Phase Angle Is a Stronger Predictor of Hospital Outcome than Subjective Global Assessment-Results from the Prospective Dessau Hospital Malnutrition Study.

This prospective cohort study of 16,943 consecutive patients compared phase angle (PhA, foot-to-hand at 50 kHz) and subjective global assessment (SGA) to predict outcomes length of hospital stay (LOS) and in-hospital mortality in patients at risk of malnutrition (NRS-2002 ≥ 3). In 1505 patients, the independent effects on LOS were determined by competing risk analysis and on mortality by logistic regression. In model I, including influence factors age, sex, BMI, and diagnoses, malnourished (SGA B and C) patients had a lower chance for a regular discharge (HR 0.74; 95%CI 0.69−0.79) and an increased risk of mortality (OR 2.87; 95%CI 1.38−5.94). The association of SGA and outcomes regular discharge and mortality was completely abrogated when PhA was added (model II). Low PhA reduced the chance of a regular discharge by 53% in patients with a PhA ≤ 3° (HR 0.47; 95%CI 0.39−0.56) as compared to PhA > 5°. Mortality was reduced by 56% for each 1° of PhA (OR 0.44; 95%CI 0.32−0.61). Even when CRP was added in model III, PhA ≤ 3° was associated with a 41% lower chance for a regular discharge (HR 0.59; 95%CI 0.48−0.72). In patients at risk of malnutrition, the objective measure PhA was a stronger predictor of LOS and mortality than SGA.

[ESPEN Practical Guideline: clinical nutrition in liver disease]. / Guía Práctica ESPEN: nutrición clínica en las enfermedades del hígado.

Introduction: Background: the Practical Guideline is based on the current scientific ESPEN guide on Clinical Nutrition in Liver Disease. Methods: it has been shortened and transformed into flow charts for easier use in clinical practice. The guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with chronic liver disease. Results: a total of 103 statements and recommendations are presented with short commentaries for the nutritional and metabolic management of patients with (i) acute liver failure, (ii) alcoholic steatohepatitis, (iii) non-alcoholic fatty liver disease, (iv) liver cirrhosis, and (v) liver surgery/transplantation. Disease-related recommendations are preceded by general recommendations on the diagnosis of nutritional status in liver patients and on liver complications associated with medical nutrition. Conclusion: this Practical Guideline gives guidance to health care providers involved in the management of liver disease on how to offer optimal nutritional care.

Introducción: Introducción: la Guía Práctica se basa en la actual guía científica de la ESPEN sobre nutrición clínica en las enfermedades hepáticas. Métodos: se ha reducido y transformado en diagramas de flujo para facilitar su uso en la práctica clínica. La guía está dedicada a todos los profesionales, incluidos médicos, dietistas, nutricionistas y enfermeras, que trabajan con pacientes con enfermedad hepática crónica. Resultados: la guía presenta un total de 103 pronunciamientos y recomendaciones con breves comentarios para el manejo nutricional y metabólico de pacientes con (i) insuficiencia hepática aguda grave, (ii) esteatohepatitis alcohólica, (iii) enfermedad hepática grasa no alcohólica, (iv) cirrosis hepática, y (v) cirugía o trasplante de hígado. Conclusión: las recomendaciones relacionadas con enfermedades están precedidas por recomendaciones generales sobre el diagnóstico del estado nutricional en los pacientes hepáticos y sobre las complicaciones hepáticas asociadas a la nutrición médica.

ESPEN practical guideline: Clinical nutrition in liver disease.

BACKGROUND: The Practical guideline is based on the current scientific ESPEN guideline on Clinical Nutrition in Liver Disease. METHODS: It has been shortened and transformed into flow charts for easier use in clinical practice. The guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with chronic liver disease. RESULTS: A total of 103 statements and recommendations are presented with short commentaries for the nutritional and metabolic management of patients with (i) acute liver failure, (ii) alcoholic steatohepatitis, (iii) non-alcoholic fatty liver disease, (iv) liver cirrhosis, and (v) liver surgery/transplantation. The disease-related recommendations are preceded by general recommendations on the diagnostics of nutritional status in liver patients and on liver complications associated with medical nutrition. CONCLUSION: This practical guideline gives guidance to health care providers involved in the management of liver disease to offer optimal nutritional care.

