RESUMO
Research indicates that a large percentage of hospitalised patients in the United States and England suffer from protein energy malnutrition (P.E.M.) but this condition is usually undiagnosed. The study aimed to investigate the situation at a rural Jamaican hospital by firstly determining the nutritional status of the patients and secondly, assessing the awareness of the doctors of nutrition, in the management of their patients. The sample comprised 297 patients (108 medical, 90 surgical and 99 paediatric) consecutively admitted to the hospital during the three month study period. The investigator assessed the nutritional status using four standard anthropometric measurements viz:- weight, height, mid upper arm circumference (M.U.A.C.) and triceps skinfold thickness (T.S.F.) within twenty-four hours of admission. In addition, the patients' hospital notes were examined and records made of the nutritional management requested for each patient. Signs and symptons suggestive of malnutrition and biochemical analyses carried out or requested, were also recorded. These were used as an indication of the awareness of nutrition on the part of the attending physician. Of the 207 patients on whom anthropometric measurements were taken, 51 (38percent) adult patients from the medical and surgical wards, and 32 (43 percent) of the paediatric cases, were wasted to some degree. In addition, 25 (42 percent) of the paediatric patients measured were underweight and 8 of the adult patients were overweight. Of the 19 cases of obesity found among the adults, 15 were females. Triceps skinfold thickness were especially low among the adult population, 100 (72 percent ) having values below 60 percent of the reference used. Arm muscle circumference were high for those patients. Five of the moderate to severely malnourished adults (those under 80 percent weight for height) suffered from neoplastic diseases. Apart from this, malnutrition was not related to any specific diagnostic category. Signs and symptoms suggestive of malnutrition were infrequently mentioned in the patients' physical examination notes. A quarter of the adult patients were examined for oedema (mostly from the medical wards) while paediatric patients were checked for diarrhoea (28 percent ), vomiting (38 percent ) and dehydration (32 percent ). While pallor was examined for on all three wards to the same extent (42 percent ), anorexia was mentioned only in the dockets of nine patients. Thirty-eight (11 percent ) patients had no diet prescribed in their hospital notes. Generally, dietary prescription was based primarily on the patients' diagnosis but age and physical condition were also considered. Prescribed diets were usually appropriate for the patients in terms of the recorded diagnoses. However, with respect to nutritional status as derived from the study, the diets were incorrect in several cases. No diets were prescribed for the nutritional rehabilitation of malnourished patients. This study suggests that although P.E.M. is common in hospitalised patients, inadequate attention is paid to nutritional status in patient management (AU)
