RESUMO
PURPOSE OF REVIEW: Malnutrition affects prognosis in many groups of patients. Although screening tools are available to identify adults at risk for poor nutritional status, a need exists to improve the assessment of malnutrition by identifying the loss of functional tissues that can lead to frailty, compromised physical function, and increased risk of morbidity and mortality, particularly among hospitalized and ill patients and older adults. Bioimpedance analysis (BIA) offers a practical approach to identify malnutrition and prognosis by assessing whole-body cell membrane quality and depicting fluid distribution for an individual. RECENT FINDINGS: Two novel applications of BIA afford opportunities to safely, rapidly, and noninvasively assess nutritional status and prognosis. One method utilizes single-frequency phase-sensitive measurements to determine phase angle, evaluate nutritional status, and relate it to prognosis, mortality, and functional outcomes. Another approach uses the ratio of multifrequency impedance values to indicate altered fluid distribution and predict prognosis. SUMMARY: Use of basic BIA measurements, independent of use of regression prediction models and assumptions of constant chemical composition of the fat-free body, enables new options for practical assessment and clinical evaluation of impaired nutritional status and prognosis among hospitalized patients and elders that potentially can contribute to improved patient care and clinical outcomes. However, these novel applications have some technical and physiological limitations that should be considered.
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Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estado Terminal , Fenômenos Fisiológicos da Nutrição do Idoso , Impedância Elétrica , Avaliação Geriátrica , Humanos , Desnutrição/complicações , Pessoa de Meia-Idade , Neoplasias/complicações , PrognósticoRESUMO
OBJECTIVE: Critically ill children with acute kidney injury (AKI) are at high risk of underfeeding. Newer guidelines for nutrition support recommend higher protein intake. Therefore, the study evaluated the effects of protein feeding on the resolution of AKI and compared energy and protein intake in patients with and without AKI after implementation of Nutrition Support guidelines. DESIGN: Retrospective study. SUBJECTS: Five hundred twenty critically ill children from October 2012 to June 2013 and October to December 2013. MAIN OUTCOME MEASURE: Energy and protein intake in patients with no AKI, resolved, or persistent AKI. Energy and protein intake was documented for days 1-8 of Pediatric Intensive Care Unit stay and in the postimplementation versus preimplementation period of nutrition support guidelines. AKI was defined by modified pRIFLE. Persistent AKI was defined as patients who did not resolve their AKI during the study period. RESULTS: A higher percentage of patients with resolved and persistent AKI met ≥ 80% of protein needs versus no AKI. After adjustment for Pediatric Risk of Mortality Score, the odds ratio for protein intake of ≥ 80% compared to <80% of estimated protein needs was not significant, which suggests that higher protein intake was not associated with nonresolution of AKI. There were significant improvements in the cumulative protein gap in patients with no AKI in the postimplementation (-1.0 [-1.7 to -0.6] g/kg/day) compared to preimplementation period (-1.3 [-1.7 to -0.9] g/kg/day, P = .001) and persistent AKI in the postimplementation (-0.8 [-1.4 to -0.1] g/kg/day) compared to preimplementation (-1.3 [-1.7 to -0.9] g/kg/day, P = .03). CONCLUSIONS: Higher protein intake was not associated with a delay in renal recovery in patients with AKI after adjustment for severity of illness. Protein intake was improved in critically ill children with no AKI, resolved, and persistent AKI after implementation of Nutrition Support Guidelines, but underfeeding persisted in these patients.
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Injúria Renal Aguda/terapia , Proteínas Alimentares/administração & dosagem , Desnutrição/terapia , Apoio Nutricional/métodos , Injúria Renal Aguda/complicações , Adolescente , Criança , Pré-Escolar , Estado Terminal , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Rim/fisiopatologia , Masculino , Desnutrição/diagnóstico , Desnutrição/etiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: low fat-free mass has been related to high mortality in patients. This study evaluated the relationship between body composition of healthy elderly subjects and mortality. METHODS: in 1999, 203 older subjects underwent measurements of body composition by bioelectrical impedance analysis, Charlson co-morbidity index and estimation of energy expenditure through physical activity by a validated questionnaire. These measurements were repeated in 2002, 2005 and 2008 in all consenting subjects. Mortality data between 1999 and 2010 were retrieved from the local death registers. The relationship between mortality and the last indexes of fat and fat-free masses was analysed by multiple Cox regression models. RESULTS: women's and men's data at last follow-up were: age 81.1 ± 5.9 and 80.9 ± 5.8 years, body mass index 25.3 ± 4.6 and 26.1 ± 3.4 kg/m(2), fat-free mass index 16.4 ± 1.8 and 19.3 ± 1.9 kg/m(2) and fat mass index 9.0 ± 3.2 and 6.8 ± 2.0 kg/m(2). Fifty-eight subjects died between 1999 and 2010. The fat-free mass index (hazard ratio 0.77; 95% confidence interval 0.63-0.95) but not the fat mass index, predicted mortality in addition to sex and Charlson index. The multiple Cox regression model explained 31% of the variance of mortality. CONCLUSION: a low fat-free mass index is an independent risk factor of mortality in elderly subjects, healthy at the time of body composition measurement.