Nutritional Intervention in Chronic Liver Failure.

Patients suffering from chronic liver failure (CLF) frequently are malnourished and do not achieve an adequate intake of nutrients, in particular protein. Low protein intake and loss of muscle mass and function, termed sarcopenia, are indicators of a poor outcome. CLF patients, therefore, should be screened for risk of malnutrition using a validated tool, and if positive, full assessment of nutritional status is mandatory including search for sarcopenia. The main goal of nutritional intervention is to provide enough protein (1.2-1.5 g × kg-1 × day-1) and to ensure adequate energy intake (total energy 30 kcal × kg-1 × day-1; 1.3 × resting energy expenditure). Livers of CLF patients are deplete in glycogen and, therefore, prolonged periods of fasting (>12 h) must be avoided in order to prevent further breakdown of muscle protein for gluconeogenesis. Therefore, late evening snacks or even nocturnal oral nutritional supplements improve total body -protein status and thus, are recommended. Nutrition intervention should be stepped up from nutrition counselling to oral nutritional supplements, to enteral tube feeding, or to parenteral nutrition as appropriate. As in other malnourished patients, the prevention of refeeding syndrome or vitamin/trace element deficiency should be taken care of.

[Nutrition in Liver Cirrhosis: Clinical Practice Recommendations]. / Ernährung bei Leberzirrhose: wichtige Tipps für Klinik und Praxis.

Liver disease and nutritional status affect each other mutually. Hepatic function is impaired by malnutrition and can be improved by nutrition therapy. Liver cirrhosis leads to prognostically relevant malnutrition in a stage dependent manner. Protein depletion and sarcopenia are its key features. Patients with liver cirrhosis should undergo systematic screening for risk of malnutrition and if positive sarcopenia should be assessed and a nutrition plan devised. In cirrhotic patients, spontaneous food intake frequently does not meet requirements and prolonged (> 12 h) periods of fasting must be avoided. In a stepwise fashion nutritional counseling, oral nutritional supplements, enteral tube feeding and parenteral nutrition as third-line-therapy should be used. In cirrhotic patients, nutrition therapy can improve morbidity and mortality by ensuring the adequate provision of energy, protein and micronutrients.

ESPEN guideline on clinical nutrition in liver disease.

This update of evidence-based guidelines (GL) aims to translate current evidence and expert opinion into recommendations for multidisciplinary teams responsible for the optimal nutritional and metabolic management of adult patients with liver disease. The GL was commissioned and financially supported by ESPEN. Members of the guideline group were selected by ESPEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. A total of 85 recommendations were made for the nutritional and metabolic management of patients with acute liver failure, severe alcoholic steatohepatitis, non-alcoholic fatty liver disease, liver cirrhosis, liver surgery and transplantation as well as nutrition associated liver injury distinct from fatty liver disease. The recommendations are preceded by statements covering current knowledge of the underlying pathophysiology and pathobiochemistry as well as pertinent methods for the assessment of nutritional status and body composition.

Performance of CT-based low skeletal muscle index, low mean muscle attenuation, and bioelectric impedance derived low phase angle in the detection of an increased risk of nutrition related mortality.

