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Pre-operative nutritional assessment

Published online by Cambridge University Press:  28 February 2007

Clare A. Corish
Clare A. Corish*
Affiliation:
Unit of Nutrition and Dietetic Studies, Department of Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Republic of Ireland
*
Corresponding Author: Mrs C. Corish, fax +353 1 4542043, 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 surgical patients admitted to hospital. Nutritional status is known to deteriorate over the course of the hospital stay, with poor awareness by medical and nursing staff as to the deleterious effects of impaired nutritional status on clinical outcome and hospital costs. While there is no consensus on the best method for assessment of the nutritional status of surgical patients pre-operatively, there are a number of techniques available. These techniques can be divided into two types, those suitable for screening for nutrition risk on admission to hospital and those used to fully assess nutritional status. Both techniques have their limitations, but if used correctly, and their limitations recognized, should identify the appropriate degree of nutritional intervention for an individual patient in a timely and cost-effective manner. The techniques currently available for nutritional screening and nutritional assessment are reviewed, and their applicability to the Irish setting are discussed in the present paper.

Keywords

UndernutritionNutritional screeningNutritional assessment
Type
Symposium on ‘Nutrition and surgical practice’
Information
Proceedings of the Nutrition Society , Volume 58 , Issue 4 , November 1999 , pp. 821 - 829
Copyright
The Nutrition Society

References

American Society for Parenteral and Enteral Nutrition (1993) Rationale for adult nutrition support guidelines. Journal of Parenteral and Enteral Nutrition 17, 5S–11S.Google Scholar
American Society for Parenteral and Enteral Nutrition (1995) Standards for nutrition support: hospitalized patients. Nutrition in Clinical Practice 10, 208–219.Google Scholar
Arora, NS & Rochester, DF (1982) Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. American Review of Respiratory Diseases 126, 5–8.Google Scholar
Baker, JP, Detsky, AS, Wesson, DE, Wolman, SL, Stewart, S, Whitewell, J, Langer, B & Jeejeebhoy, K (1982) Nutritional assessment: a comparison of clinical judgement and objective measurements. New England Journal of Medicine 306, 969–972.Google Scholar
Bashir, Y, Graham, TR, Torrance, A, Gibson, GJ & Corris, PA (1990) Nutritional state of patients with lung cancer undergoing thoracotomy. Thorax 45, 183–186.CrossRefGoogle ScholarPubMed
Bastow, MD, Rawlings, J & 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 & 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
Beier-Holgersen, R & Boesby, S (1996) Influence of postoperative enteral nutrition on postsurgical infections. Gut 39, 833–835.Google Scholar
Benjamin, DR (1989) Laboratory tests and nutritional assessment. Protein–energy status. Pediatric Clinics of North America 36, 139–161.CrossRefGoogle ScholarPubMed
Bishop, CW, Bowen, PE & 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, Hallowell, E & Heddle, R (1974) Protein status of general surgical patients. Journal of the American Medical Association 230, 858–860.Google Scholar
Blackburn, GL, Bistrian, BR, Maini, BS, Schlamm, HT & Smith, MS (1977) Nutritional and metabolic assessment of the hospitalized patient. Journal of Parenteral and Enteral Nutrition 1, 11–22.Google Scholar
Burr, ML & Phillips, KM (1984) Anthropometric norms in the elderly. British Journal of Nutrition 51, 165–169.Google Scholar
Busby, GP, Mullen, JL, Mathews, DC, Hobbs, CL & Rosato, EF (1980) Prognostic nutritional index in gastrointestinal surgery. American Journal of Surgery 139, 160–167.Google Scholar
