Nutrition in patients undergoing orthotopic liver transplant

Thirteen patients with severe liver disease had nutritional assessment in the weeks prior to orthotopic liver transplantation. Parameters measured included height and weight, upper arm anthropometry, delayed cutaneous hypersensitivity, total lymphocyte count, serum levels of albumin and transferrin, and plasma amino acids. Weight, when expressed as a percentage of ideal body weight, was greater than 85%, considered the normal lower limit, in all but two patients. However, mean triceps skinfold and arm muscle circumference were 49 +/- 25 and 78 +/- 9% standard, respectively. Mean serum albumin was 2.7 +/- 0.6 g/dl and although mean serum transferrin level was 184 +/- 86, eight patients had levels less than normal. Seven patients were anergic to Multitest CMI (58%) and 12 patients had depressed total lymphocyte count. All these later measurements in the aggregate support a diagnosis of protein-calorie malnutrition. High preoperative levels of amino acids, especially aspartate, phenylalanine, tyrosine, and methionine, were returned to normal by transplantation. We conclude that protein-calorie malnutrition is common in the group of patients likely to require liver transplant, although individual nutritional assessment parameters may lack sensitivity and specificity in determining nutritional status.     

Continuous nasoenteral feeding: inverse relation between infusion rate and serum levels of bilirubin

The relation between nasoenteric formula caloric infusion rate and the serum bilirubin level was examined in 15 healthy subjects. The study protocol spanned 3 days and included fasting studies on day 1, continuous maintenance nasogastric feeding of a formula diet on day 2, and continuous feeding at a rate twice the maintenance level on day 3. Blood studies were performed in the early morning of each day. Fifteen subjects underwent the fasting measurements and the maintenance infusion, while 11 underwent all 3 days of the protocol. With the maintenance infusion serum bilirubin fell from the fasting value of (X +/- SD) 0.77 +/- 0.53 to 0.63 +/- 0.49 mg/dl for a reduction of 18% (p less than 0.05). For the subgroup of 11 subjects receiving two levels of formula infusion, fasting and maintenance serum bilirubin levels were 0.81 +/- 0.57 and 0.65 +/- 0.47 mg/dl, respectively, (p less than 0.05). With the twice maintenance infusion the plasma bilirubin decreased further to 0.46 +/- 0.29 mg/dl, a decrement of 43% relative to fasting (p less than 0.01). No other significant changes were detected during the protocol in the standard blood chemical and hematologic studies. Thus, the serum level of bilirubin is inversely related to the formula caloric infusion rate during continuous nasoenteric feeding.     

Nutritional status of diabetic and nondiabetic patients after renal transplantation

To assess whether there was improvement in the nutritional status of Type I insulin-dependent diabetics treated with renal transplantation as compared with dialysis, 24 diabetics and 21 nondiabetics were studied 22.6 +/- 23.8 mo after transplantation. Nutritional assessment included weight, height, triceps skinfold thickness, midarm muscle circumference (MAMC), serum albumin, and transferrin. Mean age of the 28 males and 17 females was 37.1 +/- 9.4 yr. Weight of diabetics increased from 55.6 +/- 8.4 kg to 61.5 +/- 9.5 kg (p less than 0.05); weight for height, from 81 +/- 8% to 95 +/- 9% (p less than 0.001); and serum albumin, from 3.8 +/- 0.5 gm/dl to 4.3 +/- 0.4 gm/dl (p less than 0.001). Weight also increased significantly in nondiabetics from 64.5 +/- 10.5 kg to 72.1 +/- 13.5 kg (p = 0.05); weight for height, from 96 +/- 15% to 108 +/- 16% (p less than 0.05); but not albumin, 4.1 +/- 0.7 gm/dl to 4.4 +/- 0.6 gm/dl (p greater than 0.05). Serum transferrin was 210 +/- 62 mg/dl in diabetics and 226 +/- 52 mg/dl in nondiabetics. Forty-two percent of diabetics and 29% of nondiabetics had a MAMC less than 5th percentile, indicating protein-calorie malnutrition. Results suggest a significant improvement in nutritional status after transplantation in both diabetics and nondiabetics, but particularly in the diabetic group.     

