Comparison between Nutritional Risk Tools and Parameters Derived from Bioelectrical Impedance Analysis with Subjective Global Assessment

BackgroundNutritional risk and malnutrition are highly prevalent among hospitalized patients. As a result, several methods have been developed to produce an adequate nutritional diagnosis.ObjectiveWe aimed to assess the relationship between nutritional risk tools and parameters derived from bioelectrical impedance analysis with a Subjective Global Assessment (SGA).DesignA cross-sectional study was conducted from April to September 2010.Participants/settingThe study included 124 patients admitted to the Surgical Clinic I, University Hospital, Federal University of Santa Catarina, Florianópolis, Brazil, to undergo elective surgery.Main outcome measuresWe utilized SGA and Nutritional Risk Screening 2002 (NRS 2002), Nutritional Risk Index (NRI), Fat-Free Mass Index (FFMI), Fat Mass Index (FMI), body cell mass as a percentage of the total weight (%BCM), and standardized phase angle (SPA).Statistical analysis performedThe agreement was tested by κ coefficient, while bivariate associations were tested by Mann-Whitney U test.ResultsPrevalence of nutritional risk by NRS 2002 and NRI or malnutrition by SGA, FFMI, FMI, %BCM, and SPA was 19.3%, 69.5%, 35.5%, 12.9%, 8.1%, 46.8%, and 4.8%, respectively. The best agreement was between SGA and NRS 2002 (κ=.490), possibly because they constitute similar instruments. Patients identified as malnourished by SGA (B+C) showed considerably lower values of FFMI, FMI, BCM, and SPA.ConclusionsThe results suggest that the NRS 2002 and parameters derived from bioelectrical impedance analysis identify patients with impaired nutritional status.     

Malnutrition and Clinical Outcome of 234 Head and Neck Cancer Patients who Underwent Percutaneous Endoscopic Gastrostomy

Head and neck cancer (HNC) patients who underwent percutaneous endoscopic gastrostomy (PEG) present malnutrition risk and speech impairments. Their assessment relies on objective anthropometric/laboratory data. Focusing on HNC PEG patients, our aims were to evaluate: 1) outcome; 2) nutritional status when the patients underwent PEG; and 3) association of nutritional status/outcome, creating a survival predictive model. We evaluated the outcome based on NRS 2002, dietary assessment, body mass index (BMI), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), albumin, transferrin, and cholesterol on the day of gastrostomy. Using BMI, TSF, MAMC, and laboratory data, a survival predictive model was created. Of the 234 patients (cancer stages III–IV), 149 died, 33 were still PEG-fed, and 36 resumed oral intake (NRS-2002≥3, caloric needs <50% in all). BMI was 12.7–43. 189, 197, and 168 patients displayed, respectively, low MUAC, TSF, and MAMC. 91, 155, and 119 patients displayed low albumin, transferrin, and cholesterol. Albumin, cholesterol, and transferrin were strongly associated with the outcome. A predictive model was created, discriminating between short-term survivors (<4 months) and long-term survivors. HNC patients were malnourished. Using anthropometric/laboratory parameters, a predictive model provides discrimination between patients surviving PEG for <4 months and long-term survivors. Teams taking care of PEG patients may provide special support to potential short-term survivors.     

脑卒中住院康复治疗患者营养状态评估方法的比较

目的分析比较营养风险筛查2002(NRS2002)、主观全面评估法(SGA)、微型营养评定法(MNA)在脑卒中住院康复治疗患者营养评估中的作用。方法以BMI、近三个月体重变化、白蛋白水平作为判断营养状态的标准诊断方法,分别采用SGA、MNA、NRS2002法对106例脑卒中患者进行营养状况评估,比较其与标准诊断方法的一致性及灵敏度、特异度。结果SGA与标准诊断方法有较好的一致性(Kappa值在0.410);在灵敏度、特异度比较中,发现SGA的特异度较高(94.4%),而MNA、NRS2002的灵敏度较高(92.3%)。结论SGA在判断营养正常时与标准诊断一致性良好,但判断营养不良时NRS2002及MNA灵敏度更高。     

Small bowel bacterial overgrowth: a cause of malnutrition in the elderly?