Charney, P (1995) Nutrition assessment in the 1990s: Where are we now? Nutrition in Clinical Practice 10, 131–139.Google Scholar
Christou, N (1990) Perioperative nutritional support: immunologic defects. Journal of Parenteral and Enteral Nutrition 14, 186S–192S.CrossRefGoogle ScholarPubMed
Chumlea, WC, Roche, AF & Steinbaugh, ML (1985) Estimating stature from knee height for persons 60–90 years of age. Journal of the American Geriatrics Society 33, 116–120.Google Scholar
Coats, KG, Morgan, SL, Bartolucci, AA & Weinsier, RL (1993) Hospital-associated malnutrition: a reevaluation 12 years later. Journal of the American Dietetic Association 93, 27–33.Google Scholar
Corish, C, Flood, P, Mulligan, S & Kennedy, NP (1998a) Prevalence of undernutrition and weight loss changes during the course of hospitalization among patients admitted to two Dublin hospitals. Proceedings of the Nutrition Society 57, 10A.Google Scholar
Corish, C, Flood, P, Reynolds, JV & Kennedy, NP (1998b) Nutritional characteristics of Irish patients undergoing resection of major carcinoma. Proceedings of the Nutrition Society 57, 145A.Google Scholar
de Fine, Olivarius N, Andreasen, AH & Løken, J (1997) Accuracy of 1-, 5- and 10-year body weight recall given a standard questionnaire. International Journal of Obesity 21, 67–71.Google Scholar
Delmi, M, Rapin, C-H, Bengoa, J-M, Delmas, PD, Vasey, H & Bonjour, J-P (1990) Dietary supplementation in elderly patients with fractured neck of femur. Lancet 335, 1013–1016.CrossRefGoogle Scholar
DelPrete, LR, Caldwell, M, English, C, Banspach, SW & Lefebvre, C (1992) Self-reported and measured weights and heights of participants in community-based weight loss programs. Journal of the American Dietetic Association 92, 1483–1486.Google Scholar
Dempsey, DT, Mullen, JL & Busby, GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it? American Journal of Clinical Nutrition 47, 352–356.Google Scholar
Detsky, AS, Baker, JP, Mendelson, RA, Wolman, SL, Wesson, DE & Jeejeebhoy, KN (1984) Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. Journal of Parenteral and Enteral Nutrition 8, 153–160.Google Scholar
Detsky, AS, Baker, JP, O'Rourke, K, Johnston, N, Whitwell, J, Mendelson, RA & Jeejeebhoy, KN (1987a) Predicting nutrition associated complications for patients undergoing gastrointestinal surgery. Journal of Parenteral and Enteral Nutrition 11, 440–446.CrossRefGoogle ScholarPubMed
Detsky, AS, McLaughlin, JR, Baker, JP, Johnston, N, Whittaker, S, Mendelson R., A & Jeejeebhoy, KN (1987b) What is subjective global assessment of nutritional status? Journal of Parenteral and Enteral Nutrition 11, 8–13.Google Scholar
Detsky, AS & Smalley, PS (1994) Is this patient malnourished? Journal of the American Medical Association 271, 54–58.Google Scholar
Doshi, MK, Lawson, R, Ingoe, LE, Colligan, JM, Barton, JR & Cobden, I (1998) Effect of nutritional supplementation on clinical outcome in post-operative orthopaedic patients. Clinical Nutrition 17, 30A.CrossRefGoogle Scholar
Dougherty, D, Bankhead, R, Kushner, R, Mirtallo, J & Winkler, M (1995) Nutrition care given new importance in JCAHO standards. Nutrition in Clinical Practice 10, 26–31.CrossRefGoogle ScholarPubMed
Doweiko, J & Nompleggi, D (1991) Role of albumin in human physiology and pathophysiology. Journal of Parenteral and Enteral Nutrition 15, 207–211.Google Scholar
Doyle, M, Corish, C, Flood, P & Kennedy, NP (1998) Can patients'; knowledge of their own weight and height be used to replace measured weight and height in the calculation of BMI. Proceedings of the Nutrition Society 57, 165A.Google Scholar
Durnin, JVGA & Womersley, J (1974) Body fat assessed from total body density and its estimation from skinfold thickness. British Journal of Nutrition 32, 77–97.Google Scholar
Edington, J, Kon, P & Martyn, CN (1996) Prevalence of malnutrition in general practice. Clinical Nutrition 15, 60–63.CrossRefGoogle ScholarPubMed