Plant protein rehabilitation diets and iron supplementation of the protein-energy malnourished child

Thirty-eight children admitted to the paediatric ward of Obafemi Awolowo University Teaching Hospital, Ile-Ife, were treated using a local therapeutic regimen for protein-energy malnutrition (PEM). Serum transferrin concentration was measured at weekly intervals to determine the response to and nutritional adequacy of the dietary component of this therapeutic regimen. At discharge, weight for height measurements in the children showed a significant (P less than 0.001) increase in growth although the expected weight for height was not attained. Serum transferrin concentration rose significantly from a mean basal level of 132.1 +/- 17.2 mg/dl to 222.0 +/- 24.6 mg/dl at the end of the first week of hospitalization and at discharge was 403.2 +/- 27.8 mg/dl. Although not statistically significant, mortality was highest amongst children for whom iron supplementation started early on admission. Earlier studies on the aetiology and treatment of anaemia in PEM have argued in favour of routine treatment with iron to prevent the development of anaemia during the recovery phase, but data from this study suggest that iron therapy should not be instituted during the first week of treatment.     

Obstruction in patients with colorectal cancer increases morbidity and mortality in association with altered nutritional status

Intestinal obstruction aggravates the prognosis of colorectal cancer (CRC) patients. The aim of this study was to carry out a comparative analysis of nutritional status and inflammatory response in CRC patients with or without intestinal obstruction. The study was carried out on 43 patients with CRC. Twenty-three of these patients had intestinal obstruction. Anthropometric measurements, serum protein content, acute phase reactants, and diagnostic and risk nutritional indices were analyzed. The presence of intestinal obstruction reduced albumin (31 +/- 5.2 vs. 36 +/- 4.2 g/l; P = 0.0025) and prealbumin (0.13 +/- 0.047 vs. 0.21 +/- 0.042 g/l; P = 0.0001) and increased C-reactive protein (49 +/- 43.8 vs. 14 +/- 16.7 mg/l; P = 0.006) and alpha1-antitrypsin (189 +/- 34.7 vs. 148 +/- 35.4 mg/dl; P = 0.0011). Intestinal obstruction was related to malnutrition (86% vs. 33%; P = 0.019) and Mullen's prognostic nutritional index (48 +/- 21.7 vs. 31 +/- 17.9; P = 0.038) in CRC patients. Mullen's nutritional risk index was inversely correlated to total cholesterol (r = -0.51; P = 0.0002) and albumin (r = -0.81; P = 0.0001). No correlation was found between Duke's tumor stages and acute phase response, inflammatory parameters, and malnutrition. In conclusion, intestinal obstruction occurred more frequently in CRC patients with malnutrition. The increased morbidity and mortality of CRC patients was also associated with acute phase response, inflammation, and low serum cholesterol and triglyceride concentration.     

Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring.

PURPOSE: To determine the incidence of hypophosphatemia in adolescents with anorexia nervosa (AN) hospitalized for nutritional rehabilitation and to examine factors predisposing to its development. METHODS: A retrospective chart review of 69 patients (66 female, 3 male) with AN consecutively admitted to an inpatient adolescent medical unit between July 1, 1998 and June 30, 2000. Mean age was 15.5 +/- 2.4 (range 8 to 22) years and mean % ideal body weight (IBW) was 72.7 +/- 7%. Serum phosphorus was measured daily for 1 week and then biweekly to weekly. Patients were started on 1200-1400 kcal/day and calories were increased by 200 kcal every 24-48 hours. RESULTS: Four (5.8%) patients developed moderate hypophosphatemia (<2.5 and > or = 1.0 mg/dl) and 15 (21.7%) had mild hypophosphatemia (<3.0 and > or = 2.5 mg/dl). Patients who developed moderate hypophosphatemia were significantly more malnourished than those who did not (p = 0.02). Phosphorus nadirs were directly proportional to % IBW (r = 0.3, p = 0.01). Over three-quarters of the patients (81%) reached their phosphorus nadir within the first week of hospitalization. The patient with the lowest phosphorus level experienced short runs of ventricular tachycardia. No other severe complications were seen. Overall, 19 (27.5%) patients required phosphorus supplementation. CONCLUSIONS: Phosphorus drops to its nadir during the first week of refeeding. We recommend daily monitoring of serum phosphorus with supplementation as needed during the first week of hospitalization, especially in those who are severely malnourished.     