BACKGROUND & AIMS: The aim of this study was to evaluate in a head to head comparison the performance of bioimpedance derived low phase angle (PA), CT-based low skeletal muscle index (SMI) and low mean muscle attenuation (MA), and Pandora Score (PS) to detect an increased nutrition related mortality in hospitalized patients. METHODS: A total of 7736 patients were hospitalized in Dessau community hospital (Nov 11, 2016-Feb 05, 2017). In 227/7736 patients an abdominal CT scan was obtained and low values (below threshold) of skeletal muscle index (SMI) and mean muscle attenuation (MA) were obtained at L3 level using Slice-O-Matic. In 180/227 patients, malnutrition screening (NRS-2002 ≥ 3), determination of low PA (<5th percentile) and calculation of 30-day mortality risk (PS ≥ 5%) were done within 6 days after the CT scan. RESULTS: PA was low in 116 (64%), SMI was low in 95 (53%), and MA was below threshold in 137 (77%) patients. Using hospital mortality (8.3%) as a gold standard, low SMI, low MA, or low PA showed high sensitivity (SMI 93.3%; MA 86.7%; PA 86.7%) and high negative predictive (NPV) values (SMI 98.9%; MA 95.3%; PA 96.9%) and improved specificity (NRS + SMI 65.5%; NRS + MA 50.3%; NRS + PA 50.3%) when combined with the criterion NRS ≥ 3. Using hospital mortality as a gold standard, a PS ≥ 36 (predicted mortality ≥ 5%) showed a sensitivity of 73.3%, a specificity of 62.2% and an NPV of 96.4%. PS predicted mortality was ≥5% in 70 (39%) patients and was higher (median 5.2%; IQR: 2.8; 11.8 vs 1.7%; IQR: 1.0; 2.8; p < 0.001) in patients with a low PA and this was also observed for low vs normal SMI (median 5.7%; IQR: 2.6; 11.1 vs 2.7%; IQR:1.4;5.5; p < 0.001) but not for low vs normal MA (median 3.9%; IQR: 2.1; 8.8 vs 3.4%; IQR: 2.0; 8.1; ns). CONCLUSION: Determination of phase angle < 5th percentile is a convenient non-invasive and inexpensive bedside method with high sensitivity and a high negative predictive value to detect patients at risk of nutrition related mortality with a performance comparable to CT derived skeletal muscle index or mean muscle attenuation.

[Nutrition of Polymorbid Patients - Data or Opinions?] / Ernährung bei multimorbiden Patienten ­ Daten oder Meinungen?

Polymorbidity and old age are rather the rule than the exception in hospitalised patients. Malnutrition is common in such patients and should be identified by appropriate screening and assessment measures in order to devise a nutrition plan and act accordingly. Unlike in the UK or The Netherlands, malnutrition screening and nutrition teams are not mandatory for German hospitals. Malnutrition and, in particular, sarcopenia are indicators of a nutrition associated risk or increased morbidity and mortality. Malnutrition can affect patients of any medical discipline and, therefore, is managed most efficiently by the interdisciplinary and multiprofessional nutrition team. By this approach goal directed nutrition therapy can improve morbidity and mortality of hospitalised patients.

White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study.

BACKGROUND & AIMS: Early detection of neoplastic lesions is essential in patients with long-standing ulcerative colitis but the best technique of colonoscopy still is controversial. METHODS: We performed a prospective multicenter study in patients with long-standing ulcerative colitis. Two colonoscopies were performed in each patient within 3 weeks to 3 months. In white-light (WL) colonoscopy, stepwise random biopsy specimens (4 biopsy specimens every 10 cm), segmental random biopsies (2 biopsy specimens in 5 segments), and targeted biopsy specimens were taken. In NBI colonoscopy, segmental and targeted biopsy specimens were taken. The sequence of WL and NBI colonoscopy was randomized. RESULTS: In 36 of 159 patients enrolled (22.6%), 54 lesions with intraepithelial neoplasia (IN) were found (51 low-grade, 3 high-grade). In WL colonoscopy we found 11 IN in stepwise biopsy specimens, 4 in segmental biopsy specimens, and 15 in targeted biopsy specimens. In NBI colonoscopy 7 IN were detected in segmental biopsy specimens and 24 IN were detected in targeted biopsy specimens. Almost all IN were found with one technique alone (κ value of WL vs NBI, -0.86; P < .001). Statistically equivalent numbers of IN were found in NBI colonoscopy with targeted and segmental biopsy specimens as in WL colonoscopy with targeted and stepwise biopsy specimens, but with fewer biopsy specimens (11.9 vs 38.6 biopsy specimens, respectively; P < .001), and less withdrawal time was necessary (23 vs 13 min, respectively; P < .001). CONCLUSIONS: Stepwise biopsy specimens are indispensable in WL colonoscopy. The combination of targeted and segmental biopsy specimens in the NBI technique is as sensitive as targeted together with stepwise biopsy specimens in WL colonoscopy, but requires fewer biopsy specimens and less time. The highest sensitivity should be reached by combining the WL and NBI techniques by switching between the modes.

Weight gain in long-term survivors of kidney or liver transplantation--another paradigm of sarcopenic obesity?

