.Google Scholar
Strain, NC, Wright, CE, Ward, K and Shaffer, JL (1999) Can the true prevalence of malnutrition be assessed on admission to hospital?.Proceedings of the Nutrition Society 58, 112A.Google Scholar
Studley, HO (1936) Percentage of weight loss. A basic indicator of surgical risk in patients with chronic peptic ulcer.Journal of the American Medical Association 106, 458–460.CrossRefGoogle Scholar
Tessier, S, Kelly, IE, Cahill, A, Morris, SE, Crumley, A, Mclaughlin, D, McKee RF and Lean, MEJ (2000) Still hungry in hospital: identifying malnutrition in acute hospital admissions.Proceedings of the Nutrition Society.(In the Press)Google Scholar
Tucker, HN and Miguel, SG (1996) Cost containment through nutrition intervention.Nutrition Reviews 54, 111–121.CrossRefGoogle ScholarPubMed
Van Itallie, TB (1996) Prevalence of obesity.Endocrinology and Metabolism Clinics of North America 25, 887–905.CrossRefGoogle ScholarPubMed
Veterans Affairs Total Parenteral Nutrition Co-operative Study Group (1991), Perioperative total parenteral nutrition in surgical patients.New England Journal of Medicine 325, 525–532.CrossRefGoogle Scholar
Vlaming, S, Biehler, A, Chattopadhyay, S, Jamieson, C, Cunliffe, A and Powell-Tuck, J (1999) Nutritional status of patients on admission to acute services of a London teaching hospital.Proceedings of the Nutrition Society 58, 119A.Google Scholar
Von Meyenfeldt, MF, Meijerink, WJHJ, Rouflart, MMJ, Buil-Maassen, NTHJ and Soeters, PB (1992) Perioperative nutritional support: a randomised clinical trial.Clinical Nutrition 11, 180–186.CrossRefGoogle ScholarPubMed
Watters, JM, Kirkpatrick, SM, Norris, SB, Shamji, FM and Wells, GA (1997) Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility.Annals of Surgery 226, 369–380.CrossRefGoogle ScholarPubMed
Webb, AE, Newman, LA, Taylor, M and Keogh, JB (1989) Hand grip dynamometry as a predictor of post operative complications. Re-appraisal using age standardised grip strengths.Journal of Parenteral and Enteral Nutrition 13, 30–33.CrossRefGoogle Scholar
Weekes, E (1999) The incidence of malnutrition in medical patients admitted to a hospital in south London.Proceedings of the Nutrition Society 58, 126A.Google Scholar
Windsor, JA and Hill, GL (1988) Weight loss with physiologic impairment. A basic indicator of surgical risk.Annals of Surgery 205, 290–296.CrossRefGoogle Scholar
World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry. World Health Organization Technical Report no. 854. Geneva: WHO.Google Scholar
Zemel, BS, Riley, EM and Stallings, VA (1997) Evaluation of methodology for nutritional assessment in children: anthropometry, body composition, and energy expenditure.Annual Reviews in Nutrition 17, 211–235.CrossRefGoogle ScholarPubMed