CT引导下经皮胃造口术肠内营养支持对食管癌伴吞咽困难病人放疗期间营养状况的影响

目的:探讨CT引导下经皮胃造口术肠内营养支持对食管癌伴吞咽困难病人放疗期间营养状况的影响。方法:将放疗前行CT引导下经皮胃造口术肠内营养支持的46例食管癌伴吞咽困难病人作为观察组。同期在我院放疗中心住院经口进食的43例食管癌伴吞咽困难病人作为对照组。观察组病人每日通过胃造口管摄取所需营养,对照组的营养摄入包括经口进食和静脉输注。两组病人分别于放疗前一天、放疗结束后,由责任护士测量病人身高、体重(BW),计算体质指数(BMI);遵医嘱抽取病人清晨空腹血,测定血清白蛋白(ALB)、前白蛋白(PA)、血红蛋白(HB);并观察两组病人放疗期间急性放射性食管炎的发生率和治疗计划完成情况。结果:两组病人放疗前BW、BMI、ALB、PA、HB比较,差异无统计学意义(t分别为0.84、0.63、-1.07、-0.81、1.48,P0.05)。放疗结束后观察组病人的BW、BMI、ALB、PA、HB明显高于对照组,差异有统计学意义(t分别为3.30、4.65、6.82、43.56、31.91,P0.01)。而在放疗期间,观察组病人急性放射性食管炎的总发生率明显低于对照组,差异有统计学意义χ~2=3.971,P0.05)。此外,观察组病人治疗计划完成率显著高于对照组(χ~2=6.811,P0.01)。结论:对食管癌伴吞咽困难病人放疗期间行CT引导下经皮胃造口术,进行肠内营养支持,有利于改善病人的营养不良状况,提高病人的机体免疫功能,减少放疗期间急性放射性食管炎的发生率,保证治疗计划的顺利完成。     

Nasoenteric feeding tubes in critically ill patients (fluoroscopy versus blind)

Numerous complications have been encountered with small-bore nasoenteric feeding tubes, some potentially life threatening. Patients particularly at risk are those with anatomic abnormalities, debilitation, or neurologic impairment. Fluoroscopy has been reported to be a safe, efficacious modality for the placement of these tubes. Thirty critically ill patients were studied to assess caloric delivery, costs, and complications associated with both fluoroscopically and blindly placed feeding tubes. All patients had either a tracheostomy or an endotracheal tube. They were randomized to group A (fluoroscopy) or group B (blind). Caloric delivery was greater in group A patients on days 1 through 5, with statistically significant differences on days 1 through 4. The mean daily calories per patient over the study period was 1135 +/- 96 and 662 +/- 110 (mean +/- SEM) in groups A and B, respectively (P < 0.01). Costs were similar in both groups. The most frequent problems encountered were difficult insertion, tubes requiring replacement, and failure to intubate the duodenum. We conclude that critically ill patients intubated either endotracheally or with tracheostomy should have nasoenteric feeding tubes placed with the guidance of fluoroscopy.     

Assessment of adherence to a low-fat diet for breast cancer prevention.

BACKGROUND. The relationships between self-reported adherence to a low-fat diet in healthy women between the ages of 44 and 69 and a number of correlates of this self-reported behavior were examined in an attempt to improve monitoring of adherence to nutritional intervention trials for breast cancer prevention. METHODS. Dietary fat intake in 87 women who completed 6 months of nutritional intervention was reduced from 38.2 +/- 5.9% to 21.7 +/- 7.8% of total energy intake (P less than 0.005). Reported total calorie intake was reduced by approximately 20%. RESULTS. Body weight decreased by 2.7% from 68.1 +/- 11.2 kg to 66.3 +/- 11.9 kg (P less than 0.05). Fasting total plasma cholesterol levels decreased from 205 +/- 31 mg/dl to 184 +/- 29 mg/dl (P less than 0.05). Fasting plasma triglyceride levels did not change significantly (97 +/- 44 mg/dl vs 101 +/- 55 mg/dl). Relative percentage changes in body weight correlated with percentage changes in dietary fat intake (r = 0.23, P less than 0.05). CONCLUSION. Self-reported changes in dietary behavior correlated significantly with objective changes in body weight and fasting cholesterol in these healthy women encouraged to consume a low-fat diet for prevention of breast cancer.     

Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients

BACKGROUND & AIMS: The extent of malnutrition in hospitalised stroke patients and its influence on outcomes including hospital complications, length of stay and discharge destination are important issues. The aim of this study was to determine the nutritional status of patients admitted to an acute stroke unit and the association between nutritional status and health outcomes. METHODS: Nutritional status was determined prospectively using the scored patient generated subjective global assessment (PG-SGA) in patients (n=73) admitted to an acute stroke unit within 48 h of admission to an Australian private hospital. Outcome data were collected by retrospective audit. RESULTS: On admission, 19.2% of patients were malnourished and this was associated with a significantly greater PG-SGA score (15 vs. 5) and lower body weight (59.8 kg vs. 75.8 kg) compared to well-nourished patients. In terms of health outcomes, malnourished patients had longer length of stay (13 vs. 8 days), increased complications (50% vs. 14%), increased frequency of dysphagia (71% vs. 32%) and enteral feeding (93% vs. 59%). No association was found between nutritional status and serum albumin level or discharge destination. CONCLUSIONS: Malnutrition on admission to hospital after acute stroke is associated with poor outcomes including increased length of stay and increased prevalence of dysphagia and complications. The scored PG-SGA is a nutrition assessment tool that allows quick identification of malnourished stroke patients.     

Refractory myasthenia gravis, dysphagia and malnutrition: A case report to suggest disease-specific nutritional issues

ObjectiveWe describe a case of refractory myasthenia gravis with bulbar involvement and the nutritional treatment solutions proposed to treat the associated dysphagia and malnutrition.MethodsA 39-y-old woman with refractory myasthenia gravis was referred to our clinical nutrition unit for deteriorating dysphagia and progressive malnutrition.ResultsThe first-line nutritional approach consisted of dietary counseling and thickened meals. Unfortunately, no adequate oral intake was achieved and an enteral nutrition treatment was proposed. A nasogastric tube was removed after a few days due to local pain and poor quality of life. Despite consistent weight loss and overt malnutrition, the patient refused percutaneous endoscopic gastrostomy placement. Neurologic symptoms did not show any improvement but unexpectedly the patient's weight started to increase to previous values. Anamnestic recall revealed that the patient learned by herself how to position the nasogastric tube that is now temporarily used for formula infusion coinciding with neurologic poussés.ConclusionsCurrent guidelines consider chronic neurologic diseases with associated dysphagia, where refractory myesthania gravis has also been considered, a unique category. Chronic neurogenic dysphagia with high risk of aspiration, long-term inability to obtain adequate oral intakes, and malnutrition are established indications for percutaneous endoscopic gastrostomy placement. However, patients may need different forms of nutritional intervention during the course of their illness and choices and indications should contemplate ethical reasons, clinical benefits, minimal risks, and acceptable quality of life. Minimally invasive intermittent enteral nutrition might be considered a possible clue for nutritional management of exacerbating dysphagia.     

A pilot audit of weight loss in upper gastrointestinal oncology outpatients

BACKGROUND: Patients with upper gastrointestinal malignancies have a high incidence of weight loss and malnutrition which has been associated with a reduced quality of life, performance status, increased risk of chemotherapy induced toxicity and decreased response to treatment. AIM: The aim of the pilot audit was to identify how many patients attending an upper gastrointestinal oncology outpatient clinic had lost weight or had nutritional problems. METHOD: A short questionnaire on present weight, weight loss and occurrence of symptoms was completed by 40 patients attending an upper gastrointestinal oncology outpatient clinic. RESULTS: Nutritional screening, including weight, was not routinely carried out on all patients. Only 40% of patients had been weighed at their clinic visit and 65% self-reported that they had lost weight. The frequency of symptoms in the weight loss group was higher than in the nonweight loss group and the incidence of nausea and dysphagia was significantly higher. Only 35% of patients had received dietary advice, but 68% of the remaining patients would have liked some. CONCLUSION: A significant number of patients reported weight loss and this was linked with a higher occurrence of symptoms influencing appetite and oral intake.     