OBJECTIVE: Obesity in transplant recipients is a frequent phenomenon but data from body composition analyses in long-term survivors are limited. Body composition and energy metabolism were studied in patients after liver (LTX) and kidney (KTX) transplantation and patients with liver cirrhosis (LCI) or on chronic hemodialysis (HD) and compared to healthy controls. METHODS: In 42 patients 50.0 mo (median; range 17.1-100.6) after LTX and 30 patients 93.0 mo (31.2-180.1) after KTX as wells as in LCI (n = 39) or HD (n = 10) patients mid-arm muscle and fat area, body cell mass, and phase angle (bioimpedance analysis), and resting energy expenditure (indirect calorimetry, REE(CALO)) were measured. RESULTS: Obesity was more prevalent in LTX (17%) than LCI (3%) and in KTX (27%) than in HD (10%). In LTX and KTX, phase angle was higher than in end-stage disease (LTX 5.6° [4.1-7.2] versus LCI 4.4° [2.9-7.3], P < 0.001; KTX 5.9° [4.4-8.7] versus HD 4.3° [2.9-6.8]) but was lower in all patient groups than in controls (7.1°; 4.6-8.9; P < 0.001). In LCI and HD REE(CALO) was higher than predicted, while in LTX and KTX REE(CALO) was not different from predicted REE. CONCLUSIONS: Despite excellent graft function, many long-term LTX or KTX survivors exhibit a phenotype of sarcopenic obesity with increased fat but low muscle mass. This abnormal body composition is observed despite normalization of the hypermetabolism found in chronic disease and cannot be explained by overeating. The role of appropriate nutrition and physiotherapy after transplantation merits further investigation.

Branched-chain amino acids in liver disease: new aspects of long known phenomena.

PURPOSE OF REVIEW: To provide an overview of findings on the role of branched-chain amino acids (BCAAs) in the pathophysiology, pathobiochemistry, and treatment of liver cirrhosis and its complications that have been published since or were not included in the last review on this topic in 2007 in this journal. RECENT FINDINGS: There has been continued interest in the potential of oral BCAA supplements in improving energy metabolism, nitrogen metabolism, carbohydrate metabolism, insulin resistance, severity of liver disease, serum albumin levels, quality of serum albumin, or postoperative complication rates. Unfortunately, many trials suffer from lacking or inadequate controls or small sample size. In a fine example of scientific perseverance, Dutch researchers uncovered the long-known phenomenon of ingested blood being highly comagenic in patients with cirrhosis to be due to the low biologic value of blood protein. The absence of isoleucine and the abundance of leucine in the hemoglobin molecule by way of BCAA antagonism leads to impaired protein synthesis and azotemia paving the way for hepatic encephalopathy. SUMMARY: Recognizing hypoisoleucinemia and BCAA antagonism following gastrointestinal bleeding, and its successful treatment by isoleucine infusion has advanced our understanding of the role of BCAA in liver cirrhosis.

Bioelectrical impedance analysis in clinical practice: implications for hepatitis C therapy BIA and hepatitis C.

BACKGROUND: Body composition analysis using phase angle (PA), determined by bioelectrical impedance analysis (BIA), reflects tissue electrical properties and has prognostic value in liver cirrhosis. Objective of this prospective study was to investigate clinical use and prognostic value of BIA-derived phase angle and alterations in body composition for hepatitis C infection (HCV) following antiviral therapy. METHODS: 37 consecutive patients with HCV infection were enrolled, BIA was performed, and PA was calculated from each pair of measurements. 22 HCV genotype 3 patients treated for 24 weeks and 15 genotype 1 patients treated for 48 weeks, were examined before and after antiviral treatment and compared to 10 untreated HCV patients at 0, 24, and 48 weeks. Basic laboratory data were correlated to body composition alterations. RESULTS: Significant reduction in body fat (BF: 24.2 +/- 6.7 kg vs. 19.9 +/- 6.6 kg, genotype 1; 15.4 +/- 10.9 kg vs. 13.2 +/- 12.1 kg, genotype 3) and body cell mass (BCM: 27.3 +/- 6.8 kg vs. 24.3 +/- 7.2 kg, genotype 1; 27.7 +/- 8.8 kg vs. 24.6 +/- 7.6 kg, genotype 3) was found following treatment. PA in genotype 3 patients was significantly lowered after antiviral treatment compared to initial measurements (5.9 +/- 0.7 degrees vs. 5.4 +/- 0.8 degrees). Total body water (TBW) was significantly decreased in treated patients with genotype 1 (41.4 +/- 7.9 l vs. 40.8 +/- 9.5 l). PA reduction was accompanied by flu-like syndromes, whereas TBW decline was more frequently associated with fatigue and cephalgia. DISCUSSION: BIA offers a sophisticated analysis of body composition including BF, BCM, and TBW for HCV patients following antiviral regimens. PA reduction was associated with increased adverse effects of the antiviral therapy allowing a more dynamic therapy application.

