Measured versus estimated energy requirement in hospitalized patients.

BACKGROUND & AIM: Failure to identify a patient's energy requirement has a variety of consequences both physiological and economical. Previous studies have shown that predictive formulas, including the Harris Benedict equation (HB), both over- and underestimates energy requirement in severely ill patients and healthy younger adults, compared to the golden standard, indirect calorimetry (IC). The comparison between measured and estimated energy requirements in hospitalized patients in regular wards is underreported. The aim of this study was to assess the agreement between measured energy requirements and requirements estimated by HB in the individual hospitalized patients, and to investigate whether those findings were associated with other specific patient characteristics. METHODS: IC (n = 86) was used to measure resting energy expenditure (REE) and bioimpedance analysis (BIA) (n = 67) was used for body composition in patients admitted to Aalborg University Hospital. Furthermore, height, weight, body mass index, calf circumference, while information regarding hospital ward, vital values, dieticians estimated energy requirements and blood samples were collected in the patients' electronic medical records. Bland-Altman plots, multiple linear regression analysis, and Chi2 tests were performed. RESULTS: On average a difference between IC compared with the HB (6.2%), dietitians' estimation (7.8%) and BIA (4.50%) was observed (p < 0.05). Association between REE and skeletal muscle mass (SMM) (R2 = 0.58, ß = 149.0 kJ), body fat mass (BFM) (R2 = 0.51, ß = 59.1 kJ), and weight (R2 = 0.62, ß = 45.6 kJ) were found (p < 0.05). A positive association between measured REE and HB were found in the following variables (p < 0.05): CRP, age, surgical patients, and respiratory rate. CONCLUSION: This study found a general underestimation of estimated energy expenditure compared to measured REE. A positive correlation between measured REE and SMM, BRM and weight was found. Lastly, the study found a greater association between CRP, age, surgical patients, and respiratory rate and a general greater than ±10% difference between measured and estimation of energy requirements.

Prevalence of sarcopenia in patients with chronic intestinal failure-how are SARC-F and the EWGSOP algorithm associated before and after a physical exercise intervention.

INTRODUCTION: Patients with chronic intestinal failure (IF) have a low degree of physical activity, decreased muscle mass, and decreased muscle strength, leading to a high risk of sarcopenia. We aimed to test the prevalence of sarcopenia by the use of SARC-F and EWGSOP and to investigate the association between the two at baseline and after 12 weeks of an exercise intervention. METHODS: Thirty-one patients with chronic IF completed 12 weeks of three weekly home-based individualized exercise sessions. Body composition was measured by bioimpedance analysis and physical function by handgrip strength (HGS) and timed up-and-go (TUG). Sarcopenia was assessed by SARC-F and EWGSOP. Multiple regression analysis was used to test for the association between the two tools. RESULTS: The prevalence of sarcopenia measured by EWGSOP was 59%. This prevalence did not change after the intervention. At baseline, 38.8% of patients were screened as at risk for sarcopenia by SARC-F. This decreased to 29.0% after the intervention (P < 0.001). A statistically significant increase was achieved in muscle mass (P = 0.017) and muscle mass index (P = 0.016). Furthermore, both TUG (P = 0.033) and HGS (P = 0.019) improved. CONCLUSIONS: Sarcopenia is prevalent in patients with chronic IF. EWGSOP finds more patients to be at risk of sarcopenia than SARC-F but was not sufficiently sensitive to measure changes induced by the physical intervention. The significant change in SARC-F may illustrate that patients, themselves, find an improvement in self-perceived health.

Chronic obstructive pulmonary disease outpatients bear risks of both unplanned weight loss and obesity.

BACKGROUND & AIMS: Malnutrition is commonly seen in chronic obstructive pulmonary disease (COPD) and has been associated with negative outcomes. The objective of this study was to examine unintended weight loss (UWL) within three months, as a primary indicator for disease related malnutrition among COPD outpatients, to evaluate the prevalence of UWL, and to identify possible characteristics for UWL. METHODS: A cross-sectional study including a patient questionnaire and medical record data extraction was made with all patients visiting a Danish COPD outpatient clinic. RESULTS: Among the 200 included patients (68.7 ± 11.2 years of age), UWL was seen in 21.5%, with a median weight loss of 3.5 (2-16) kg. Underweight (BMI<18.5 kg/m2) was recognized in 13.5%, while 34.5% were obese (BMI>30 kg/m2). Reduced food intake (RFI) within the past week was experienced among 22.0% of the patients. The most common nutrition impact symptoms (NIS) were shortness of breath, reduced appetite and nausea. NIS, RFI and BMI<18.5 kg/m2 were associated to UWL, while co-morbidities, hospitalization within three months and resent exacerbations showed no association to UWL. CONCLUSIONS: A high prevalence of UWL was found in COPD outpatients, and NIS and RFI as characteristics associated with UWL. Shortness of breath, reduced appetite and nausea were the most common NIS. This study found 13.5% of patients underweight, 23.5 overweight and 34.5% obese. Underweight as well as obesity may have negative consequences for the patient and the community.