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Envelhecimento/fisiologia , Composição Corporal , Índice de Massa Corporal , Mortalidade , Atividade Motora/fisiologia , Idoso , Idoso de 80 Anos ou mais , Impedância Elétrica , Feminino , Humanos , Estudos Longitudinais , Masculino , Modelos de Riscos Proporcionais , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: H1N1 influenza with coinfections has been implicated to have high morbidity and mortality. We hypothesized that critically ill children with 2009 H1N1 and coinfections are at a higher risk of developing disseminated intravascular coagulation. DESIGN: The chart review included demographics, length-of-stay, severity of illness score (Pediatric Risk of Mortality III acute physiology score), clinical laboratories, and outcomes at hospital day 90 data. Patients were classified as having methicillin-sensitive or -resistant Staphylococcus aureus, other, or no coinfections. SETTING: Single-center pediatric intensive care unit. PATIENTS: Sixty-six consecutive patients with 2009 H1N1 and influenza A infection. INTERVENTIONS: None. MAIN RESULTS: : There were 12, 22, and 32 patients with methicillin-sensitive or -resistant Staphylococcus aureus, other, and no coinfections, respectively. Pediatric critical care unit length-of-stay was 11, 10, and 5.5 days (median), and survival at day 90 was 83%, 96%, and 91% in patients with methicillin-sensitive or -resistant Staphylococcus aureus, other, and no coinfections. Patients with methicillin-sensitive or -resistant Staphylococcus aureus coinfections compared to patients with other, and no coinfections had higher Pediatric Risk of Mortality III acute physiology scores (14 [6-25] vs. 7 [2-10], p = .052 and 6 [2.5-10], p = .008; median [interquartile range]), higher D-dimer (16.1 [7.9-19.3] vs. 1.6 [1.1-4], p = .02 and 2.3 [0.8-8.7] µg/mL, p = .05), longer prothrombin time (19.3 [15.4-25.9] vs. 15.3 [14.8-17.1], p = .04 and 16.6 [14.7-20.4] secs, p < .39) at admission, and lower day-7 platelet counts (90K [26-161K] vs. 277K [98-314], p = .03 and 256K [152-339]/mm, p < .07). Patients with methicillin-sensitive or -resistant Staphylococcus aureus coinfections compared to patients without coinfections were more likely to be sicker with Pediatric Risk of Mortality III acute physiology score >10 vs. <10 (relative risk 2.4; 95% confidence interval 1.2-4.7; p = .035) and have overt disseminated intravascular coagulation (relative risk 4.4; 95% confidence interval 1.3-15.8, p = .025). CONCLUSIONS: During the 2009-2010 H1N1 pandemic, pediatric patients with influenza A and methicillin-sensitive or -resistant Staphylococcus aureus coinfections were sicker and more likely to develop disseminated intravascular coagulation than patients with other or no coinfections.
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Transtornos da Coagulação Sanguínea/microbiologia , Coinfecção/complicações , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus , Transtornos da Coagulação Sanguínea/patologia , Criança , Pré-Escolar , Estado Terminal , Feminino , Humanos , Lactente , Influenza Humana/microbiologia , Unidades de Terapia Intensiva Pediátrica , Masculino , Auditoria Médica , Medição de Risco , Índice de Gravidade de DoençaRESUMO
INTRODUCTION: This population study aimed to test the sensitivity and specificity of nutritional risk index (NRI), malnutrition universal screening tool (MUST) and nutritional risk screening tool 2002 (NRS-2002) compared to subjective global assessment (SGA) and to evaluate the association between nutritional risk determined by these screening tools and length of hospital stay (LOS). METHODS: Patients (n=995) were assessed at hospital admission by four screening tools (SGA, NRI, MUST and NRS-2002). Sensitivity, specificity and predictive values were calculated to evaluate NRI, MUST and NRS-2002 compared to SGA. Multiple logistic regressions, adjusted for age, were used to estimate odds ratios (OR) and confidence interval (CI) for medium and high, compared to low risk in patients hospitalized >11, compared to 1-10 days LOS. RESULTS: The sensitivity was 62%, 61% and 43% and specificity was 93%, 76% and 89% with the NRS-2002, MUST and NRI, respectively. NRS-2002 had higher positive (85%) and negative predictive values (79%) than the MUST (65% and 76%) or NRI (76% and 66%, respectively). Patients who were severely malnourished or at high nutritional risk by SGA (OR 2.4, CI 1.5-3.9), MUST (OR 3.1, CI 2.1-4.7) and NRS-2002 (OR 2.9, CI 1.7-4.9) were significantly more likely to be hospitalized >11 days, compared to 1-10 days, than patients assessed as low risk. CONCLUSION: NRS-2002 had higher sensitivity and specificity than the MUST and NRI, compared to SGA. There was a significant association between LOS and nutritional status and risk by SGA, NRS-2002, MUST and NRI. Nutritional status and risk can be assessed by SGA, NRS-2002 and MUST in patients at hospital admission.