Nutritional assessment and management in hospitalised patients: implication for DRG-based reimbursement and health care quality

INTRODUCTION: Malnutrition is associated with a higher morbidity resulting in an increased need for medical resources and economic expenses. In order to ensure sufficient nutritional care it is mandatory to identify the effect of malnutrition and nutritional care on direct cost and reimbursement. The primary aim of this study was to evaluate the economic effect of a nutritional screening procedure on the identification and coding of malnutrition in the G-DRG system. METHODS: All G-DRG relevant parameters of 541 consecutive patients at a gastroenterology ward were documented. Moreover, all patients were screened for malnutrition by a dietician according to the subjective global assessment (SGA). Patients were then grouped into the appropriate G-DRG and the effective cost weight (CW) was calculated. RESULTS: Ninety-two of 541 patients (19%) were classified malnourished (SGA B or C). Recognition of malnutrition increase from 4% to 19%. Malnourished patients exhibited a significantly increased length of hospital stay (7.7+/-7 to 11+/-9, P<0.0001). In 26/98 (27%) patients, the coding of malnutrition was considered relevant by grouping and resulted in a rise of DRG benefit. Mean case mix value and patients' complexity and comorbidity level (PCCL) increased after including malnutrition in the codification (CV 1.53+/-2.9 to 1.65+/-2.9, P=0.001 and PCCL 2.69+/-1.4 to 3.47+/-0.82, P<0.0001). The reimbursement increase by 360/malnourished patient or an additional reimbursement of 35280 (8.3% of the total reimbursement for all patients of 423186). Nutritional support in a subgroup of 50 randomly selected patients resulted in additional costs of 10268 . Forty-four of these patients (86%) were classified malnourished (32 SGA B and 12 SGA C). However, the subsequent reimbursement covered only approximately 75% of the expenses (7869), but did not include the potential financial benefits resulting from clinical interventions. CONCLUSION: Malnourished patients can be detected with a structured assessment and documentation of nutritional status and this is partly reflected in the G-DRG/ICD 10 system. In addition to increasing direct health care reimbursement, nutritional screening and intervention has the potential to improve health care quality.     

肠外和肠内贯序营养支持对脑卒中合并吞咽困难病人的治疗作用

目的 探讨肠外和肠内贯序营养支持对脑卒中合并吞咽困难患者的治疗作用。方法将72例脑卒中合并吞咽困难患者随机分为A组（肠内和肠外贯序营养方法）和B组（肠外营养），从起病48h后开始给予营养支持，入院3周末测量两组患者多项营养指标，同期观察并发症。结果 3周末A组各营养指标高于B组，差异有统计学意义（P〈0．05），A组各并发症出现数低于B组，其中并发应激性溃疡、吸入性肺炎者差异有统计学意义（P〈0．05），其余差异无统计学意义（P〉0．05）。结论 脑卒中合并吞咽困难患者早期应用肠外和肠内贯序营养支持，可改善机体的营养状况，有利于患者的康复。     

Hypocaloric enteral tube feeding in critically ill obese patients

OBJECTIVE: We respectively compared the nutritional and clinical efficacies of eucaloric and hypocaloric enteral feedings in 40 critically ill, obese patients admitted to the trauma or surgical intensive care unit. METHODS: Adult patients, 18 to 69 years old, with weights greater than 125% of ideal body weight, normal renal and hepatic functions, and who received at least 7 d of enteral tube feeding were studied. Patients were stratified according to feeding group: eucaloric feeding (>or=20 kcal/kg of adjusted weight per day; n = 12) or hypocaloric feeding (<20 kcal/kg of adjusted weight per day; n = 28). The goal protein intake for both groups was approximately 2 g/kg of ideal body weight per day. Clinical events and nutrition data were recorded for 4 wk. RESULTS: Patients were similar according to sex, age, weight, body mass index, Second Acute Physiology and Chronic Health Evaluation score, Trauma score, and Injury Severity Score. The hypocaloric feeding group received significantly fewer calories than the eucaloric group (P相似文献   

Malnutrition, nutritional indices, and early enteral feeding in critically ill children.

