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Problems of nutritional assessment in the acute setting

Published online by Cambridge University Press:  08 December 2008

J. P. Baxter
J. P. Baxter*
Affiliation:
Department of Digestive Diseases and Clinical Nutrition, Ninewells Hospital and Medical School, Dundee DDl SSY, UK
*
Corresponding author: Dr Janet P. Baxter, fax +44 (0)1382 644972, email janetb@dth.nhs.scot.uk
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Abstract

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Surveys have shown that 20–50 % of hospital admissions suffer from nutritional depletion and that there is failure to recognize its existence and significance. More emphasis must be placed in clinical medicine on identifying subjects who are at high risk of developing disease-related malnutrition. There is a need to screen patients on admission to hospital to identify those at risk of nutrition-related complications. More formal determination of nutritional status should be carried out to define the nutritional status of the patient and to monitor changes in nutritional status during nutritional support. The most frequently used tests of nutritional status include dietary, anthropometric, biochemical and functional indices of nutritional status. It is important, and indeed is the skill of the nutritional care team (particularly the dietitian) to be able to evaluate these measurements, as many of them are affected by non-nutritional factors. There is no consensus on the best method for the accurate assessment of nutritional status. Practical difficulties arise with individual measurements and in their interpretation in the acute setting. The aim of the present paper is to identify the most relevant variables to measure in clinical medicine, and to discuss the limitations of their use in the acute setting.

Keywords

Nutritional status assessmentAnthropometryBody composition assessmentBiochemical markers
Type
Joint Symposium with the British Dietetic Association on ‘Implementing dietary change: theory and practice’ Session 1: Nutritional assessment
Information
Proceedings of the Nutrition Society , Volume 58 , Issue 1 , February 1999 , pp. 39 - 46
Copyright
Copyright © The Nutrition Society 1999

