Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-25T02:05:05.816Z Has data issue: false hasContentIssue false

Contribution of body composition to nutritional assessment at hospital admission in 995 patients: a controlled population study

Published online by Cambridge University Press:  09 March 2007

Ursula G. Kyle
Affiliation:
Clinical Nutrition and Diet Therapy, Geneva University Hospital, 1211 Geneva, Switzerland
Alfredo Morabia
Affiliation:
Clinical Epidemiology, Geneva University Hospital, 1211 Geneva, Switzerland
Daniel O. Slosman
Affiliation:
Nuclear Medicine, Geneva University Hospital, 1211 Geneva, Switzerland
Nouri Mensi
Affiliation:
Central Clinical Laboratory, Geneva University Hospital, 1211 Geneva, Switzerland
Pierre Unger
Affiliation:
Emergency Department, Geneva University Hospital,1211 Geneva, Switzerland
Claude Pichard*
Affiliation:
Clinical Nutrition and Diet Therapy, Geneva University Hospital, 1211 Geneva, Switzerland
*
*Corresponding author: Dr Claude Pichard, fax +41 22 372 9363, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Body weight, weight changes and BMI are easily obtainable indicators of nutritional status, but they do not provide information on the amount of fat-free and fat masses. The purpose of the present study was to determine if fat-free mass (FFM) and fat mass were depleted in patients with normal BMI or serum albumin at hospital admission. A group of 995 consecutive patients were evaluated for malnutrition by BMI, serum albumin, and 50 kHz bioelectrical impedance analysis and compared with 995 healthy adults, matched for age and height, and then compared with FFM and fat mass percentiles previously determined in 5225 healthy adults. A BMI of ≤20 kg/m2 was noted in 17·3 % of patients and serum albumin of ≤35 g/l was found in 14·9 % of patients. In contrast, 31 % of all patients were below the tenth percentile for FFM, compared with 10·1 % of controls (χ2, P=0·0001), while 73 % of patients with BMI ≤20 kg/m2 and 31 % of patients with BMI 20–24·9 kg/m2 fell below the tenth percentile for FFM. Furthermore, the FFM was lower in patients than controls and the differences with age in FFM (lower) and fat mass (higher) were greater in patients than in controls. BMI and albumin significantly underestimated the prevalence of malnutrition in patients at hospital admission compared with body composition measurements. Optimal nutritional assessment should therefore include objective measurement of FFM and fat mass.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2001