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Testes Diagnósticos de Rotina/métodos , Avaliação Nutricional , Antropometria , Humanos , Tempo de Internação , Desnutrição/diagnóstico , Razão de Chances , Medição de Risco , Sensibilidade e Especificidade , Inquéritos e Questionários , Redução de PesoRESUMO
BACKGROUND AND AIMS: Weight measured by dual-energy X-ray (DXA) was shown to be increasingly underestimated in subjects over 75 kg compared to an electronic scale. This study compares body weight and composition measured by balance beam scale and three DXA acquisition modes in obese subjects. METHODS: In 39 obese, body weight was measured by balance beam scale, and body weight and composition by DXA Hologic QDR4500A in normal (NPM) and high power mode (HPM) (Enhanced v8.26 and v8.26* software) and DXA GE-Lunar Prodigy (v6.5 software). To ensure linearity of body weight and composition measured by the different DXA acquisitions, we also measured 13 women with a body mass index (BMI) of 25-30 kg/m(2). RESULTS: While QDR4500A HPM overestimates scale weight by about 2 kg over the whole BMI spectrum, QDR4500A NPM underestimates scale weight as a weight-dependent response (-1.7+/-1.8 kg overall, -4.1+/-1.6 kg in morbidly obese women). These results suggest switching from one mode to the other at a specific threshold, i.e. in our study a weight of 90 kg or a BMI of 34 kg/m(2). Prodigy gives weight about similar to scale (+0.5+/-0.8 kg). Both Hologic acquisition modes underestimate fat mass but overestimate lean body mass compared to Prodigy. CONCLUSIONS: The QDR4500A NPM is inappropriate in women over 90 kg. Unfortunately, the QDR4500A HPM overestimates body weight in the range of 90-150 kg. The difference between scale and Prodigy weight remains stable throughout weight ranges. To better assess their accuracies in terms of body composition, QDR4500A NPM, HPM and Prodigy should be tested against phantoms or in vivo multi-compartment models.
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Absorciometria de Fóton/instrumentação , Absorciometria de Fóton/métodos , Composição Corporal , Peso Corporal , Obesidade/fisiopatologia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
BACKGROUND & AIMS: Enteral nutrition (EN) is the preferred method of nutrition support in hospitalized patients but only 50-90% of the required calories are actually delivered. In order to identify where our nutrition support team (NST) should focus its activity, we prospectively evaluated the level of coverage of energy and protein needs during the first 5 days of EN in intensive care unit (ICU) and non-ICU patients and the relationship of energy and protein coverage with serum albumin, transthryretin, insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP). METHODS: Subjects (n=183) who required nutrition support and received EN were prospectively recruited. Calorie prescription was 20 and 25, 25 and 30 kcal/kg BW for women and men 60 years and <60 years, respectively. Protein needs were estimated as 1.2g protein/kg BW. Logistic regression analysis was used to estimate odds ratios (OR) for energy and protein delivery 66.6% and <66.6% and albumin, transthryretin, IGF-1 (low vs. normal) and CRP (high vs. normal) in ventilated vs. non-ventilated patients. RESULTS: Significantly more mechanically ventilated than non-ventilated patients received <66.6% of energy (71% vs. 48%) and protein (96% vs. 65%). The ventilated patients were more likely to be energy (OR 2.1, CI 1.1-4.0) and protein (OR 15.7, CI 4.9-50.8) underfed than non-ventilated patients. There was a significant association on day 5 between low protein delivery and low albumin (OR 2.9, CI 1.3-6.5), low transthyretin (OR 3.0, CI 1.4-6.5), low IGF-1 (OR 2.8, CI 1.2-6.7) and high CRP (OR 3.5, CI 1.6-7.8). CONCLUSIONS: The energy and protein needs of hospitalized patients are not met during the first 5 days of EN. Ventilated patients are more likely to be energy and protein underfed than non-ventilated patients and to have low plasma protein level. These findings support our decision to intensify EN monitoring by our NST in ventilated patients to optimize their nutritional coverage.