A study was conducted to examine the effect of small bowel contamination on the nutritional status in the elderly. Dietary assessment and anthropometric measurements were used to assess malnutrition. Sixteen elderly patients were studied before and after regular treatment with antibiotics. A significant gain in body weight, triceps skinfold thickness, mid-arm circumference and arm muscle circumference was noticed after eliminating bacterial overgrowth of the small bowel. Occult malabsorption due to bacterial overgrowth should therefore be considered as a cause of malnutrition in the elderly.     

Is plasma albumin concentration useful in the assessment of nutritional status of hospital patients?

Anthropometric measurements (body weight, height, triceps skinfold thickness and mid-arm circumference measurements) and plasma albumin concentrations were obtained from 546 (308 medical, 238 surgical) general hospital patients. In a subgroup (n = 50) receiving nutritional support, the relationship between nitrogen balance and change in plasma albumin concentration was followed over a minimum period of 2 weeks. Results showed that there was no association between albumin concentration and body weight expressed as percentage of ideal, nor was there an association between albumin concentrations and triceps skinfold thicknesses. However, low albumin concentrations were associated with low mid-arm muscle circumferences and triceps skinfold thicknesses were positively associated with body weight measurements. Patients admitted with low albumin concentrations had the highest mortality rates. In the patients receiving nutritional support, there was no association between improvement in nitrogen balance and increase in albumin concentrations. Furthermore, reductions in albumin concentrations were associated with higher mortality rates. It is concluded that plasma albumin concentrations provide little useful nutritional information in sick patients. They provide a better index of degree of sickness and risk of mortality.     

营养风险筛查和主观全面评定用于肺癌非手术患者营养筛查的比较

目的调查肺癌非手术患者营养风险、营养不良（不足）、超重／肥胖发生率，比较营养风险筛查2002（NRS2002）和主观全面评定（SGA）用于肺癌非手术患者营养筛查的适用性和结果。方法连续定点抽样，对符合入选标准、获知情同意的153例肺癌非手术患者在人院次日晨分别采用NRS2002和SGA进行营养筛查，NRS2002筛查营养不足以体重指数（BMI）的中国标准判定。结果153例患者均完成NRS2002和SGA。用BMI中国标准判定营养不足、超重和肥胖发生率分别为10．5％、37．9％和9．1％。NRS2002筛查显示营养风险发生率为34．6％，SGA筛查显示营养不足发生率为33．3％；两种方法在营养不足筛查结果间差异无显著性（P=0．845）。结论NRS2002和SGA均适用于肺癌非手术患者营养不足筛查，NRS2002还可同时筛查患者的营养风险。     

Subjective vs objective nutritional assessment study in children: a cross-sectional study in the northwest of Iran

Different methods have been used to assess nutritional status in hospitalized pediatric patients, and there is no agreement on the finest index which reflects nutritional status. The aim of this study was to compare the subjective global assessment (SGA) and objective assessment of nutritional status in hospitalized pediatric patients. One hundred forty children with mean age of 6.43 ± 0.23 years hospitalized consecutively in Tabriz Pediatric Hospital from June to August in 2008 underwent a subjective assessment using the SGA questionnaire and objective assessment (anthropometric and biochemical measurements). An agreement between 2 assessment methods were analyzed by the κ statistic. According to the result of SGA method, the overall prevalence of malnutrition was higher than the objective assessment method. The agreement between the 2 methods were merely fair to moderate (κ = 0.336, P = .000). The linear relationship between 2 methods was also fair to moderate (r = 0.374, P < .05). Our findings indicated that the differences between two evaluated methods in assessing nutritional status of pediatric patients, and it can also detect the changing trend of nutritional status, which may be missed by one-time anthropometry and biochemical methods.     

Grip strength as an index for assessment of nutritional status of children aged 6-10 years

The purpose of this study was to evaluate the use of grip strength as an index of nutritional status in 6-10 y old children. Seven hundred and eighty seven children (364 boys and 423 girls) in the age group of 6 to 10 y were selected from private and municipal schools, orphanages and slums in the cities of Mumbai and Pune, India. Grip strength was measured using the dominant hand. Height, weight, mid-arm circumference and triceps skinfold were also measured in all subjects. A significantly high correlation (p<0.01) was observed between grip strength and age for both sexes. Boys had a higher grip strength than girls at all ages. Grip strength was significantly correlated with height, weight, mid arm circumference, triceps skinfold, arm fat and arm muscle areas (p<0.01). Stepwise multiple regression analyses showed height, weight, triceps skinfold and age to be independent variables influencing grip strength. Grip strength was found to be a specific measure of lean body mass (75 to 94%), but sensitivity was quite low (about 25%). The positive predictive value was variable, ranging from 54.6 to 21.5%. The specificity, sensitivity and positive predictive values were very high when compared with arm muscle area. Grip strength may have a potential value as an additional test for nutritional assessment in field situations and clinical settings.     