Edington, J, Kon, P & Martyn, CN (1997) Prevalence of malnutrition after major surgery. Journal of Human Nutrition and Dietetics 10, 111–116.CrossRefGoogle Scholar
Ek, AC, Larsson, F, von Schenck, H, Thorslund, S, Unosson, M & Bjurulf, P (1990) The correlation between anergy, malnutrition and clinical outcome in an elderly hospital population. Clinical Nutrition 9, 185–189.Google Scholar
Fischer, JE (1982) Nutritional assessment before surgery. American Journal of Clinical Nutrition 35, 1128–1131.Google Scholar
Flegal, KM, Carroll, MD, Kuczmarski, RJ & 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
Forse, RA & Shizgal, HM (1980) The assessment of malnutrition. Surgery 88, 17–24.Google Scholar
Fowler, HW & Fowler, FG (1991) The Concise Oxford Dictionary of Current English. [Allan, RE, editor]. London: Oxford University Press.Google Scholar
Friedmann, JM, Jensen, GL, Smiciklas-Wright, H & McCamish, MA (1997) Predicting early nonelective hospital readmission in nutritionally compromised older adults. American Journal of Clinical Nutrition 65, 1714–1720.Google Scholar
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.Google Scholar
Gallagher-Allred, CR, Coble Voss, C, Finn, SC & McCamish, MA (1996) Malnutrition and clinical outcomes: the case for medical nutrition therapy. Journal of the American Dietetic Association 96, 361–369.CrossRefGoogle ScholarPubMed
Galuska, DA, Serdula, M, Pamuk, E, Siegel, PZ & 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.Google Scholar
Giner, M, Laviano, A, Meguid, MM & Gleason, JR (1996) In1995 a correlation between malnutrition and poor outcome still exists. Nutrition 12, 23–29.Google Scholar
Han, TS & Lean, ME (1996) Lower leg length as an index of stature in adults. International Journal of Obesity and Related Metabolic Disorders 20, 21–27.Google Scholar
Haydock, DA & Hill, GL (1986) Impaired wound healing in surgical patients with varying degrees of malnutrition. Journal of Parenteral and Enteral Nutrition 10, 550–554.Google Scholar
Heslin, MJ, Latkany, L, Leung, D, Brooks, AD, Hochwald, SN, Pisters, PWT, Shike, M & Brennan, MF (1997) A prospective randomised trial of early enteral feeding after resection of upper gastrointestinal malignancy. Annals of Surgery 226, 567–580.Google Scholar
Heymsfield, SB, Bethel, RA, Ansley, JD, Gibbs, DM, Felner, JM & Nutter, DO (1978) Cardiac abnormalities in cachectic patients before and during nutritional repletion. American Heart Journal 95, 584–593.Google Scholar
Heymsfield, SB, McManus, C, Stevens, V & Smith, J (1982) Muscle mass: reliable indicator of protein-energy malnutrition severity and outcome. American Journal of Clinical Nutrition 35, 1192–1199.CrossRefGoogle ScholarPubMed
Hill, GL, Blackett, RL, Pickford, I, Birkenshaw, L, Young, GA, Warren, JB, Schorah, CG & Morgan, DB (1977) Malnutrition in surgical patients: an unrecognised problem. Lancet i, 689–692.Google Scholar
Jebb, SA (1999) Obesity: from molecules to man. Proceedings of the Nutrition Society 58, 1–14.Google Scholar
Jeejeebhoy, KN, Detsky, AS & Baker, JP (1990) Assessment of nutritional status. Journal of Parenteral and Enteral Nutrition 14, 193S–196S.CrossRefGoogle ScholarPubMed
Jensen, MB & Hessov, I (1997) Randomization to nutritional intervention at home did not improve postoperative function, fatigue or well-being. British Journal of Surgery 84, 113–118.Google Scholar
Keele, AM, Bray, MJ, Emery, PW, Duncan, HD & Silk, DBA (1997) Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients. Gut 40, 393–399.CrossRefGoogle ScholarPubMed
Kilkenny Health Project (1992) A Pilot Programme for Coronary Heart Disease Prevention in Ireland 1985–1990. Kilkenny: Kilkenny Health Project.Google Scholar
Klein, S (1990) The myth of serum albumin as a measure of nutritional status. Gastroenterology 99, 1845–1851.CrossRefGoogle ScholarPubMed
