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1.
Spinal Cord ; 59(7): 730-737, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33077901

RESUMO

STUDY DESIGN: Observational. OBJECTIVES: To compare two methods for predicting segmental (arms, legs, trunk) lean tissue mass (LTM: non-bone fat-free mass) from bioimpedance spectroscopy (BIS) against LTM measured from dual energy X-ray absorptiometry (DXA) in individuals with acute spinal cord injury (SCI). SETTING: Austin Health Victorian Spinal Cord Service, Victoria, Australia. METHODS: Fourteen participants (two female), within 8 weeks of traumatic SCI had BIS measured following an overnight fast and within 24 h of DXA scanning. Total body fat-free mass (FFM, body weight minus fat mass) and segmental LTM were predicted from BIS using manufacturer's proprietary software and a previously established SCI-specific prediction method. Appendicular LTM (ALM) was calculated from the sum of the LTM of the arms and legs. Agreement and strength of relationships with DXA for predicted LTM measures using both approaches were assessed using Lin's concordance coefficient and limits of agreement analysis (LOA). RESULTS: The BIS proprietary method performed better than the SCI-specific prediction method in predicting DXA LTM, demonstrating substantial concordance for total body FFM (rc = 0.80), ALM (rc = 0.78), arm (rc = 0.76) and leg LTM (rc = 0.65) and a smaller bias and LOA for ALM (+0.8 vs. -3.4 kg; LOA -4.9-6.4 vs. -11.9-5.1 kg), arm (+0.02 vs. -0.3 kg; LOA -1.1-1.1 kg vs. -2.2-1.6 kg) and leg (+0.4 vs. -1.4 kg; LOA -2.0-2.8 vs. -5.6-2.8) LTM. CONCLUSIONS: BIS can be used to accurately predict total body FFM, segmental LTM and ALM in individuals with acute SCI.


Assuntos
Composição Corporal , Traumatismos da Medula Espinal , Absorciometria de Fóton , Impedância Elétrica , Feminino , Humanos , Masculino , Análise Espectral , Traumatismos da Medula Espinal/diagnóstico por imagem , Vitória
2.
Spinal Cord ; 57(7): 562-570, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30728440

RESUMO

STUDY DESIGN: Prospective, observational OBJECTIVES: To evaluate agreement between a reference method (doubly labelled water, DLW) of total energy expenditure (TEE) and published equations for estimating energy requirements in acute spinal cord injury (SCI). SETTING: Victoria, Australia METHODS: Twenty participants (18 male) within 8 weeks of traumatic SCI completed DLW, anthropometric and dietary intake assessments. Energy requirements were predicted using Harris-Benedict, Schofield, Henry, Nelson, Buchholz and Chun equations, multiplied by a combined activity and stress factor of 1.3, and the ratio method (kJ/kg body weight). Fat-free mass (FFM) and fat mass (FM) were calculated from TBW-derived DLW and from bioelectrical impedance spectroscopy (BIS). RESULTS: Median time since injury was 41 days. Median TEE was 9.1 MJ. Fair agreement was found between TEE and predicted energy requirements for the Chun (rc = 0.39), the Harris-Benedict equation (rc = 0.30), the ratio method (rc = 0.23) and the Buchholz (rc = 0.31) and Nelson equations (rc = 0.35), which incorporate measures of FFM and/or FM. Other equations showed weak concordance with DLW. When two hypermetabolic patients were removed, agreement between TEE and predicted energy requirements using the Buchholz equation increased to substantial (rc = 0.72) and using the Nelson (rc = 0.53) and Chun equations (rc = 0.53) increased to moderate. The Buchholz equation had the smallest limits of agreement (-2.4-2.3 MJ/d). CONCLUSION: The population-specific Buchholz equation that incorporates FFM, predicted from either BIS or DLW, demonstrated the best agreement in patients with acute SCI. SPONSORSHIP: The study was funded by grants from the Institute for Safety, Compensation and Recovery Research (ISCRR Project # NGE-E-13-078) and Austin Medical Research Foundation. M Panisset was supported by an Australian Postgraduate Award.


Assuntos
Algoritmos , Metabolismo Energético/fisiologia , Traumatismos da Medula Espinal/metabolismo , Óxido de Deutério/urina , Feminino , Humanos , Masculino , Radioisótopos de Oxigênio/urina
3.
Nutrition ; 120: 112345, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38301395

