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Energy Intake and In-Hospital Starvation: A Clinically Relevant Relationship

Energy Intake and In-Hospital Starvation: A Clinically Relevant Relationship Abstract Background: Malnutrition is a common finding in the acute-care hospital. Objectives: To assess the adequacy of nutritional intake to individual needs and the effects of the hospitalization on nutritional status, and to identify the reasons for inadequate energy intake. Methods: A total of 286 patients with a mean (±SD) age of 79±6 years (range, 70 to 99 years), consecutively admitted to the geriatrics and internal medicine wards of an acute-care university hospital, underwent multidisciplinary assessment on admission and at discharge and daily dietary data collection. The needed, prescribed, and actual daily energy intake for each individual was measured. Nutritional depletion was diagnosed if midarm circumference decreased by 3.6% or more from admission to discharge. Results: Nutritional depletion occurred in 27% of the patients and correlated with anorexia (86.4% vs 65.5% and 40% in patients whose midarm circumference was unchanged and increased, respectively; P<.001), Mini— Mental State Examination score (21.6±8.3 vs 23±6.9 and 26.5±3.6; P<.05), simplified premorbid Activities of Daily Living score (4.4±2.2 vs 5.1 ±1.8 and 5.0±1.8; P<.03), lymphocyte count (1.32 ±0.63 × 109/L vs 1.62±0.88×109/L and 1.47±0.50×109/L; P<.03), serum albumin level (38±5 g/L vs 40±4 g/L and 39±8 g/L; P<.002), ratio of actual to needed energy intake (56.9%±22.1% vs 69.3%±30.4% and 60.0%±14.1%; P<.01), ratio of actual to prescribed energy intake (50.5%±16.9% vs 60.5%±20.5% and 65.5%±15.7%; P<.001). Patients who consumed less than 40% of the prescribed food complained of anorexia and masticatory inefficiency and were unsatisfied with quality and timing of meals compared with the other patients. Conclusions: In-hospital starvation affects mainly patients with baseline nutritional, functional, and cognitive deficits and is strongly related to the inadequate energy intake.(Arch Intern Med. 1996;156:425-429) References 1. Detsky AS, Baker JP, Mendelson RA, Wolman SL, Wesson DE, Jeejeebhoy KN. Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons . JPEN J Parenter Enteral Nutr. 1984;8:153-159.Crossref 2. Haydock DA, Hill GL. Impaired wound healing in surgical patients with varying degrees of malnutrition . JPEN J Parenter Enteral Nutr. 1986;10:550-554.Crossref 3. Sullivan DH, Walls RC. Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients . J Am Geriatr Soc. 1994;42:471-477. 4. Sullivan DH, Patch GA, Walls RC, Lipschitz DA. Impact of nutritional status on morbidity and mortality in a select population of geriatric patients . Am J Clin Nutr. 1990;51:749-758. 5. Agarwal N, Acevedo F, Leighton LS, Cayten CG, Pitchumoni CS. Predictive ability of various nutritional variables for mortality in elderly people . Am J Clin Nutr. 1988;48:1173-1178. 6. Dwyer JT, Coleman KA, Krall E, et al. Changes in relative weight among institutionalized elderly adults . J Gerontol. 1987;42:246-251.Crossref 7. Hill GL, Pickford I, Young GA, et al. Malnutrition in surgical patients: an unrecognized problem . Lancet. 1977;1:689-692.Crossref 8. Roubenoff R, Roubenoff RA, Preto J, Balke CW. Malnutrition among hospitalized patients: a problem of physician awareness . Arch Intern Med. 1987; 147:1462-1465.Crossref 9. Abbasi AA, Rudman D. Observations on the prevalence of protein-calorie undernutrition in VA nursing homes . J Am Geriatr Soc. 1993;41:117-121. 