ESPEN Guidelines on Parenteral Nutrition: hepatology.

Parenteral nutrition (PN) offers the possibility to increase or to ensure nutrient intake in patients, in whom sufficient nutrition by oral or enteral alone is insufficient or impossible. Complementary to the ESPEN guideline on enteral nutrition of liver disease (LD) patients the present guideline is intended to give evidence-based recommendations for the use of PN in LD. For this purpose three paradigm conditions of LD were chosen: alcoholic steatohepatitis (ASH), liver cirrhosis and acute liver failure. The guideline was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was presented on the ESPEN website and visitors' criticism and suggestions were welcome and included in the final revision. PN improves nutritional state and liver function in malnourished patients with ASH. PN is safe and improves mental state in patients with cirrhosis and severe HE. Perioperative (including liver transplantation) PN is safe and reduces the rate of complications. In acute liver failure PN is a safe second-line option to adequately feed patients in whom enteral nutrition is insufficient or impossible.

Impact of capsule endoscopy on outcome in mid-intestinal bleeding: a multicentre cohort study in 285 patients.

BACKGROUND: Capsule endoscopy (CE) sensitively detects the bleeding source in the small bowel. However, the influence of CE on long-term outcome is not well established. METHODS: In five tertiary hospitals, all CE investigations were retrospectively identified dating back to 3 years. Patients with intestinal bleeding and negative bidirectional endoscopy were included, and relapse of bleeding was recorded. RESULTS: A bleeding source was detected in 219 of 285 patients (76.8%); CE provided the diagnosis in 175 of 219 (79.9%) and other, repeated investigations in 44 cases (20.1%). Follow-up (mean+/-SD=20.7+/-9.4 months) in 240 patients identified rebleeding in 65 (27.1%), and readmission to a hospital in 42 (17.5%). Hospital readmission was most frequent in patients with angiectasias (31.3%, relative risk (RR)=5.0; 95% confidence interval (CI)=2.4-10.4). Other risk factors included patients being older than 60 years of age (RR=3.8; 95% CI=1.5-9.5), and anticoagulant medication (RR=3.0; 95% CI=1.5-6.0). Therapeutic measures had a mean recurrence rate of 3.7% in surgical candidates (Meckel's diverticulum, tumor), 40% in endoscopically treated and 16% in medically treated patients. In case all the detected angiectasias had been cauterized, the relapse rate was low (11.8%), but in incompletely treated patients, it was high (85.7%). Bleeding relapse was never lethal. CONCLUSION: CE guides therapeutic measures and predicts the risk of recurrent bleeding in small intestinal bleeding. High risk of rebleeding in angiectasias is significantly reduced by the cauterization of all demonstrable lesions.

Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life.

BACKGROUND: Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, phosphate-restricted, renal-specific oral supplement could maintain adequate nutritional intake and prevent malnutrition in maintenance haemodialysis patients with insufficient intake. METHODS: Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5(R) daily for 3 months (SUPP). Dietary intake, serum (S) albumin, prealbumin, protein nitrogen appearance (nPNA), C-reactive protein, subjective global assessment (SGA) and quality of life (QOL) were recorded at baseline and after 3 months. RESULTS: While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary intake between groups, per protocol (PP) analysis showed that the SUPP group increased protein (P < 0.01) and energy (P < 0.01) intakes. In contrast, protein and energy intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase phosphate intake, phosphataemia remained unaffected, and the use of phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). CONCLUSION: This study shows that providing maintenance haemodialysis patients with insufficient intake with a renal-specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for phosphate binders.

Clinical practice of nutrition in acute liver failure--a European survey.