左卡尼汀对腹膜透析患者瘦素及营养状态的影响

目的观察左卡尼汀对腹膜透析(PD)患者血清瘦素(leptin)水平及营养状态的影响。方法 40例PD患者随机分为治疗组和对照组,各20例。治疗组每日给予左卡尼汀1 g,静脉推注,连用6个月;对照组仅给予常规治疗。于治疗前及治疗6个月后检测生化指标、血清瘦素水平及肱三头肌处皮褶厚度(TSF)、上臂肌围(MAMC)、体质量指数(BMI)和改良主观总体评价(SGA)评分;结果治疗6个月后,治疗组患者血清白蛋白(Alb)、血红蛋白(Hb)、前白蛋白(PA)明显升高(P<0.05),leptin与改良SGA评分较治疗前明显下降(P<0.05);治疗前后胆固醇(TC)、甘油三酯(TG)、TSF、MAMC和BMI变化不明显(P>0.05)。结论左卡尼汀能有效降低PD患者血清瘦素水平,改善患者营养状态。     

Nutritional status of surgical patients and the relationship of nutrition to postoperative outcome.

A preoperative nutritional assessment including anthropometry, biochemical indices and global subjective assessment was performed for 127 patients admitted for elective gastrointestinal surgery. Of these, 24 were subjected to minor surgery, 65 to intermediate surgery and 38 to major procedures. Patients were followed postoperatively, recording complications or mortality. Intermediate and major surgery patients had lower triceps skinfold thickness and mid-arm circumference and greater weight loss than did minor surgery patients. Thirty-six percent of the patients suffered complications. No association was found between preoperative nutritional status and incidence of postoperative complications. Six patients died and they showed greater preoperative weight loss (21 +/? 6.5 vs 12 +/? 1.4%) and lower serum albumin levels (25 +/? 4 vs 35 +/? 1 g/l) than patients who survived complications. Global subjective assessment classified 43% of survivors as malnourished, compared to 100% of patients who died.     

Nutritional status of surgical patients and the relationship of nutrition to postoperative outcome.

A preoperative nutritional assessment including anthropometry, biochemical indices and global subjective assessment was performed for 127 patients admitted for elective gastrointestinal surgery. Of these, 24 were subjected to minor surgery, 65 to intermediate surgery and 38 to major procedures. Patients were followed postoperatively, recording complications or mortality. Intermediate and major surgery patients had lower triceps skinfold thickness and mid-arm circumference and greater weight loss than did minor surgery patients. Thirty-six percent of the patients suffered complications. No association was found between preoperative nutritional status and incidence of postoperative complications. Six patients died and they showed greater preoperative weight loss (21 +/- 6.5 vs 12 +/- 1.4%) and lower serum albumin levels (25 +/- 4 vs 35 +/- 1 g/l) than patients who survived complications. Global subjective assessment classified 43% of survivors as malnourished, compared to 100% of patients who died.     

Interchangeability among the percentages of body fat estimated by mid-arm adipose area,triceps skinfold thickness and arm-to-arm segmental bioimpedance analysis

BACKGROUND: Assessing nutritional status based on the upper limbs is useful at the clinical level. The aim of this study is to evaluate the agreement degree of the body fat percentages (%BF) estimated by the mid-arm adipose area (%BFARM), the Siri triceps skin-fold equation (%BFTRICEPS) and the arm-to-arm segmental bioimpedance analysis (%BFBIA), as well as the Siri four-skinfold equation (%BFSIRI), assessing their interchangeability. METHODS: A cross-sectional study. Body fat assessments were made on a total of 145 subjects (83 males, 62 females) anthropometrically and by bioelectrical impedance analysis (Omron BF 300). The agreement between methods were analyzed using the interclass correlation coefficient (ICC) and the Bland-Altman method. RESULTS: The ICC between %BFARM and %BFTRICEPS was 0.8322 (CI .95% 0.7672-0.8791); between %BFARM-%BFBIA 0.7337 (0.6305-0.8080) and between %BFTRICEPS-%BFBIA 0.9290 (0.9015; 0.9488). For the Bland-Altman method, the agreement interval between %BFARM-%BFTRICEPS (-11.2; 16.96) and between %BFARM-%BFBIA (-13.04; 21.76) exceeded the cutoff point (+/- 10%), but not between %BFTRICEPS-%BFBIA (-6.64; 9.6), %BFSIRI-%BFTRICEPS (-5.27; 4.52) and %BFSIRI-%BFBIA (-6.31; 8.52). The BMI has no bearing on the results. CONCLUSIONS: The method utilized influences the nutritional assessment made based on the upper limbs. The mid-arm adipose area method overestimated the %BF with relationship to the Siri triceps skinfold or four-skinfold equation and to the bioelectrical impedance analysis, and although this result suggests that mid-arm adipose area may not be a good indicator of global adiposity, this must be confirmed against a gold standard.     