Klein, S, Kinney, J, Jeejeebhoy, K, Alpers, D, Hellerstein, M, Murray, M, Twomey, P & Others, (1997) Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. American Journal of Clinical Nutrition 66, 683–706.Google Scholar
Klidjian, AM, Foster, KJ, Kammerling, RM, Cooper, A & Karran, SJ (1980) Relation of anthropometric and dynamometric variables to serious postoperative complications. British Medical Journal 281, 899–901.Google Scholar
Kwok, T & Whitelaw, MN (1991) The use of armspan in nutritional assessment of the elderly. Journal of the American Geriatrics Society 39, 492–496.Google Scholar
Larsson, J, Akerlind, I, Permerth, J & Hornvist, JO (1994) The relation between nutritional state and quality of life in surgical patients. European Journal of Surgery 160, 329–334.Google Scholar
Lee, P & Cunningham, K (1990) Irish National Nutrition Survey. Dublin: Irish Nutrition and Dietetic Institute.Google Scholar
Lennard-Jones, JE, Arrowsmith, H, Davison, C, Denham, AF & Micklewright, A (1995) Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital. Clinical Nutrition 14, 336–340.Google Scholar
Lumbers, M, Driver, L, Howland, RJ, Older, MWJ & Williams, CM (1996) Nutritional status and clinical outcome in elderly female surgical orthopaedic patients. Clinical Nutrition 15, 101–107.Google Scholar
Lupo, L, Pannarale, O, Altomare, D, Memeo, V & Rubino, M (1993) Reliability of clinical judgement in evaluation of the nutritional status of surgical patients. British Journal of Surgery 80, 1553–1556.Google Scholar
McAleese, P & Odling-Smee, W (1994) The effect of complications on length of stay. Annals of Surgery 220, 740–744.Google Scholar
McWhirter, JP & Pennington, CR (1994) Incidence and recognition of malnutrition in hospital. British Medical Journal 308, 945–948.Google Scholar
Meguid, MM, Campos, ACL, Meguid, V, Debonis, D & 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
Morgan, DB, Hill, GL & Burkinshaw, L (1980) The assessment of weight loss from a single measurement of body weight: the problems and limitations. American Journal of Clinical Nutrition 33, 2101–2105.Google Scholar
Mullen, JL, Busby, GP, Mathews, DC, Snale, BF & Resato, EF (1980) Reduction of operative morbidity and mortality by combined pre-operative and post-operative nutritional support. Annals of Surgery 192, 604–613.CrossRefGoogle Scholar
Pichard, C, Hoshino, E, Allard, JP, Charlton, MP, Atwood, HL & Jeejeebhoy, KN (1991) Intracellular potassium and membrane potential in rat muscles during malnutrition and subsequent refeeding. American Journal of Clinical Nutrition 54, 489–498.Google Scholar
Prentice, AM & Jebb, SA (1995) Obesity in Britain: gluttony or sloth? British Medical Journal 311, 437–439.Google Scholar
Reeves, SL, Varakamin, C & Henry, CJK (1996) The relationship between arm-span measurement and height with special reference to gender and ethnicity. European Journal of Clinical Nutrition 50, 398–400.Google Scholar
Reilly, HM (1996) Screening for nutritional risk. Proceedings of the Nutrition Society 55, 841–853.Google Scholar
Reilly, HM, Martineau, JK, Moran, A & Kennedy, H (1995) Nutritional screening–evaluation and implementation of a simple nutrition risk score. Clinical Nutrition 14, 269–273.Google Scholar
Reilly, JJ, Hull, SF, Albert, N, Waller, A & Bringardener, S (1988) Economic impact of malnutrition: a model system for hospitalised patients. Journal of Parenteral and Enteral Nutrition 12, 371–376.Google Scholar
Reynolds, JV, Kanwar, S, Welsh, FKS, Windsor, ACJ, Murchan, P, Barclay, GR & Guillou, PJ (1997) Does the route of feeding modify gut barrier function and clinical outcome in patients after major upper gastrointestinal surgery? Journal of Parenteral and Enteral Nutrition 21, 196–201.Google Scholar
Reynolds, JV, O'Farrelly, C, Feighery, C, Murchan, P, Leonard, N, Fulton, G, O'Morain, C, Keane, FBV & Tanner, WA (1996) Impaired gut barrier function in malnourished patients. British Journal of Surgery 83, 1288–1291.Google Scholar