References

Referenses

Baumgartner, RN, Koehler, KM, Gallagher, D, Romero, L, Heymsfield, SB, Ross, RR, Garry, PJ & Lindeman, RD (1998) Epidemiology of sarcopenia among the elderly in New Mexico. American Journal of Epidemiology 147, 755763.CrossRefGoogle ScholarPubMed
Bistrian, BR, Blackburn, GL & Vitale, J (1976) Prevalence of malnutrition in general medical patients. Journal of the American Medical Association 235, 15671570.CrossRefGoogle ScholarPubMed
Bruera, E (1992) Clinical management of anorexia and cachexia in patients with advanced cancer. Oncology 49, 3542.CrossRefGoogle ScholarPubMed
Bruun, LI, Bosaeus, I, Bergstad, I & Nygaard, K (1999) Prevalence of malnutrition in surgical patients: evaluation of nutritional support and documentation. Clinical Nutrition 18, 141147.CrossRefGoogle ScholarPubMed
Corish, CA (1999) Pre-operative nutritional assessment. Proceedings of the Nutrition Society 58, 821829.CrossRefGoogle ScholarPubMed
Costelli, P & Baccino, FM (2000) Cancer cachexia: from experimental models to patient management. Current Opinion in Clinical Nutrition and Metabolic Care 3, 177181.Google ScholarPubMed
Covinsky, KE, Martin, GE, Beyth, RJ, Justice, AC, Sehgal, AR & Landefeld, CS (1999) The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients. Journal of the American Geriatrics Society 47, 532538.Google ScholarPubMed
Curtin, F, Morabia, A, Pichard, C & Slosman, D (1997) Body mass index compared to dual-energy X-ray absorptiometry: evidence for a spectrum bias. Journal of Clinical Epidemiology 50, 837843.CrossRefGoogle ScholarPubMed
Dempsey, DT, Mullen, JL & Buzby, GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it?. American Journal of Clinical Nutrition 47, 352356.CrossRefGoogle Scholar
Detsky, AS, Baker, JP, O'Rourke, K & Goel, V (1987) Perioperative parenteral nutrition: A meta-analysis. Annals of Internal Medicine 107, 195203.CrossRefGoogle ScholarPubMed
Edington, J, Boorman, J, Durrant, ER, Perkins, A, Giffin, CV, James, R, Thomson, JM, Oldroyd, JC, Smith, JC, Torrance, AD, Blackshaw, V, Green, S, Hill, CJ, Berry, C, McKenzie, C, Vicca, N, Ward, JE & Coles, SJ (2000) Prevalence of malnutrition on admission to four hospitals in England. Clinical Nutrition 19, 191195.Google ScholarPubMed
Engelen, MPKJ, Schols, AMWJ, Baken, WC, Wesseling, GJ & Wouters, EFM (1994) Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD. European Respiratory Journal 7, 17931797.CrossRefGoogle ScholarPubMed
Fink, PC, Romer, M, Haeckel, R, Fateh-Moghadam, A, Delanghe, J, Gressner, AM & Dubs, RW (1989) Measurement of proteins with the Behring Nephelometer. A multicentre evaluation. Journal of Clinical Chemistry and Clinical Biochemistry 27, 261276.Google ScholarPubMed
Galanos, AN, Pieper, CF, Kussin, PS, Winchell, MT, Fulkerson, WJ, Harrell, FE, Teno, JM, Layde, P, Connors, AF, Phillips, RS & Wenger, NS (1997) Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. SUPPORT Investigators The Study to Understand Prognoses and Preferences for Outcome and Risks of Treatments. Critical Care Medicine 25, 19621968.CrossRefGoogle Scholar
Genton, LC, Karsegard, VL, Kyle, UG, Hans, DB, Michel, JP, Slosman, DO & Pichard, C (2001) Comparison of four bioelectrical impedance analysis formulas in healthy elderly subjects Gerontology (In the press).CrossRefGoogle ScholarPubMed
Ham, RJ (1992) Indicators of poor nutritional status in older Americans. American Family Physician 45, 219228.Google ScholarPubMed
Houtkooper, LB, Lohman, TG, Going, SB & Howell, WH (1996) Why bioelectrical impedance analysis should be used for estimating adiposity. American Journal of Clinical Nutrition 64, 436S448S.CrossRefGoogle ScholarPubMed
Kotler, DP, Tierney, AR, Wang, J & Pierson, RM (1989) Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. American Journal of Clinical Nutrition 50, 444447.CrossRefGoogle ScholarPubMed