We measured the incidences of protein and fat depletions and the frequencies of acute and chronic protein-energy malnutrition during stress states in children and investigated the influence of early enteral feeding on nutrition indices and acute-phase proteins. Seventy-one, consecutively enrolled, critically ill children received early enteral feeding (energy intakes equal to 0.50, 1, 1.25, 1.5, and 1.5 of the predicted basal metabolic rates on days 1 through 5, respectively) through nasogastric tubes. On the first day of the study, 16.7% of the patients already were depleted of protein and 31% of fat stores. Overall, 16.9% were at risk for chronic protein-energy malnutrition and 21.1% for acute protein-energy malnutrition, whereas 4.2% and 5.6% already had chronic and acute, respectively protein-energy malnutrition. Only 22.7% of patients without protein deficiencies versus 37% of those at risk or already deficient developed multiple-organ system failure. Transferrin and prealbumin levels improved at the end of the period of early enteral feeding (187 +/- 6.6 versus 233 +/- 7 mg/dL, P < 0.0001; 15.1 +/- 2 versus 21.9 +/- 2.9 mg/dL, P < 0.0001; respectively); survivors had higher prealbumin levels than non-survivors (22.3 versus 15.5 mg/dL). With logistic regression analysis, only repleted energy, not anthropometric or nutrition indices, was independently associated with survival (P = 0.05). These results reinforce the observation that critically ill children are at risk for fat or protein depletion and development of malnutrition, which is associated with increased morbidity and mortality. We conclude that early enteral nutrition improves nutrition indices and outcomes.     

Response to total parenteral nutrition in the extremely malnourished patient

Changes in serum albumin levels and body weight are often used as indicators of the efficiency of a nutritional support regimen. Patients with moderate nutritional depletion demonstrate two distinct patterns of response during refeeding. The first is characterized by a decrease in the previously expanded extracellular fluid space with a rise in serum albumin and a loss of weight and the second by continued fluid retention with weight gain and no rise in serum albumin concentration. The second pattern has been observed in patients with ongoing stress such as infection. This study examines severely malnourished patients with no apparent inflammatory complications and demonstrates that this group responds to nutritional support in a pattern similar to that seen in the stressed patient. Eight patients with profound malnutrition were studied during the 1st week of nutritional support. Nitrogen balance was measured and the findings confirmed that all patients were anabolic. Sodium balances were used as an indicator of changes in the extracellular fluid compartment. Body weight and serum albumin were assessed daily. Body weight increased from 59 +/- 4 to 62 +/- 4% of normal (p less than 0.01) while serum albumin changed insignificantly (3.00 +/- 0.27 to 2.85 +/- 0.23 g/100 ml, NS) during the initial week of an adequate nutritional support regimen (nitrogen balance was +21.0 +/- 4.3 g, p less than 0.05). These changes were associated with a positive sodium balance (+215 +/- 20 mEq, p less than 0.05). These data confirm that some extremely malnourished patients do not experience a diuresis during the initial phase of nutritional support but rather may retain water and increase body weight.(ABSTRACT TRUNCATED AT 250 WORDS)     

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 factors associated with survival following enteral tube feeding in patients with motor neurone disease

Background:  Motor neurone disease (MND) is a progressive neurodegenerative disease leading to limb weakness, wasting and respiratory failure. Prolonged poor nutritional intake causes fatigue, weight loss and malnutrition. Consequently, disease progression requires decisions to be made regarding enteral tube feeding. The present study aimed to investigate the survival, nutritional status and complications in patients with MND treated with enteral tube feeding. Methods:  A retrospective case note review was performed to identify patients diagnosed with MND who were treated with enteral tube feeding. A total of 159 consecutive cases were identified suitable for analysis. Patients were treated with percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG) or nasogastric feeding tube (NGT). Nutritional status was assessed by body mass index (BMI) and % weight loss (% WL). Serious complications arising from tube insertion and prescribed daily energy intake were both recorded. Results:  Median survival from disease onset was 842 days [interquartile range (IQR) 573–1263]. Median time from disease onset to feeding tube was PEG 521 days (IQR 443–1032), RIG 633 days (IQR 496–1039) and NGT 427 days (IQR 77–781) (P = 0.28). Median survival from tube placement was PEG 200 (IQR 106–546) days, RIG 216 (IQR 83–383) days and NGT 28 (IQR 14–107) days. Survival between gastrostomy and NGT treated patients was significant (P ≤ 0.001). Analysis of serious complications by nutritional status was BMI (P = 0.347) and % WL (P = 0.489). Conclusions:  Nutritional factors associated with reduced survival were weight loss, malnutrition and severe dysphagia. Serious complications were not related to nutritional status but to method of tube insertion. There was no difference in survival between PEG and RIG treated patients.