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Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Nutrição Enteral/normas , Necessidades Nutricionais , Respiração Artificial , Idoso , Proteína C-Reativa/metabolismo , Intervalos de Confiança , Feminino , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pré-Albumina/metabolismo , Estudos Prospectivos , Fatores de Risco , Albumina Sérica/metabolismoRESUMO
STUDY OBJECTIVE: To evaluate the contribution of body composition measurements to clinical assessment in patients on home nasal positive-pressure ventilation for chronic hypercapnic respiratory failure (CHRF), and their relationship to respiratory impairment. METHODS: Patients with CHRF (restrictive lung disease (RLD), n=37; chronic obstructive pulmonary disease (COPD), n=19), during elective yearly evaluations underwent pulmonary function testing (forced expiratory volumes, arterial blood gases, maximal inspiratory and expiratory pressure (PI(max) or PE(max))), and bioelectrical impedance analysis to determine fat-free mass (FFM) index (kg/m(2)) and body fat mass index. RESULTS: When compared with age- and sex-matched healthy controls, RLD patients (OR 5.5, CI 1.9-15.6, P<0.002) and COPD (OR 5.2, CI 1.1-24.9, P=0.04) were significantly more likely to have a low FFM index. Roughly one-half of patients with RLD and one-third with COPD had abnormally low FFM index. Estimation of nutritional status by body mass index (BMI) alone clearly underestimated the prevalence of FFM index depletion. Muscle mass assessed by FFM index explained 26% of variance of PI(max) (P<0.001) and 27% of that of PE(max) (P<0.001). CONCLUSION: BMI alone clearly underestimated FFM depletion, and presence of a very high body fat mass index. Indeed, normal or high BMI can be associated with FFM depletion. Because of its relationship to respiratory muscle strength, an assessment of FFM appears to be valuable in CHRF.
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Composição Corporal/fisiologia , Hipercapnia/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva/métodos , Capacidade Vital/fisiologiaRESUMO
OBJECTIVE: Weight changes result in fat-free mass (FFM) and body fat (BF) changes. This study determined FFM and BF changes after weight gain or loss and whether these changes differ by gender, physical activity, and age. METHODS: Healthy volunteers, recruited between 1991 and 2003, were followed for 1 y (n = 400) or 3 y (n = 305). Active subjects performed >3 h of physical activity of > or =4.0 metabolic equivalents/wk, sedentary subjects performed <3 h/wk. Body weight and body composition by bioelectrical impedance analysis were determined at year 0, 1, or 3. RESULTS: At years 1 and 3, FFM and BF decreased with weight loss and increased with weight gain. BF was more sensitive (P < 0.03) to weight change than FFM. Compared to weight-stable individuals at year 1, weight gains of 1.0-1.9, 2.0-2.9, and > or =3.0 kg changed FFM by -0.04 (P = 0.90), +0.48 (P = 0.15), and +1.39 kg and BF by +1.35, +1.87, and +3.09 kg, respectively (all P < 0.001). Comparable FFM and BF decreases were observed for weight losses (FFM -0.28 kg, P = 0.38; -0.75 kg, P = 0.04; -1.51 kg, P < 0.001; BF -1.01 kg, P < 0.01; -1.55 kg, P = 0.01; -3.13 kg, P < 0.001). These relations were similar across gender and age strata. At year 1, active individuals were less likely to gain BF with weight gain and more likely to lose BF with weight loss than were sedentary individuals, except for weight losses >3 kg. At year 3, the association between body weight and FFM and BF change was similar between active and sedentary individuals. CONCLUSION: Greater weight changes (>3 kg) are necessary for weight change to have a significant effect on FFM than to have an effect on BF.