References

Anderson, CF & Wochos, DN (1982) The utility of serum albumin values in the nutritional assessment of hospitalised patients. Mayo Clinic Proceedings 57, 181–183.Google Scholar
Benjamin, DR (1989) Laboratory tests and nutritional assessment. Pediatric Clinics of North America 36, 140–159.CrossRefGoogle ScholarPubMed
Bishop, CW, Bowen, PE & Richley, SI (1981) Norms for nutritional assessment of American adults by upper arm anthropometry. American Journal of Clinical Nutrition 34, 2530–2539.CrossRefGoogle ScholarPubMed
Bistrian, BR, Blackburn, GL, Hallowell, E & Heddle, R (1974) Protein status of general surgical patients. Journal of the American Medical Association 230, 858–860.CrossRefGoogle ScholarPubMed
Bistrian, BR, Blackburn, GL, Vitale, J, Cochran, D & Naylor, J (1976) Prevalence of malnutrition in general medical patients. Journal of the American Medical Association 253, 1567–1570.CrossRefGoogle Scholar
Blackburn, GL, Bistrian, BR, Maini, BS, Schlamm, HT & Smith, MF (1977) Nutritional assessment of the hospitalised patient. Journal of Parenteral and Enteral Nutrition 1, 11–22.Google Scholar
Borowitz, D & Conboy, K (1994) Are bioelectrical impedance measurements valid in patients with cystic fibrosis? Journal of Pediatric Gastroenterology and Nutrition 18, 453–456.Google Scholar
Bozzetti, F (1987) Nutritional assessment from the perspective of a clinician. Journal of Parenteral and Enteral Nutrition 11, 115S–121S.CrossRefGoogle ScholarPubMed
Burkinshaw, L, Jones, PRM & Krupowicz, DW (1973) Observer error in skinfold thickness measurements. Human Biology 45, 273–279.Google Scholar
Burr, ML & Phillips, KM (1984) Anthropometric norms in the elderly. British Journal of Nutrition 51, 165–169.Google Scholar
Buzby, GP, Mullen, JL, Matthews, DC, Hobbs, CL & Rosato, EF (1980) Prognostic nutritional index in gastrointestinal surgery. American Journal of Surgery 139, 160–167.Google Scholar
Cabre, E, de-Leon, R, Planas, R, Bertran, X, Domenach, E & Gassull, MA (1995) Reliability of bioelectrical impedance analysis as a method of nutritional monitoring in cirrhosis with ascites. Gastroenterology and Hepatology 18, 359–365.Google Scholar
Carpentier, YA, Barthel, J & Bruyns, J (1982) Plasma protein concentrations in nutritional assessment. Proceedings of the Nutrition Society 41, 405–408.Google Scholar
Cherlow, GM, Lowrie, EG, Wilmore, DW, Gonzalez, J, Lew, NL, Ling, J, Leboff, MS, Gottlieb, MN, Huang, W & Zebrowski, B (1995) Nutritional assessment with bioelectrical impedance analysis in maintenance hemodialysis patients. Journal of the American Society of Nephrology 6, 75–81.CrossRefGoogle Scholar
Chumlea, WC, Roche, AF & Steinbaugh, ML (1985 a) Estimating stature from knee height for persons 60 to 90 years of age. Journal of the American Geriatric Society 33, 116–120.CrossRefGoogle ScholarPubMed
Chumlea, WC, Roche, AF, Steinbaugh, ML & Mukherjee, D (1985 b) Errors of measurement for methods of recumbent nutritional anthropometry in the elderly. Journal of Nutrition in the Elderly 5, 3–11.Google Scholar
Dempsey, DT & Mullen, JL (1987) Prognostic value of nutritional indices. Journal of Parenteral and Enteral Nutrition 11, 109S–114S.Google Scholar
Dempsey, DT, Mullen, JL & Buzby, GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it? American Journal of Clinical Nutrition 47, 352–356.CrossRefGoogle Scholar
Deurenberg, P, Kooy, K, Evers, P & Hulshof, T (1989) Assessment of body composition by bioelectrical impedance in a population aged > 60 years. American Journal of Clinical Nutrition 51, 3–6.CrossRefGoogle Scholar
Dreblow, DM, Anderson, CF & Moxness, K (1981) Nutritional assessment of orthopedic patients. Mayo Clinic Proceedings 56, 51–55.Google ScholarPubMed
Durnin, JVGA & Womersley, J (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurement on 481 men and women aged from 16 to 72 years. British Journal of Nutrition 32, 77–97.CrossRefGoogle ScholarPubMed
Farthing, MJG (1983) Serum thyroxine binding pre-albumin may reflect energy and nitrogen intake rather than overall nutritional status in chronic intestinal disease. Nutrition Research 3, 618.CrossRefGoogle Scholar
Fearon, KCH, Richardson, RA & Hannan, J (1992) An evaluation of bioelectrical impedance analysis in the measurement of the body composition of surgical patients. British Journal of Surgery 79, 421–423.CrossRefGoogle ScholarPubMed
Fleck, A, Colley, CM & Myers, MA (1985) Liver export proteins and trauma. British Medical Bulletin 41, 265–273.CrossRefGoogle ScholarPubMed