Reproducibility of upper-arm anthropometry in subjects of differing body mass

A study was performed to assess the reproducibility of upper-arm anthropometry using two observers with subjects of differing body mass. Subjects were divided into four groups according to their body mass index:
Group 1: <20
Group 2: >20-<25
Group 3: >25-<30
Group 4: >30-<40.
Results show a much greater observer error related to triceps skinfold thickness than to mid-arm circumference when expressed as restricted coefficient of variation. An increase in observer error in both triceps skinfold thickness and mid-arm circumference with an increase in body mass has also been demonstrated, the error again being greater with triceps skinfold thickness. These results question the validity of work where two or more observers are used to collect data on upper-arm anthropometry without first attempting to quantify observer error and control for body mass.     

Alternative anthropometric measurements for the Thai elderly: Mindex and Demiquet

This cross-sectional study examined the relationship between alternative anthropometric indices and the nutritional and metabolic status of the Thai elderly. Four rural communities, each from the 4 main regions of Thailand were surveyed. A total of 2,324 subjects, 60 years old and over were included in the study. Mindex and Demiquet had a very strong relationship to body mass index with the r values of 0.93 and 0.88, respectively. Fat weight had the highest correlation with body mass index in older women, r = 0.94 (P< 0.001) and with Mindex, r = 0.93 (P< 0.001). In regard to anthropometric measurements, the mid-arm circumference had the strongest relationship to all three Quetelet indices, r = 0.76-0.87 (P< 0.001), while subscapular skinfold thickness performed best among skinfold measurements, r = 0.69-0.74 (P< 0.001). BMI achieved a significantly higher degree of correlation with triceps and supra-iliac skinfold thickness, mid-arm circumference and fat weight than Demiquet (P< 0.001 for all variables). The lymphocyte count was the only laboratory test that related rather well to all three Quetelet indices. All three Quetelet indices had nearly the same pattern of relationship to various nutritional parameters. The cut-off points of Mindex denoting under-nutrition, overweight and obesity I in women were 55.95, 69.55 and 75.60 kilogram/metre, respectively. At the same time, the cut-off points of Demiquet denoting under-nutrition, overweight and obesity I in men were 75.60, 93.98 and 102.16 kilogram/metre2, respectively. All this information supports the benefit of using Mindex and Demiquet as alternatives to body mass index for nutritional assessment in older Asian people, especially for the malnourished ones.     

妇科恶性肿瘤病人不同营养评估方法的对比分析

目的:对比分析主观整体评估(PG-SGA)、营养风险筛查2002(NRS 2002)和生物电阻抗分析(BIA)在评估妇科恶性肿瘤病人营养状况中的应用价值。方法:随机选取妇科恶性肿瘤病人118例,应用不同方法(PG-SGA、NRS 2002、BIA)评估病人营养状况,比较其一致性。结果:应用PG-SGA、NRS 2002和BIA法病人营养不良/存在营养风险的检出率依次为64.4%、57.6%和33.9%。在总体中,PG-SGA与NRS 2002一致性较高(P0.001),而BIA与NRS 2002、BIA与PG-SGA一致性均较低(P0.001),仅在宫颈癌病人中一致性有所增加(P0.001)。结论:妇科恶性肿瘤尤其是卵巢癌病人营养不良/存在营养风险率较高,可用PG-SGA和NRS 2002评价其营养状态,而BIA在评估宫颈癌病人营养状态中有一定价值。     