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Tecido Adiposo/metabolismo , Composição Corporal/fisiologia , Peso Corporal/fisiologia , Exercício Físico/fisiologia , Músculo Esquelético/metabolismo , Adulto , Idoso , Envelhecimento/fisiologia , Impedância Elétrica , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Redução de PesoRESUMO
BACKGROUND: Critically ill children are at risk of developing malnutrition, and undernutrition is a risk factor for morbidity and mortality. OBJECTIVE: The study evaluated changes in the energy and protein intake before and after implementation of nutrition support (NS) guidelines for a pediatric critical care unit (PICU). DESIGN: This retrospective study documented energy and protein intake for the first 8 days of PICU stay. Basal metabolic rate and protein needs were estimated by Schofield and American Society for Parenteral and Enteral Nutrition Guidelines, respectively. PARTICIPANTS/SETTING: Three hundred thirty-five children from August to December 2012 (pre-implementation) and 185 from October to December 2013 (post-implementation). INTERVENTION: Implementation of NS Guidelines. MAIN OUTCOME MEASURES: Changes in actual energy and protein intake in the post- compared with the pre-Implementation period. STATISTICAL ANALYSIS PERFORMED: Unpaired t tests, Pearson's χ(2) (unadjusted analysis) were used. Logistic regressions were used to estimate odds ratios and 95% confidence intervals for protein and energy intake, adjusted for age, sex, and Pediatric Risk of Mortality score. RESULTS: After the implementation of guidelines, significant improvements were seen during days 5 through 8 in energy intake among children 2 years of age and older, and in protein intake in both age groups (P<0.05). For the 8-day period, statistically or clinically significant improvements occurred in the cumulative protein deficit/kg/day, as follows: younger than 2-year-olds, -1.5±0.7 g/kg/day vs -1.3±0.8 g/kg/day, P=0.02; 2-year-olds or older, -1.0±0.6 g/kg/day vs -0.7±0.8 g/kg/day, P=0.01; and for the energy deficit/kg/d in 2-year-olds and older, -17.2±13.6 kcal/kg/day vs -13.3±18.1 kcal/kg/day, unpaired t test, P=0.07, in the pre- vs post-implementation period, respectively. CONCLUSIONS: The implementation of NS guidelines was associated with improvements in total energy in 2-year-olds and older and protein in younger than 2 and 2 years and older children by days 5 through 8, and protein deficits were significantly lower in the post- vs the pre-implementation period. The implementation of NS guidelines may have had a positive effect on improving NS in critically ill children.
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Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Unidades de Terapia Intensiva Pediátrica/normas , Política Nutricional , Apoio Nutricional/métodos , Adolescente , Metabolismo Basal , Criança , Pré-Escolar , Estado Terminal/terapia , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Desnutrição/terapia , Necessidades Nutricionais , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate whether classification of patients as having low, moderate, or high stress based on clinical parameters is associated with plasma levels of stress hormone. DESIGN AND SETTING: Prospective, blinded, observational study in an 18-bed medical ICU. PATIENTS: Eighty-eight consecutive patients. INTERVENTIONS: Patients were classified as low (n=28), moderate (n=33) or high stress (n=27) on days 0 and 3 of ICU stay, based on 1 point for each abnormal parameter: body temperature, heart rate, systemic arterial pressure, respiratory rate, physical agitation, presence of infection and catecholamine administration. The stress categories were: high: 4 points or more, moderate 2-3 points, low 1 point. Plasma growth hormone (GH), insulin-like growth factor 1 (IGF-1), insulin, glucagon, cortisol were measured on days 0 and 3. MEASUREMENTS AND RESULTS: Plasma cortisol and glucagon were significantly higher and IGF-1 lower in high vs. low stress patients on days 0 and 3. High stress patients were more likely to have high cortisol levels (odds ratio 5.8, confidence interval 1.8-18.9), high glucagon (8.7, 2.1-36.1), and low IGF-1 levels (5.9, 1.8-19.0) than low stress patients on day 0. Moderate stress patients were also more likely to have high cortisol and glucagon levels than low stress patients. Insulin and GH did not differ significantly. Results were similar for day 3. CONCLUSIONS: Moderate and severe stress was significantly associated with high catabolic (cortisol, glucagon) and low anabolic (IGF-1) hormone levels. The hormonal stress level in ICU patients can be estimated from simple clinical parameters during routine clinical evaluation.