Riley, RH & Burke, V (1997) Prevalence of obesity in surgical patients: a comparative survey in the United States and Australia. Journal of Quality in Clinical Practice 17, 147–154.Google Scholar
Rowland, ML (1990) Self-reported weight and height. American Journal of Clinical Nutrition 52, 1125–1133.Google Scholar
Sagar, PM & MacFie, J (1994) Effect of preoperative nutritional status on the outcome of cardiac valve replacement. Nutrition 10, 490A.Google Scholar
Seltzer, MH, Bastidas, JA, Cooper, DM, Engler, P, Slocum, B & Fletcher, HS (1979) Instant nutritional assessment. Journal of Parenteral and Enteral Nutrition 3, 157–159.Google Scholar
Shaw-Stiffel, TA, Zarney, LA, Pleban, WE, Rosman, DD, Rudolf, RA & Bernstein, LH (1993) Effect of nutrition status and other factors on length of hospital stay after major gastrointestinal surgery. Nutrition 9, 140–145.Google Scholar
Shenkin, A (1997) Impact of disease on markers of macronutrient status. Proceedings of the Nutrition Society 56, 433–441.CrossRefGoogle ScholarPubMed
Sizer, T, Russell, CA, Wood, S, Irwin, P, Allison, S, Wheatley, C & Whitney, S (1996) Standards and Guidelines for Nutritional Support of Patients in Hospital. A Report of a BAPEN Working Party.Maidenhead, Berks.: BAPEN.Google Scholar
Smith, LC & Mullen, JL (1991) Nutritional assessment and indications for nutritional support. Surgical Clinics of North America 71, 449–457.Google Scholar
Stack, JA, Babineau, TJ & Bistrian, BR (1996) Assessment of nutritional status in clinical practice. Gastroenterologist 4, 8S–15S.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.Google Scholar
Tucker, HN & Miguel, SG (1996) Cost containment through nutrition intervention. Nutrition Reviews 54, 111–121.Google Scholar
Van Itallie, TB (1996) Prevalence of obesity. Endocrinology and Metabolism Clinics of North America 25, 887–905.Google Scholar
Affairs Total Parenteral Nutrition Cooperative Study Group (1991) Perioperative total parenteral nutrition in surgical patients. New England Journal of Medicine 325, 525–532.CrossRefGoogle Scholar
Von Meyenfeldt, MF, Meijerink, WJHJ, Rouflart, MMJ, Buil-Maassen, MTHJ & Soeters, PB (1992) Perioperative nutritional support: a randomised clinical trial. Clinical Nutrition 11, 180–186.Google Scholar
Watters, JM, Kirkpatrick, SM, Norris, SB, Shamji, FM & Wells, GA (1997) Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility. Annals of Surgery 226, 369–380.Google Scholar
Webb, AR, Newman, LA, Taylor, M & Keogh, JB (1989) Hand grip dynamometry as a predictor of postoperative complications: reappraisal using age standardised grip strengths. Journal of Parenteral and Enteral Nutrition 13, 30–33.Google Scholar
Weinsier, RL, Hunker, EM, Krumdieck, CL & Butterworth, CE (1979) Hospital malnutrition: a prospective evaluation of general medical patients during the course of hospitalization. American Journal of Clinical Nutrition 32, 418–426.Google Scholar
Welsh, FKS, Farmery, SM, Ramsden, C, Guillou, PJ & Reynolds, JV (1996) Reversible impairment in monocyte major histocompatibility complex class 11 expression in malnourished surgical patients. Journal of Parenteral and Enteral Nutrition 20, 344–348.Google Scholar
Windsor, JA & Hill, GL (1988) Weight loss with physiologic impairment. A basic indicator of surgical risk. Annals of Surgery 207, 290–296.Google Scholar
Wolinsky, FD, Coe, RM, McIntosh, WMA, Kubena, KS, Prendergast, JM, Chavez, MN, Miller, DK, Romeis, JC & Landmann, WA (1990) Progress in the development of a Nutritional Risk Index. Journal of Nutrition 120, 1549–1553.Google Scholar
World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry. World Health Organization Technical Report no. 854. Geneva: WHO.Google Scholar
Young, VR, Marchini, JS & Cortiella, J (1990) Assessment of protein nutritional status. Journal of Nutrition 120, 1496–1502.Google Scholar