Anthropometry of elderly people living in geriatric institutions, Brazil

OBJECTIVE: To provide anthropometric and body composition information on elderly people living in geriatric institutions. METHODS: Three-hundred and five elderly people, of both sexes, living in six geriatric institutions in Fortaleza were assessed. The following anthropometric variables were studied: weight, height, body mass index, mid-arm circumference, triceps skinfold thickness, arm muscle circumference, and corrected arm-muscle area. The body mass index was calculated as weight divided by the square of the height (m2). The arm muscle circumference and corrected arm-muscle area were calculated using specific equations. The results are presented as means, standard deviations and percentiles (5th, 10th, 25th, 50th, 75th, 90th and 95th). The analyses included Student t-test to detect differences in mean values of the variables between both sexes. Age impact was investigated by ANOVA. RESULTS: In all variables, mean values in men were higher than those in women, except for triceps skinfold thickness . The mean difference of the variables body mass index and mid-arm circumference for both sexes were not statistically significant (p>0.05). Age has significantly contributed to reducing the variables' values. This means that specific reference standards are needed for elderly people. CONCLUSIONS: Despite being institutionalized, there was seen a trend of decreasing anthropometric values in the study population similar to that found in other studies of elderly people but with different values. Thereby, such values could be useful in the nutritional assessment of institutionalized elderly people.     

应用主观全面评定法评价维持性血液透析患者营养状况

目的应用主观全面评定法（SGA）对维持性血液透析患者（MHD）的营养状态进行评价。方法对116例MHD患者应用SGA方法进行营养评估，测定肱三头肌皮褶厚度、上臂围、上臂肌围（MAMC）等人体测量学指标和血清白蛋白（ALB）、C反应蛋白（CRP）等实验室指标，并进行相关性分析。结果SGA法的评定结果与年龄、透析时间、肱三头肌皮褶厚度、上臂围、MAMC、体质指数（BMI）、ALB、CRP均有显著相关性（P〈0．01）；与总蛋白、血清肌酐无相关性（P〉0．05）。多因素分析显示，在调节年龄、BMI后，SGA评分与CRP、ALB、MAMC仍存在显著相关性（相关系数分别为0．2816、0．3368、0．6143，P〈0．05）。结论SGA法在我国MHD患者的营养评价中适用，是一种经济、有效的营养评定方法。     

三种营养筛查工具对维持性血液透析病人透析相关性蛋白质-能量消耗的评价比较

目的:比较三种营养筛查工具对血液透析病人透析相关性蛋白质-能量消耗(PEW)的预测作用,以筛选出一种快速、准确和易行的方法。方法:采用营养风险筛查2002(NRS 2002)、7分主观整体评估(7分SGA)、营养不良炎症评分(MIS)三种筛查工具对205例行维持性血液透析病人进行PEW患病率调查。同时,将三种筛查工具与人体测量指标、血生化指标等进行相关性分析,并与国际肾脏营养与代谢学会(ISRNM)制订的PEW诊断金标准进行比较。结果:根据ISRNM标准,31.2%的透析病人存在PEW,基于MIS、7分SGA、NRS 2002的评价标准,透析病人PEW的患病率分别为58.0%、40.8%和46.8%。三种筛查工具均与血生化和人体测量学指标呈明显相关关系(P0.05),其中NRS 2002与常用客观营养指标的复合相关系数最大(r=0.787,P0.001),相关性最为密切。在透析病人中,NRS 2002有较高的灵敏度和正确指数,分别为87.5%和59.1%。结论:对透析病人,MIS、7分SGA、NRS 2002三种筛查工具均有较好的准确性,以NRS 2002更优。NRS 2002可能是预测透析病人PEW更快速、准确、易行的营养筛查工具。     

营养风险筛查2002的临床应用和分析

目的 评估营养风险筛查2002 (NRS 2002)在住院患者营养筛查中的应用价值.方法 以2008年11月-2009年3月天津天和医院新住院患者400例为研究对象,在入院后第2天清晨测定身高、体重,详细记录病史及患者情况,采用NRS 2002对患者进行营养风险评价并进行分析.结果 400例患者中,306例为强适用(76.5%),94例为弱适用(23.5%);96例(24.0%)存在营养风险,其中普通内科(38.3%)和神经科(31.8%)患者的发生率居前两位.有营养风险患者的平均年龄为(79.0±11.4)岁,明显高于无营养风险患者的(58.1±15.8)岁(P<0.01).结论 NRS 2002可有效用于筛查住院患者的营养状况.