Malnutrition measured by unintended weight loss among patients in general practice.

OBJECTIVE: Disease-related malnutrition should be managed before negative consequences occur. The aim of this study was to investigate the prevalence of unintended weight loss and reduced food intake among patients ≥18 y of age attending a general practice. METHODS: All patients visiting five general practices in Denmark, for 4 d in each place, were invited to participate in this questionnaire-based cross-sectional study. The questionnaire consisted of eight questions including unintended weight loss within the previous 2 mo, reduced food intake within the previous week, and symptoms that affected nutrition. Descriptive statistics, χ2 tests, and simple and multivariable logistic regression analysis were performed. The study included 1087 patients with an 88.7% response rate. RESULTS: Unintended weight loss was found in 14.2% and 12.9% had reduced food intake. Of the patients with unintended weight loss, 62.3% also had reduced food intake. Patients 18 to 39 and >80 y of age; underweight patients; and patients visiting general practice for chronic pain, mental discomfort, and suspicion of serious illness had significantly higher odds for unintended weight loss and reduced food intake. Patients with reduced food intake had higher odds for unintended weight loss, and those visiting the general practice due to fatigue had higher odds for reduced food intake. Patients in obesity class 1 to 3 and patients who had come for a general health checkup had lower odds. Patients visiting for follow-up on chronic physical illness had higher odds of having unintended weight loss and reduced food intake combined. CONCLUSION: Overall, 14.2% of the patients had unintended weight loss, 12.9% had reduced food intake, and 62.3% had both, indicating a high prevalence of unintended weight loss among patients in general practice. Unintended weight loss seems relevant and feasible to use as an initial indicator for the need for further nutritional screening in general practice. Studies are needed to investigate the effect of interventions and outcomes.

Healthcare professionals' experiences with practice for managing disease-related malnutrition in general practice and proposals for improvement: A qualitative study.

BACKGROUND & AIM: Disease-related malnutrition is prevalent in all healthcare settings, including general practice, and is associated with negative consequences for the individual and the community. The aim of this study was to investigate general practitioners and general practice nurses' perceptions of how they manage disease-related malnutrition, and their view on introducing an early intervention against disease-related malnutrition. METHODS: Content analysis was used to analyse individual semi-structured interviews with the general practitioners (n = 9) and five focus group interviews with the general practice nurses (n = 21) from five general practices in Denmark. RESULTS: General practice has no tradition for detection of disease-related malnutrition and find that they rarely see patients with unintended weight loss. Nutritional guidance is to a low degree and only randomly performed. Furthermore, most of the health professionals do not have access to nutritional guidance material for patients and lack information about patients' nutrition, when patients when patients receive treatment in the hospital. Suggestions for improvement were handouts with pictures and including nutritional status as a standard in the communication from hospital to general practice. An early intervention against unintended weight loss in specific groups was found feasible. Barriers and facilitators were seen as lack of time, lack of educational opportunities and skills. A financial incentive from the health authorities, and interventions adapted to the individual general practice were among suggested facilitators. CONCLUSION: Disease-related malnutrition was rarely recognised and managed in general practice. The health professionals found they lacked means to perform nutritional guidance to patients with unintended weight loss. However, the health professionals had suggestions for improvement for an early intervention including handouts for patients. Further research on implementation of early intervention against unintended weight loss in general practice is needed.

Personalized exercise intervention in HPN patients - A feasibility study.

BACKGROUND: Physical health status may be predictive of readmissions, psychological health and mortality in patients with short bowel syndrome. AIMS: This study aimed to investigate the feasibility and effect of an individualized exercise intervention and secondary, oral nutrition intake counseling on Timed-Up-and-Go (TUG) and 30 s Chair Stand Test (CST) as well as body-composition and EuroQol (EQ)-5D-5L, in patients with chronic intestinal failure (IF) type III receiving HPN and/or fluid therapy. METHODS: A 12-week individualized exercise intervention consisting on three weekly home based sessions, and nutrition counselling focusing on protein intake and reducing high stoma output, was performed. Weekly follow-up by phone was done on motivation to exercise. RESULTS: The study invited 71 patients, 44 accepted the invitation (62%), 37(52%) were included, and 31 (84%) completed the intervention. The exercise intervention was well tolerated. TUG improved from 8.9(SD 5.5) to 7.7(SD 3.8) (p = 0.033). CST improved by four repetitions (<0.001∗). A statistical, however not clinically relevant improvement was seen in muscle mass. No improvement was seen in (EQ)-5D-5L total, but insignificantly (p = 0.055) for physical function only. Protein intake improved by 10.6 g/day (p = 0.008). CONCLUSIONS: A 12 weeks individualized exercise intervention showed very feasible and beneficial in HPN patients. Physical function improved statistically and clinically, and oral protein intake improved. QoL overall did not improve, however COVID-19 was an uninvited partner throughout the study period, which may have influenced general QoL. As only 62% accepted the invitation to participate, home based exercise intervention may not apply to all patients.