Kyle, UG, Genton, L, Karsegard, L, Slosman, DO & Pichard, C (2001 a) Single prediction equation for bioelectrical impedance analysis in adults aged 20–94 yrs. Nutrition 17, 248253.CrossRefGoogle Scholar
Kyle, UG, Genton, L, Mentha, H, Nicod, L, Slosman, D & Pichard, C (2001 b) Reliable bioelectrical impedance analysis estimate of fat-free mass in liver, lung and heart transplant patients. Journal of Parenteral and Enteral Nutrition 25, 4551.CrossRefGoogle ScholarPubMed
Kyle, UG, Genton, LC, Slosman, DO & Pichard, C (2001 c) Fat free and fat mass percentiles in 5225 healthy subjects aged 15 to 98 years. Nutrition 17, 534541.CrossRefGoogle ScholarPubMed
Kyle, UG & Pichard, C (2000) Dynamic assessment of fat-free mass during catabolism and recovery. Current Opinion in Clinical Nutrition and Metabolic Care 3, 317322.Google ScholarPubMed
Lukaski, HC (1986) Validation of tetrapolar bioelectrical impedance measurements to assess human body composition. Journal of Applied Physiology 60, 13271332.CrossRefGoogle ScholarPubMed
McWhirter, JP & Pennington, CR (1994) Incidence and recognition of malnutrition in hospital. British Medical Journal 308, 945948.CrossRefGoogle ScholarPubMed
Martyn, CN, Winter, PD, Coles, SJ & Edington, J (1998) Effect of nutritional status on use of health care resources by patients with chronic disease living in the community. Clinical Nutrition 17, 119123.CrossRefGoogle ScholarPubMed
Metropolitan Life Insurance Company (1983) Build Study, 1979. Society of Actuaries and Association of Life Insurance Medical Directors of America, Philadelphia, US. Recording and Statistical Corporation (1980). New York, USA: Metropolian Life Insurance Company.Google Scholar
Morabia, A, Ross, A, Curtin, F, Slosman, DO & Pichard, C (1999) Relation of BMI to a dual-energy X-ray absorptiometry measure of fatness. British Journal of Nutrition 82, 4955.CrossRefGoogle ScholarPubMed
Paccagnella, A, Calò, MA, Caenaro, G, Salandin, V, Jus, P, Simini, G & Heymsfield, SB (1994) Cardiac cachexia: Preoperative and post operative nutrition management. Journal of Parenteral and Enteral Nutrition 18, 409416.CrossRefGoogle ScholarPubMed
Peter D Hart Research Associates Inc. (1993) National Survey on Nutritional Screening and Treatment of the Elderly. Washington, DC: Peter D Hart Research Associates Inc.Google Scholar
Potter, JF, Schafer, DF & Bohi, RL (1988) In-hospital mortality as a function of body mass index: an age-dependent variable. Journal of Gerontology 43, M59M69.CrossRefGoogle ScholarPubMed
Rajala, SA, Kanto, AJ, Haavisto, MV, Kaarela, RH, Koivunen, MJ & Heikinheimo, RJ (1990) Body weight and the three-year prognosis in very old people. International Journal of Obesity 14, 9971003.Google ScholarPubMed
Reilly, JJ, Hull, SF, Albert, N, Waller, A & Bringardener, S (1988) Economic impact of malnutrition: a model system for hospitalized patients. Journal of Parenteral and Enteral Nutrition 12, 371376.CrossRefGoogle Scholar
Reynolds, MW, Fredman, L, Langenberg, P & Magaziner, J (1999) Weight, weight change, mortality in a random sample of older community-dwelling women. Journal of the American Geriatrics Society 47, 14091414.CrossRefGoogle Scholar
Schols, AM, Slangen, J, Volovics, L & Wouters, EF (1998) Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 157, 17911797.CrossRefGoogle ScholarPubMed
Sheils, JF, Rubin, R & Stapleton, DC (1999) The estimated costs and savings of medical nutrition therapy: The Medicare population. Journal of the American Dietetic Association 99, 428435.CrossRefGoogle ScholarPubMed
Volkert, D, Kruse, W, Oster, P & Schlierf, G (1992) Malnutrition in geriatric patients: diagnostic and prognostic significance of nutritional parameter. Annals of Nutrition and Metabolism 36, 97112.CrossRefGoogle Scholar
Von Roenn, JH, Armstrong, D, Kotler, DP, Cohn, DL, Klimas, NG, Teckmedyan, NS, Cone, L, Brennan, PJ & Weitzman, SA (1994) Megestrol acetate in patients with AIDS-related cachexia. Annals of Internal Medicine 121, 393399.Google ScholarPubMed