Galina, DL, Ausman, LM, Kriauciunas, K & Hegsted, DM (1987) Dissociated response of plasma albumin and transferrin to protein energy restriction in squirrel monkeys. American Journal of Clinical Nutrition 46, 941–948.CrossRefGoogle Scholar
Garrow, JS (1980) Combined medical-surgical approaches to treatment of obesity. American Journal of Clinical Nutrition 33, 425–430.CrossRefGoogle ScholarPubMed
Grant, J, Custer, PB & Thurlow, J (1981) Current techniques of nutritional assessment. Surgical Clinics of North America 61, 437–463.CrossRefGoogle ScholarPubMed
Gray, CE & Gray, LK (1979) Validity of anthropometric norms used in the assessment of hospitalised patients. Journal of Parenteral and Enteral Nutrition 3, 366–368.CrossRefGoogle Scholar
Gregory, J, Foster, K, Tyler, H & Wiseman, M (1990) Dietary and Nutritional Survey of British Adults. London: H.M. Stationery Office.Google Scholar
Gray, GE & Meguid, MM (1990) Can total parenteral nutrition reverse hypoalbuminemia in oncology patients? Nutrition 6, 225–228.Google ScholarPubMed
Hehir, DJ, Jenkins, RL, Bistrian, BR & Blackburn, GL (1985) Nutrition in patients undergoing orthotopic liver transplant. Journal of Parenteral and Enteral Nutrition 9, 695–700.CrossRefGoogle ScholarPubMed
Heymsfield, SB, McManus, CB, Seitz, SB, Nixon, DW & Andrews, JS (1984) Anthropometric assessment of adult protein-energy malnutrition. In Nutrition Assessment, pp. 27–82 [Wright, RA, Heymsfield, SB and McManus, CB, editors]. Boston, MA: Blackwell Scientific.Google Scholar
Heymsfield, SB, McManus, CB, Smith, J, Stevens, V & Nixon, DW (1982 a) Anthropometric measurement of muscle mass: revised equations for calculating bone free muscle area. American Journal of Clinical Nutrition 36, 680–690.CrossRefGoogle ScholarPubMed
Heymsfield, SB, Stevens, V, Noel, R, McManus, CB, Smith, J & Nixon, D (1982 b) Biochemical composition of muscle in normal and semistarved human subjects: relevance to anthropometric measurements. American Journal of Clinical Nutrition 36, 131–142.CrossRefGoogle ScholarPubMed
Heymsfield, SB, Wang, Z & Baumgarter, RN (1997) Human body composition: advances in models and methods. Annual Review of Nutrition 17, 527–558.Google Scholar
Hill, GL, Blackett, RL, Pickford, I, Burkenshaw, L, Young, GA, Warren, JB, Sharach, CG & Morgan, DB (1977) Malnutrition in surgical patients - an unrecognised problem. Lancet i, 689–692.CrossRefGoogle Scholar
Hunt, D, Rowlands, B & Johnston, D (1985) Hand grip strength - a simple prognostic indicator in surgical patients. Journal of Parenteral and Enteral Nutrition 9, 701–704.Google Scholar
Ingenbleek, Y, Van den Schneck, HG & De Nayer, P (1975) Albumin, transferrin and the thyroxin binding pre-albumin/retinol binding protein (TBPA-RPB) complex in assessment of malnutrition. Clinica Chimica Acta 63, 61–65.Google Scholar
Jelliffe, DB (1966) The Assessment of the Nutritional Status of the Community. WHO Monograph no. 53. Geneva: WHO.Google Scholar
Jensen, TG (1981) A comparison of triceps skinfold and upper arm circumference measurements taken in standard and supine positions. Journal of Parenteral and Enteral Nutrition 5, 519–521.Google Scholar
Kerr, PG, Strauss, BJ & Atkins, RC (1996) Assessment of nutritional status of dialysis patients. Blood Purification 14, 382–387.Google Scholar
Keys, AJ, Brozek, J, Henchel, O, Michelson, O & Taylor, HL (1950) In The Biology of Human Starvation, pp. 140–160 Minneapolis, MN: University of Minnesota Press.CrossRefGoogle Scholar
Khaled, MA, McCutcheon, MJ, Reddy, S, Pearman, PL, Hunter, GR & Weinsier, RL (1988) Electrical impedance in assessing human body composition: the BIA method. American Journal of Clinical Nutrition 47, 789–792.CrossRefGoogle ScholarPubMed
Klidjian, AM, Foster, KJ, Kammering, RM, Cooper, A & Karran, SJ (1980) Relationship of anthropometric variables to serious post operative complications. British Medical Journal 281, 899–901.CrossRefGoogle Scholar
Lennard-Jones, JE, Arrowsmith, H, Davison, C, Denham, AF & Micklewright, A (1995) Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital. Clinical Nutrition 14, 336–340.Google Scholar
Llewellyn-Jones, D & Abraham, SF (1984) Quetelet index in anorexia nervosa. British Medical Journal 288, 1800.CrossRefGoogle ScholarPubMed
Lohman, TG (1981) Skinfolds and body density and their relation to body fatness. A review. Human Biology 2, 181–225.Google Scholar
Lopez, J, Russell, DM, Whitwell, J & Jeejeebhoy, K (1982) Skeletal muscle function in malnutrition. American Journal of Clinical Nutrition 36, 602–610.Google Scholar
Lukaski, HC (1986) Validation of tetrapolar bioelectrical impedance method to assess human body composition. Journal of Applied Physiology 60, 1327–1332.Google Scholar