10. McWhirther JP, Pennington CR. Incidence and recognition of malnutrition in hospital . BMJ. 1994;308:945-948.Crossref 11. Keeler EB, Solomon DH, Beck JC, Mendenhall RC, Kane RL. Effect of patient's age on duration of medical encounters with physicians . Med Care. 1982;20:1101-1108.Crossref 12. Gross JS, Neufeld RR, Libow LS, Gerber I, Rodstein M. Autopsy study of the elderly institutionalized patients . Arch Intern Med. 1988;148:173-178.Crossref 13. Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status . Am J Clin Nutr. 1981;34:2540-2545. 14. Fuller NJ, Jebb SA, Goldberg GR, et al. Interobserver variability in the measurement of body composition . Eur J Clin Nutr. 1991;45:43-49. 15. Sullivan DH, Patch GA, Baden AL, Lipschitz DA. An approach to assessing the reliability of anthropometrics in elderly patients . J Am Geriatr Soc. 1989;37:607-613. 16. Consumer and Food Economics Institute. Composition of Foods: Raw, Processed, Prepared . Washington, DC: US Dept of Agriculture; 1976-1984. Agricultural Handbook No. 8-1 to 8-15. 17. American Society of Hospital Pharmacologists. Drug Product Information File . Burlingame, Calif: American Druggist Blue Book Data Center; 1983. 18. FAO/WHO/UNU. Energy and Protein Requirements: Report of a Joint FAO/ WHO/UNU Expert Committee. Geneva, Switzerland: World Health Organization; 1985. Technical Report Series No. 74. 19. Alpers DH, Clouse RE, Stenson WF. Manual of Nutrition Therapeutics . Boston, Mass: Little Brown & Co Inc; 1985. 20. Tayback M, Kumanyika S, Chee E. Body weight as a risk factor in the elderly . Arch Intern Med. 1990;150:1065-1072.Crossref 21. Mattila K, Haavisto M, Rajala S. Body mass index and mortality in the elderly . BMJ. 1986;292:867-868.Crossref 22. Wilcoxon F. Individual comparisons by ranking methods . Biometrics Bull. 1945; 1:80-83.Crossref 23. Kruskal WH, Wallis WA. Use of ranks in one-criterion variance analysis . J Am Stat Assoc. 1952;47:583-621.Crossref 24. Sadavoy J, Smith I, Conn DK, Richards B. Depression in geriatric patients with chronic medical illness . Int J Geriatr Psychiatry. 1990;5:187-192.Crossref 25. Rapp SR, Parisi A, Walsh DA. Psychological dysfunction and physical health among elderly medical inpatients . J Consult Clin Psychol. 1988;56:851-855.Crossref 26. Chernoff R, Lipschitz DA. Nutrition and aging . In: Shils ME, Young VR, eds. Modern Nutrition in Health and Disease. 7th ed. Philadelphia, Pa: Lea & Febiger; 1988:982-1000. 27. Lipschitz DA. Malnutrition in the elderly . Semin Dermatol. 1991;10:273-281. 28. Haydock DA, Hill GL. Improved wound healing response in surgical patients receiving intravenous nutrition . Br J Surg. 1987;74:320-323.Crossref 29. Mullen JL, Buzby GP, Matthews DC, et al. Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support . Ann Surg. 1980;192:604-613.Crossref 30. Church JM, Choong SY, Hill GL. Abnormalities of muscle metabolism and histology in malnourished patients awaiting surgery: effects of a course of intravenous nutrition . Br J Surg. 1984;71:563-569.Crossref 31. Wilson D, Rogers RM, Sanders MH, Pennock E, Reilly JJ. Nutritional interventions in malnourished patients with emphysema . Am Rev Respir Dis. 1986;134:672-677. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Energy Intake and In-Hospital Starvation: A Clinically Relevant Relationship