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Estado Terminal , Hormônios/sangue , Estresse Fisiológico/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Glucagon/sangue , Hormônio do Crescimento/sangue , Humanos , Hidrocortisona/sangue , Insulina/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Método Simples-Cego , Somatomedinas/metabolismo , Estatísticas não Paramétricas , Estresse Fisiológico/sangue , Estresse Fisiológico/classificaçãoRESUMO
BACKGROUND: Reduced lean tissue as well as high fat mass may be independent nutritional risk factors resulting in increased length of hospital stay (LOS). This controlled population study (1707 patients, 1707 volunteers) aimed to evaluate the association between LOS in Geneva and Berlin patients at hospital admission and high fat mass index (FMI, kg/m2) and low fat-free mass index (FFMI, kg/m2), and the respective value of body mass index (BMI) and of FFMI and FMI for nutritional assessment. METHODS: Patients (891 men, 816 women) were prospectively recruited at hospital admission and compared to gender-, age- and height-matched healthy volunteers. Fat-free mass and fat mass, determined at admission by 50 kHz-bioelectrical impedance analysis, were expressed as indices (FFMI and FMI-kg/m2) to normalize for height. Patients were classified in four groups: normal, low FFMI, high FMI, or low FFMI and high FMI. Logistic regressions were used to determine the association between body composition and LOS. RESULTS: Higher FMI and lower FFMI were found in patients at hospital admission than in sex- and age-matched healthy volunteers. Low FFMI, high FMI, and low FFMI/high FMI combined, adjusted for age, were all significantly associated with longer LOS (high FFMI: 1-5 days OR 2.4, CI 2.0-2.9; 6-10 days OR 2.3, CI 1.8-3.0; 11 days OR 2.8, CI 2.2-3.5); low FMI: 1-5 days OR 1.9, CI 1.6-2.2; 6-10 days OR 2.7, CI 2.0-3.5, 11 days OR 2.1, CI 1.7-2.7; low FFMI/high FMI: 1-5 days OR 7.8, CI 5.3-11.4; 6-10 days OR 13.6, CI 7.8-23.5, 11 days OR 11.8, CI 7.0-19.8). CONCLUSION: Increased LOS is associated with adiposity (high FMI) and low muscle mass (low FFMI). The current study shows that both depletion of lean tissue and excess of fat mass negatively affect the LOS. Finally, we found that excess fat mass reduces the sensitivity of BMI to detect nutritional depletion.
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Tecido Adiposo , Composição Corporal/fisiologia , Tempo de Internação , Distúrbios Nutricionais/complicações , Obesidade/complicações , Tecido Adiposo/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria , Índice de Massa Corporal , Estudos de Casos e Controles , Impedância Elétrica , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiologia , Avaliação Nutricional , Razão de Chances , Estudos ProspectivosRESUMO
BACKGROUND: Progressive nutritional depletion has been reported during hospital stay. This prospective study compared the proportion of nutritional risk at hospital admission in three European countries and further evaluated nutritional risk at late versus early phase of hospitalization in one hospital. METHODS: Nutritional risk was determined in Geneva, Switzerland (n = 652), Berlin, Germany (n = 621) and Nice, France (n = 107) at hospital admission, and during hospital stay (0-100 d) in Nice (n = 527) by the Nutritional Risk Index (NRI) = (1.519 x serum albumin, g/l)+41.7 x (present weight/usual weight). NRI score of >100: no risk (NR); 97.5-100: mild risk; 83.5-97.5: moderate risk (MR); 83.5: severe risk (SR). Logistic regressions were used to determine the odds ratios (OR) between MR or SR and length of hospital stay (LOS) 16d compared to 1-15 d or nutritional assessment at 16-100 d compared to 1-15 d of hospitalization. RESULTS: Patients, assessed at hospital admission, who were hospitalized >16d were more likely (P < 0.001) to be at MR (OR 2.0, CI 1.4-3.0) or SR (OR 3.3, CI 1.7-6.2) than patients hospitalized 1-15 d. Nice patients assessed at 16-100 d were more likely (P < 0.001) to be at MR (OR 5.4, CI 2.1-14.3) and SR (OR 14.7, CI 5.4-40.0) than patients assessed at 1-15 d of hospitalization. CONCLUSIONS: The risk of MR or SR by NRI was greater in patients assessed during hospitalization than in patients assessed at hospital admission, which suggests that patients evaluated later during hospitalization are at greater risk than patients evaluated in the early phase of hospitalization. Ongoing assessment during hospitalization seems important to identify patients who are at increased risk for complications.
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Peso Corporal/fisiologia , Hospitalização , Tempo de Internação , Medição de Risco , Albumina Sérica/análise , Análise de Variância , Intervalos de Confiança , Feminino , França , Alemanha , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , SuíçaRESUMO
OBJECTIVE: No current studies have compared North American with European body composition parameters, i.e., fat-free mass (FFM), body fat (BF), and percentage of BF (%BF) in large populations. This study compared FFM, BF, and %BF values derived from two bioelectrical impedance analysis (BIA) equations (Geneva and National Health and Nutrition Examination Survey [NHANES]) in Swiss subjects and compared FFM, BF, and %BF values of white Swiss with those of white North American adults with the same BIA equations. METHODS: Healthy adults (3714 men and 3199 women), ages 20 to 79 y, in Switzerland were measured by single-frequency BIA and compared with means and standard deviations for body mass index and body composition parameters obtained from the NHANES III study (United States; n = 2538 men, 2862 women). FFM was calculated with the Geneva and NHANES equations. RESULTS: Mean FFMGENEVA values did not differ from FFMNHANES values in men but was significantly lower (-1.5 kg) in women. FFM and BF values in American men, who weighed 4.2 to 12.0 kg more than the Swiss men, were significantly higher (+2.1 to +6.0 kg and +1.5 to +6.4 kg, respectively) than those in the Swiss men. FFM and BF values in American women, who weighed 2.3 to 12.1 kg more than the Swiss women, were significantly higher (+1.3 to +2.1 kg and +4.8 to +11.8 kg, respectively, except FFM in subjects ages 20 to 29 y and BF in those ages 70 to 79 y) than FFMGENEVA values in Swiss women. FFM in American women was significantly lower (+1.3 and +1.9 kg) and non-significantly higher than FFMNHANES in Swiss women. CONCLUSION: NHANES and Geneva BIA equations estimate body composition equally well in men, but further research is necessary to determine the discrepancies in FFM between BIA equations in women. The greater weight of the American subjects yielded higher values for FFM, BF, and %BF in American than in Swiss men and women.