Lukaski, HC (1987) Methods for the assessment of human body composition: traditional and new. American Journal of Clinical Nutrition 46, 537–556.CrossRefGoogle ScholarPubMed
Lukaski, HC (1997) Validation of body composition techniques in the dialysis population. ASAIO Journal 43, 251–255.Google Scholar
Lukaski, HC, Johnson, PE, Bolonchuk, WW & Lykken, GI (1985) Assessment of fat free mass using bioelectrical impedance measurements of the human body. American Journal of Clinical Nutrition 41, 810–817.CrossRefGoogle ScholarPubMed
McWhirter, JP & Pennington, CR (1994) The incidence and recognition of hospital malnutrition. British Medical Journal 308, 945–948.Google Scholar
McWhirter, JP, Ryan, MF & Pennington, CR (1995) An evaluation of insulin-like growth factor-1 as an indicator of nutritional status. Clinical Nutrition 14, 74–80.CrossRefGoogle ScholarPubMed
McWhirter, JP (1995) The clinical significance of malnutrition. MPhil Thesis, Glasgow Caledonian University.Google Scholar
Miller, D, Levine, S, Bistrian, BR & D'Elia, J (1983) Diagnosis of protein calorie malnutrition in diabetic patients on haemodialysis and peritoneal dialysis. American Journal of Clinical Nutrition 41, 810–817.Google Scholar
Minuto, F (1989) Insulin-like growth factor-1 in human malnutrition: relationship with some body composition and nutritional parameters. Journal of Parenteral and Enteral Nutrition 13, 392–396.CrossRefGoogle ScholarPubMed
Mitchell, DO & Lipschitz, DA (1982) Detection of protein caloric malnutrition in the elderly. American Journal of Clinical Nutrition 35, 398–406.CrossRefGoogle Scholar
Morgan, DB, Hill, GL & Burkinshaw, L (1980) The assessment of weight loss from a single measurement of body weight: the problems and limitations. American Journal of Clinical Nutrition 33, 2101–2105.Google Scholar
Nixon, DW, Heymsfield, SB, Cohen, AE, Kutner, MH, Ansley, J, Lawson, DH & Rudman, D (1980) Protein-calorie undernutrition in hospitalised cancer patients. American Journal of Medicine 68, 683–690.CrossRefGoogle Scholar
Panaretto, BA (1968) Estimation of body composition by the dilution of hydrogen isotopes. In Body Composition in Animals and Man, pp. 200–217. Washington, DC: National Academy of Sciences, National Research Council.Google Scholar
Pirie, P, Jacobs, D & Jeffrey, R (1982) Distortion in self reported height and weight data. Journal of the American Dietetic Association 78, 601–606.Google Scholar
Quirk, PC, Ward, LC, Thomas, BJ, Holt, TL, Shepherd, RW & Cornish, BH (1997) Evaluation of bioelectrical impedance for prospective nutritional assessment in cystic fibrosis. Nutrition 13, 412–416.Google Scholar
Reilly, HE, Martineau, JK, Moran, A & Kennedy, H (1995) Nutritional screening - evaluation and implementation of a simple nutritional risk score. Clinical Nutrition 14, 269–274.Google Scholar
Robert, S, Zarowittz, BJ, Hyzy, R, Eichenhorn, M, Peterson, EL & Popovich, J (1993) Bioelectrical impedance assessment of nutritional status in critically ill patients. American Journal of Clinical Nutrition 57, 840–844.CrossRefGoogle ScholarPubMed
Royall, A, Greenberg, GR, Allard, JP, Baker, JP, Harrison, JE & Jeejeebhoy, KN (1994) Critical assessment of body composition measurements in malnourished subjects with Crohn's disease. American Journal of Clinical Nutrition 59, 325–330.CrossRefGoogle ScholarPubMed
Shetty, PS, Watrasiewicz, KE & Jung, RT (1979) Rapid turnover transport protein: an index of subclinical protein-energy malnutrition. Lancet ii, 230.Google Scholar
Sizer, T (editor) (1996) Standards and Guidelines for Nutritional Support of Patients in Hospital. A Report of a BAPEN Working Party. Maidenhead, Berks.: BAPEN.Google Scholar
Studley, HO (1936) Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. Journal of the American Medical Association 106, 458–460.Google Scholar
Tzamaloukas, AH, Patron, A & Malhotra, D (1994) Body mass index in amputees. Journal of Parenteral and Enteral Nutrition 18, 355–358.Google Scholar
Unterman, TG & Vazlues, RM (1985) Usefulness of somatomedin-C in nutritional assessment. American Journal of Medicine 78, 228–233.Google Scholar
Webb, AE, Newman, LA, Taylor, M & Keogh, JB (1989) Hand Grip Dynamometry as a predictor of post operative complications. Re-appraisal using age standardised grip strengths. Journal of Parenteral and Enteral Nutrition 13, 30–33.CrossRefGoogle Scholar
World Health Organization (1973) Energy and Protein Requirements: Report of a Joint FAO-WHO ad hoc Expert Committee. Technical Report Series no. 522. Geneva: WHOGoogle Scholar