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References (36)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1996.00440040101011
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Abstract

Abstract Background: Malnutrition is a common finding in the acute-care hospital. Objectives: To assess the adequacy of nutritional intake to individual needs and the effects of the hospitalization on nutritional status, and to identify the reasons for inadequate energy intake. Methods: A total of 286 patients with a mean (±SD) age of 79±6 years (range, 70 to 99 years), consecutively admitted to the geriatrics and internal medicine wards of an acute-care university hospital, underwent multidisciplinary assessment on admission and at discharge and daily dietary data collection. The needed, prescribed, and actual daily energy intake for each individual was measured. Nutritional depletion was diagnosed if midarm circumference decreased by 3.6% or more from admission to discharge. Results: Nutritional depletion occurred in 27% of the patients and correlated with anorexia (86.4% vs 65.5% and 40% in patients whose midarm circumference was unchanged and increased, respectively; P<.001), Mini— Mental State Examination score (21.6±8.3 vs 23±6.9 and 26.5±3.6; P<.05), simplified premorbid Activities of Daily Living score (4.4±2.2 vs 5.1 ±1.8 and 5.0±1.8; P<.03), lymphocyte count (1.32 ±0.63 × 109/L vs 1.62±0.88×109/L and 1.47±0.50×109/L; P<.03), serum albumin level (38±5 g/L vs 40±4 g/L and 39±8 g/L; P<.002), ratio of actual to needed energy intake (56.9%±22.1% vs 69.3%±30.4% and 60.0%±14.1%; P<.01), ratio of actual to prescribed energy intake (50.5%±16.9% vs 60.5%±20.5% and 65.5%±15.7%; P<.001). Patients who consumed less than 40% of the prescribed food complained of anorexia and masticatory inefficiency and were unsatisfied with quality and timing of meals compared with the other patients. Conclusions: In-hospital starvation affects mainly patients with baseline nutritional, functional, and cognitive deficits and is strongly related to the inadequate energy intake.(Arch Intern Med. 1996;156:425-429) References 1. Detsky AS, Baker JP, Mendelson RA, Wolman SL, Wesson DE, Jeejeebhoy KN. Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons . JPEN J Parenter Enteral Nutr. 1984;8:153-159.Crossref 2. Haydock DA, Hill GL. Impaired wound healing in surgical patients with varying degrees of malnutrition . JPEN J Parenter Enteral Nutr. 1986;10:550-554.Crossref 3. Sullivan DH, Walls RC. Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients . J Am Geriatr Soc. 1994;42:471-477. 4. Sullivan DH, Patch GA, Walls RC, Lipschitz DA. Impact of nutritional status on morbidity and mortality in a select population of geriatric patients . Am J Clin Nutr. 1990;51:749-758. 5. Agarwal N, Acevedo F, Leighton LS, Cayten CG, Pitchumoni CS. Predictive ability of various nutritional variables for mortality in elderly people . Am J Clin Nutr. 1988;48:1173-1178. 6. Dwyer JT, Coleman KA, Krall E, et al. Changes in relative weight among institutionalized elderly adults . J Gerontol. 1987;42:246-251.Crossref 7. Hill GL, Pickford I, Young GA, et al. Malnutrition in surgical patients: an unrecognized problem . Lancet. 1977;1:689-692.Crossref 8. Roubenoff R, Roubenoff RA, Preto J, Balke CW. Malnutrition among hospitalized patients: a problem of physician awareness . Arch Intern Med. 1987; 147:1462-1465.Crossref 9. Abbasi AA, Rudman D. Observations on the prevalence of protein-calorie undernutrition in VA nursing homes . J Am Geriatr Soc. 1993;41:117-121. 10. McWhirther JP, Pennington CR. Incidence and recognition of malnutrition in hospital . BMJ. 1994;308:945-948.Crossref 11. Keeler EB, Solomon DH, Beck JC, Mendenhall RC, Kane RL. Effect of patient's age on duration of medical encounters with physicians . Med Care. 1982;20:1101-1108.Crossref 12. Gross JS, Neufeld RR, Libow LS, Gerber I, Rodstein M. Autopsy study of the elderly institutionalized patients . Arch Intern Med. 1988;148:173-178.Crossref 13. Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status . Am J Clin Nutr. 1981;34:2540-2545. 14. Fuller NJ, Jebb SA, Goldberg GR, et al. Interobserver variability in the measurement of body composition . Eur J Clin Nutr. 1991;45:43-49. 15. Sullivan DH, Patch GA, Baden AL, Lipschitz DA. An approach to assessing the reliability of anthropometrics in elderly patients . J Am Geriatr Soc. 1989;37:607-613. 16. Consumer and Food Economics Institute. Composition of Foods: Raw, Processed, Prepared . Washington, DC: US Dept of Agriculture; 1976-1984. Agricultural Handbook No. 8-1 to 8-15. 17. American Society of Hospital Pharmacologists. Drug Product Information File . Burlingame, Calif: American Druggist Blue Book Data Center; 1983. 18. FAO/WHO/UNU. Energy and Protein Requirements: Report of a Joint FAO/ WHO/UNU Expert Committee. Geneva, Switzerland: World Health Organization; 1985. Technical Report Series No. 74. 19. Alpers DH, Clouse RE, Stenson WF. Manual of Nutrition Therapeutics . Boston, Mass: Little Brown & Co Inc; 1985. 20. Tayback M, Kumanyika S, Chee E. Body weight as a risk factor in the elderly . Arch Intern Med. 1990;150:1065-1072.Crossref 21. Mattila K, Haavisto M, Rajala S. Body mass index and mortality in the elderly . BMJ. 1986;292:867-868.Crossref 22. Wilcoxon F. Individual comparisons by ranking methods . Biometrics Bull. 1945; 1:80-83.Crossref 23. Kruskal WH, Wallis WA. Use of ranks in one-criterion variance analysis . J Am Stat Assoc. 1952;47:583-621.Crossref 24. Sadavoy J, Smith I, Conn DK, Richards B. Depression in geriatric patients with chronic medical illness . Int J Geriatr Psychiatry. 1990;5:187-192.Crossref 25. Rapp SR, Parisi A, Walsh DA. Psychological dysfunction and physical health among elderly medical inpatients . J Consult Clin Psychol. 1988;56:851-855.Crossref 26. Chernoff R, Lipschitz DA. Nutrition and aging . In: Shils ME, Young VR, eds. Modern Nutrition in Health and Disease. 7th ed. Philadelphia, Pa: Lea & Febiger; 1988:982-1000. 27. Lipschitz DA. Malnutrition in the elderly . Semin Dermatol. 1991;10:273-281. 28. Haydock DA, Hill GL. Improved wound healing response in surgical patients receiving intravenous nutrition . Br J Surg. 1987;74:320-323.Crossref 29. Mullen JL, Buzby GP, Matthews DC, et al. Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support . Ann Surg. 1980;192:604-613.Crossref 30. Church JM, Choong SY, Hill GL. Abnormalities of muscle metabolism and histology in malnourished patients awaiting surgery: effects of a course of intravenous nutrition . Br J Surg. 1984;71:563-569.Crossref 31. Wilson D, Rogers RM, Sanders MH, Pennock E, Reilly JJ. Nutritional interventions in malnourished patients with emphysema . Am Rev Respir Dis. 1986;134:672-677.

Journal

Archives of Internal Medicine – American Medical Association

Published: Feb 26, 1996

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