Assuntos
Tecido Adiposo/metabolismo , Composição Corporal/fisiologia , Impedância Elétrica , Músculo Esquelético/metabolismo , Tecido Adiposo/fisiologia , Adulto , Idoso , Antropometria , Índice de Massa Corporal , Feminino , Humanos , Masculino , Matemática , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Inquéritos Nutricionais , Valor Preditivo dos Testes , Distribuição por Sexo , Suíça , Estados UnidosRESUMO
Growth failure is a common problem in many children with chronic diseases. This article is an overview of the most common causes of growth failure/growth retardation that affect children with a number of chronic diseases. We also briefly review the nutrition considerations and treatment goals. Growth failure is multifactorial in children with chronic conditions, including patients with cystic fibrosis, chronic kidney disease, chronic liver disease, congenital heart disease, human immunodeficiency virus, inflammatory bowel disease, short bowel syndrome, and muscular dystrophies. Important contributory factors to growth failure include increased energy needs, increased energy loss, malabsorption, decreased energy intake, anorexia, pain, vomiting, intestinal obstruction, and inflammatory cytokines. Various metabolic and pathologic abnormalities that are characteristic of chronic diseases further lead to significant malnutrition and growth failure. In addition to treating disease-specific abnormalities, treatment should address the energy and protein deficits, including vitamin and mineral supplements to correct deficiencies, correct metabolic and endocrinologic abnormalities, and include long-term monitoring of weight and growth. Individualized, age-appropriate nutrition intervention will minimize the malnutrition and growth failure seen in children with chronic diseases.
Assuntos
Transtornos da Nutrição Infantil/etiologia , Doença Crônica , Insuficiência de Crescimento/etiologia , Transtornos do Crescimento/etiologia , Estado Nutricional , Criança , Crescimento , HumanosRESUMO
BACKGROUND: Low fat-free mass may be an independent risk factor for malnutrition that results in an increased length of hospital stay (LOS). OBJECTIVES: The objectives were to compare differences in fat-free mass and fat mass at hospital admission between patients and healthy control subjects and to determine the association between these differences and the LOS. DESIGN: Patients (525 men, 470 women) were prospectively recruited at hospital admission. Height-corrected fat-free mass and fat mass (fat-free-mass index or fat-mass index; in kg/m2) were determined in patients at admission by bioelectrical impedance analysis and were compared with values for sex-, age-, and height-matched control subjects. Patients were classified as well-nourished, moderately depleted, or severely depleted on the basis of a Subjective Global Assessment questionnaire and a body mass index (in kg/m2) < or > 20. RESULTS: Low fat-free mass was noted in 37% and 55.6% of patients hospitalized 1-2 d and > 12 d, respectively. The odds ratios were significant for fat-free-mass index and were higher in patients with a LOS of > 12 d [men (odds ratio: 5.6; 95% CI: 3.1, 10.4), women (4.4; 2.3, 8.7)] than in those with a LOS of 1-2 d [men (3.3; 2.2, 5.0), women (2.2; 1.6, 3.1)]. Severe nutritional depletion was significantly associated only with a LOS > 12 d. CONCLUSION: Fat-free mass and fat-free-mass index were significantly lower in patients than in control subjects. Because the fat-free-mass index is significantly associated with an increased LOS, provides nutritional assessment information that complements that from a Subjective Global Assessment questionnaire, and is a more sensitive determinant of the association of fat-free mass with LOS than is a weight loss > 10% or a body mass index < 20, it should be used to evaluate nutritional status.