RESUMO

OBJECTIVE: Spinal cord injury (SCI) is associated with low muscle mass and adiposity, however, to our knowledge, few studies have monitored the trajectory of changes over time. This study aimed to evaluate the timing, rate, magnitude, and site-specific changes in body composition and related changes in diet after SCI. METHODS: We assessed 39 patients with SCI. The analysis included five women. Of the participants, 51% had American Spinal Injury Association Impairment Scale (AIS) criteria A/B (motor complete) injuries, 18% had AIS C (sensory/motor incomplete) injuries, and 31% had AIS D (motor incomplete) injuries. The mean age of the patients was 43.2 y. They were 48.1 d post-injury and had their weight, diet, and body composition (bioimpedance spectroscopy) assessed every 2 wk. RESULTS: No significant linear changes were observed for any body composition measure. Total body fat mass (FM) changed 0.01 kg/2 wk when fitted to a quadratic model (P = 0.004), decreasing to week 15 and returning to baseline at week 28. Subgroup analysis revealed that arm lean tissue mass (LTM) increased in paraplegic versus tetraplegic participants (0.05 versus -0.01 kg/2 wk, P = 0.007). Participants with AIS A/B injuries lost FM (-0.17 kg; P = 0.010), whereas those with AIS C injuries gained appendicular LTM (ALTM; 0.15 kg; P = 0.017) and leg LTM (0.12 kg; P = 0.008) every 2 wk. Body composition remained stable in the AIS D group. Mean fortnightly changes were greater in the AIS A/B group than the C group for weight (mean difference -0.30 kg; P = 0.021), FM (-0.25 kg; P = 0.002), and leg LTM (-0.11 kg; P = 0.021) and AIS A/B versus D for FM (-0.42 kg; P = 0.013). Baseline energy and protein intakes were 2150 kcal (±741) and 102 g (±40) and decreased by 21.5 kcal (P = 0.016) and 1.3 g (P = 0.004) every 2 wk but were not associated with body composition changes. CONCLUSIONS: Neurologic level and severity of SCI, but not changes in diet, were the main determinants of heterogeneous body composition changes.


Assuntos
Traumatismos da Medula Espinal , Humanos , Feminino , Traumatismos da Medula Espinal/complicações , Obesidade/complicações , Composição Corporal/fisiologia , Dieta
4.
Nutrients ; 15(12)2023 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-37375651

RESUMO

INTRODUCTION: The aim of this study is to describe the mealtime experience using the qualitative components of the Austin Health Patient Mealtime Experience Tool (AHPMET) to complement the quantitative findings of this tool. METHODS: A multiphase, cross-sectional study was undertaken across all sites of Austin Health (Victoria, Australia) between March 2020 and November 2021. Patient mealtime experience was measured using the AHPMET. Descriptive statistics and a deductive thematic analysis approach described the patients' mealtime experiences. RESULTS: Questionnaire data were collected from 149 participants. Patients were most satisfied with staff interactions, and least satisfied with dimensions of food quality, specifically, flavour, presentation, and menu variety. Clinical symptoms, nutrition impact symptoms and the patient's position were barriers to consumption. DISCUSSION: Food quality was perceived as the poorest aspect of patient satisfaction with the hospital foodservice, particularly flavour, presentation, and menu variety. Future foodservice quality improvements must prioritise improving food quality to have the greatest impact on patient satisfaction. While clinical and organisational systems have a role in improving mealtime experience and oral intake, communicating patient perceptions of the mealtime experience is critical for responding to current perceptions of hospital food quality. CONCLUSION: Mealtime experience in the hospital has a significant impact on oral intake and patients' wider perception of hospital services. Questionnaires have been used to capture patient satisfaction with foodservice in the hospital; however, no comprehensive questionnaires including qualitative questions that capture the broader mealtime experience have been validated across different hospital settings. The tool developed through this study can be implemented in any acute and subacute health service to provide feedback and improve the mealtime experience of patients. This has the capacity to improve mealtime intake, mitigate malnutrition, and improve quality of life and patient outcomes.


Assuntos
Serviço Hospitalar de Nutrição , Desnutrição , Humanos , Estudos Transversais , Qualidade de Vida , Vitória , Refeições , Satisfação do Paciente
6.
Clin Nutr ; 24(6): 979-87, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16297506

RESUMO

BACKGROUND & AIMS: Nutrients putatively implicated in pressure ulcer healing were evaluated in a clinical setting. METHODS: Sixteen inpatients with a stage 2, 3 or 4 pressure ulcer randomised to receive daily a standard hospital diet; a standard diet plus two high-protein/energy supplements; or a standard diet plus two high-protein/energy supplements containing additional arginine (9 g), vitamin C (500 mg) and zinc (30 mg). Nutritional status measurements (dietary, anthropometric and biochemical) and pressure ulcer size and severity (by PUSH tool; Pressure Ulcer Scale for Healing; 0=completely healed, 17=greatest severity) were measured weekly for 3 weeks. RESULTS: Patients' age and BMI ranges were 37-92 years and 16.4-28.1 k g/m2) respectively. Baseline PUSH scores were similar between groups (8.7+/-0.5). Only patients receiving additional arginine, vitamin C and zinc demonstrated a clinically significant improvement in pressure ulcer healing (9.4+/-1.2 vs. 2.6+/-0.6; baseline and week 3, respectively; P<0.01). All patient groups presented with low serum albumin and zinc and elevated C-reactive protein. There were no significant changes in biochemical markers, oral dietary intake or weight in any group. CONCLUSIONS: In this small set of patients, supplementary arginine, vitamin C and zinc significantly improved the rate of pressure ulcer healing. The results need to be confirmed in a larger study.


Assuntos
Arginina/uso terapêutico , Ácido Ascórbico/uso terapêutico , Úlcera por Pressão/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Zinco/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria , Antioxidantes/uso terapêutico , Análise Química do Sangue , Suplementos Nutricionais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Índice de Gravidade de Doença , Oligoelementos/uso terapêutico , Resultado do Tratamento
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