BACKGROUND: Evidence-based guidelines for artificial nutrition in hyperacute (HLF), acute (ALF) and subacute liver failure (SLF) cannot be given at present due to scarcity of clinical studies. METHODS: Current nutritional practice was surveyed using a questionnaire which was answered by 33 hepatology units (2-170 cases/year) in 11 European countries. RESULTS: All units used specific nutrition support regimes in liver failure patients. Eight units (385 patients/year) preferentially used tube-feeding with standard diets, 25 units (377 patients/year) used parenteral nutrition (PN). For PN glucose was infused at 4.0 g/kg d (median; range 0.6-10.0). Intravenous fat was given only by some units: (18/33) in HLF at 0.9 g/kg d (0.3-2.0), (21/33) in ALF at 1.0 g/kg d (0.3-2.0), and (23/33) in SLF at 1.0 g/kg d (0.3-3.0). Amino acid solutions, predominantly enriched in branched-chain amino acids, were used in HLF (19/33 units) and in ALF (23/33) at 0.9 g/kg d (0.5-1.5) and in SLF (24/33) at 1.0 g/kg d (0.7-1.5). CONCLUSION: Hepatology units use a considerable variety of specific nutrition support strategies in liver failure. About 50% of patients receive enteral nutrition. Dosage and monitoring of PN is similar to other critical illness with a wide variety of infusion rates and accepted ranges of substrate plasma concentrations.

Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism.

BACKGROUND/AIMS: To search for changes in body composition and energy metabolism associated with the repeatedly observed weight gain of cirrhotic patients after portosystemic shunting. METHODS: Twenty-one patients were studied prospectively before and 6 and 12 months after transjugular intrahepatic portosystemic shunt (TIPS) to assess body cell mass by two independent methods (total body potassium counting: body cell mass determined by TBP, BCMTBP, bioelectric impedance analysis: body cell mass determined by BIA, BCMBIA), muscle mass (anthropometry), resting energy expenditure (REECALO) by indirect calorimetry, and nutritional intake by dietary recall analysis. RESULTS: Prior to TIPS patients were hypermetabolic in terms of measured vs. predicted REE (REECALO median 1423 (range 1164-1838) vs. REEPRED 1279 (1067-1687) kcal; P<0.05) and their body cell mass was lower (19.1 (10.9-33.4) vs. 31.7 (16.8-47.1) kg; P=0.001). After TIPS body cell mass (BCMBIA) increased to 23.5 (12.7-44.3) (P<0.025) and 25.7 (14.2-39.7) kg (P=0.05) at 6 and 12 months after TIPS and this was confirmed by total potassium counting (BCMTBP before TIPS: 18.8 (10.6-26.7) vs. 22.4 (12.9-28.5) kg at 6 months; P<0.01). Hypermetabolism persisted throughout the study period. Energy and protein intake increased significantly by 26 and 33%. CONCLUSIONS: An increase of prognostically relevant variables body cell and muscle mass contributes to the weight gain after TIPS in malnourished patients with cirrhosis and hypermetabolism.

Prevalence of malnutrition in hospitalized medical patients: impact of underlying disease.

BACKGROUND/AIMS: Malnutrition is common among hospitalized patients. We investigated whether certain diseases predispose more frequently for malnutrition than others. METHODS: Nutritional state was assessed by clinical scores, anthropometry and bioimpedance analysis in 502 consecutively admitted patients in the departments of internal medicine in two hospitals in Berlin (n = 300, university hospital; n = 202, district hospital). The prevalence of malnutrition was compared in patient groups with a different diagnosis. RESULTS: Malnutrition was present in 24.2% of all patients. A clear association between diagnoses and malnutrition was found: the prevalence of malnutrition was significantly higher in malignant than in non-malignant diseases (50.9 vs. 21.0%, p < 0.0001). High prevalence rates >30% were observed in subgroups of patients with inflammatory bowel diseases, chronic heart failure and benign lung diseases. Patients with gastrointestinal diseases, however, were not more frequently malnourished than other medical patients (28.8 vs. 22.0%). Malnourished patients were significantly older (70.0 +/- 13.6 vs. 58.3 +/- 15.6 years, p < 0.0001) and had a 40% longer hospital stay (13.1 +/- 8.1 vs. 9.3 +/- 6.8 days, p < 0.0001) than well-nourished patients. CONCLUSIONS: Patients with malignancies, inflammatory bowel disease, chronic heart failure and benign lung diseases need special attention due to the high prevalence of malnutrition.