Assuntos
Índice de Massa Corporal , Hospitalização , Tempo de Internação , Desnutrição/metabolismo , Avaliação Nutricional , Tecido Adiposo , Idoso , Estudos de Casos e Controles , Impedância Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de RegressãoRESUMO
BACKGROUND: Both undernutrition and overnutrition can affect the quality of life and survival of patients with pulmonary disease and lead to quantitative and functional alterations of fat-free mass (FFM). This longitudinal study determines the changes in weight, FFM, and body fat before and up to 4 years after lung transplant (LTR). METHODS: Height, weight, and body composition measurements (bioelectrical impedance) were obtained in 37 LTR patients. FFM and body fat were measured before and at 1, 3, 6, 9, 12, 18, 24, 36, and 48 months after LTR. RESULTS: Weight changed by +16.6%, +3.2%, -0.2%, and -3.2% and FFM by +14.0%, +2.5%, -0.3%, and -1.0% during years 1, 2, 3, and 4, respectively. A diagnosis of obliterative bronchiolitis after LTR was associated with loss of body weight, FFM, and body fat, compared with stable weight or gain in weight, FFM, and body fat in obliterative bronchiolitis-negative subjects; 76.2% and 85.7%, and 28% and 38% of men and women, respectively, demonstrated low FFM at 1 month and at 2 years after LTR, respectively. The FFM change was higher (39% of weight) during year 1 than during year 2 (25%) or year 3 (21%). CONCLUSIONS: After LTR, patients gained weight, FFM, and body fat, and two-thirds reached normal levels of FFM by year 2. A weight increase resulted in an FFM increase. Contrary to studies after heart or liver transplantation, our results suggest that despite posttransplant infections and grafts rejection, LTR permits FFM recovery.
Assuntos
Tecido Adiposo/metabolismo , Composição Corporal , Transplante de Pulmão/mortalidade , Adolescente , Adulto , Peso Corporal , Metabolismo Energético , Feminino , Seguimentos , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/mortalidade , Humanos , Estudos Longitudinais , Pneumopatias/mortalidade , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Aptidão Física , Prevalência , Qualidade de Vida , Esteroides/uso terapêutico , Taxa de SobrevidaRESUMO
BACKGROUND & AIM: Regular physical activity prevents or limits weight gain, and gain in body mass index (BMI) and decreases mortality. The aims of the study in healthy adults were to determine the differences in fat-free mass index (FFMI) (kg/m(2)) and body fat mass index (BFMI) between age groups and determine the association between physical activity and FFMI and BFMI. METHODS: Caucasian men (n=3549) and women (n=3184) between 18 and 98 years, were classified as either sedentary or physically active (at least 3h per week at moderate or high-intensity level activity). FFMI and BFMI were measured by 50 kHz bioelectrical impedance analysis. RESULTS: BFMI was significantly higher (P<0.05) in sedentary than physically active subjects and the differences became progressively greater with age. The physically active subjects were significantly less likely to have a low or high FFMI (logistic regression, P<0.001), and a high or very high BFMI (P<0.001), and more likely to have low BFMI (P<0.001) compared to sedentary adults. In contrast with fat-free mass, which was lower in older subjects, the height-normalized FFMI was stable with age until 74 years and lower thereafter. Significantly higher BFMIs were noted in older subjects. CONCLUSION: Physically active subjects are less likely to have low or high FFMI, and high or very high BFMI, and more likely to have low BFMI. In contrast to common claim that fat-free mass decreases with age, we found that FFMI was stable until 74 years. The use of FFMI and BFMI permits comparison of subjects with different heights and age.
Assuntos
Tecido Adiposo , Envelhecimento/fisiologia , Composição Corporal/fisiologia , Exercício Físico/fisiologia , Músculo Esquelético , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estatura , Índice de Massa Corporal , Impedância Elétrica , Feminino , Idoso Fragilizado , Humanos , Masculino , Pessoa de Meia-Idade , Análise de RegressãoRESUMO
The use of bioelectrical impedance analysis (BIA) is widespread both in healthy subjects and patients, but suffers from a lack of standardized method and quality control procedures. BIA allows the determination of the fat-free mass (FFM) and total body water (TBW) in subjects without significant fluid and electrolyte abnormalities, when using appropriate population, age or pathology-specific BIA equations and established procedures. Published BIA equations validated against a reference method in a sufficiently large number of subjects are presented and ranked according to the standard error of the estimate. The determination of changes in body cell mass (BCM), extra cellular (ECW) and intra cellular water (ICW) requires further research using a valid model that guarantees that ECW changes do not corrupt the ICW. The use of segmental-BIA, multifrequency BIA, or bioelectrical spectroscopy in altered hydration states also requires further research. ESPEN guidelines for the clinical use of BIA measurements are described in a paper to appear soon in Clinical Nutrition.