Korean Journal of Community Nutrition (대한지역사회영양학회지)

The Korean Society of Community Nutrition (대한지역사회영양학회)
권호 표지

Development of Nutrition Screening Index for Hospitalized Patients

입원 환자 영양검색 지표 개발

  • Kim, Su-An (Nutrition care services, Seoul National University of Bundang Hospital) ;
  • Kim, So-Yeon (Nutrition care services, Seoul National University of Bundang Hospital) ;
  • Sohn, Cheong-Min (Nutrition care services, Seoul National University of Bundang Hospital)
  • 김수안 (분당서울대학교병원 영양실) ;
  • 김소연 (분당서울대학교병원 영양실) ;
  • 손정민 (분당서울대학교병원 영양실)
  • Published : 2006.12.31
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Abstract

Several studies about hospital malnutrition have been reported that about more than 40% of hospitalized patients are having nutritional risk factors and hospital malnutrition presents a high prevalence. People in a more severe nutritional status ended up with a longer length of hospital stay and higher hospital cost. Nutrition screening tools identify individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutritional support. For the early detection and treatment of malnourished hospital patients , few valid screening instruments fur Koreans exist. Therefore, the aim of this study was to develop a simple, reliable and valid malnutrition screening tool that could be used at hospital admission to identify adult patients at risk of malnutrition using medical electrical record data. Two hundred and one patients of the university affiliated medical center were assessed on nutritional status and classified as well nourished, moderately or severely malnourished by a Patient-Generated subjective global assessment (PG-SGA) being chosen as the 'gold standard' for defining malnutrition. The combination of nutrition screening questions with the highest sensitivity and specificity at prediction PG-SGA was termed the nutrition screening index (NSI). Odd ratio, and binary logistic regression were used to predict the best nutritional status predictors. Based on regression coefficient score, albumin less than 3.5 g/dl, body mass index (BMI) less than $18.5kg/m^2$, total lymphocyte count less than 900 and age over 65 were determined as the best set of NSI. By using best nutritional predictors receiver operating characteristic curve with the area under the curve, sensitivity and 1-specificity were analyzed to determine the best optimal cut-off point to decide normal or abnormal in nutritional status. Therefore simple and beneficial NSI was developed for identifying patients with severe malnutrition. Using NSI, nutritional information of the severe malnutrition patient should be shared with physicians and they should be cared for by clinical dietitians to improve their nutritional status.

Keywords

References

  1. Afsar B. Sezer S. Ozdemir FN. Celik H. Elsurer R. Haberal M (2006): Malnutrition- inflammation score is a useful tool in peritoneal dialysis patients. Perit Dial Int 26(6): 705-11
  2. Akpele L. Bailey JL (2004):Nutrition counseling impacts serum albumin levels. J Ren Nutr 14(3): 143-8 https://doi.org/10.1053/j.jrn.2004.04.003
  3. Bauer J. Capra S. Ferguson M (2002): Use of the scored Patient-Generated Subjective
  4. Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. European Journal of Clinical Nutrition 56: 779-785 https://doi.org/10.1038/sj.ejcn.1601412
  5. Bernstein L. Pleban W (1996): Prealbumin in nutrition evaluation. Nutrition. 12(4): 255-9 https://doi.org/10.1016/S0899-9007(96)90852-7
  6. Brugler L. Stankovic AK. Schlefer M. Bernstein L (2005):A simplified nutrition screen for hospitalized patients using readily available laboratory and patient information. Nutrition 21 (6): 650-8 https://doi.org/10.1016/j.nut.2004.10.012
  7. Calle EE. Thun MJ. Petrelli JM. Rodriguez C. Heath CW Jr (1999): Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 7; 341(15): 1097-105 https://doi.org/10.1056/NEJM199910073411501
  8. Corti MC. Guralnik JM. Salive ME. Srkin JD (1994) Disability as predictors of mortality in older persons. JAMA 272(13): 1036-42 https://doi.org/10.1001/jama.272.13.1036
  9. Delgado-Rodriguez M. Medina-Cuadros M. Gomez-Ortega A. Martinez-Gallego G, Miriscal-Ortiz M, Mutinez-Cbnzalez MA, Sillero-Arenas M (2002): Cholesterol and serum albumin levels as predictors of cross infection, death, and length of hospital stay. Arch Surg 137(7): 805-12 https://doi.org/10.1001/archsurg.137.7.805
  10. Dzieniszewski J, Jarosz M, Szczygiel B, Dlugosz J, Marlicz K, Linke K, Lachowicz A, Ryzko-Skiba M, Orzeszko M (2005): Nutritional status of patients hospitalised in Poland. Eur J Clin Nutr 59(4): 552-6 https://doi.org/10.1038/sj.ejcn.1602117
  11. Ferguson M, Capra S, Bauer J, Banks M (1999): Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 15(6): 458-64 https://doi.org/10.1016/S0899-9007(99)00084-2
  12. Goiburu ME, Goiburu MM, Bianco H, Diaz JR, Alderete F, Palacios MC, Cabral V, Escobar D, Lopez R, Waitzberg DL (2006) The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients. Nutr Hosp. 21 (5): 604-10
  13. Kim P Y, Seo AR, Kim MK, Lee YM (1999): Relationship of nutritional status at the time of admission to length of hospital stay(LOS) and mortality: A prospective study based on computerized nutrition screening. Journal of the Korean Dietetic Association 5(1): 48-53
  14. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN) (2003): ESPEN guidelines for nutrition screening 2002. Clin Nutr 22(4): 415-21 https://doi.org/10.1016/S0261-5614(03)00098-0
  15. Kondrup J, Rasmussen HH Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group (2003): Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22(3): 321-36 https://doi.org/10.1016/S0261-5614(02)00214-5
  16. Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA (2005) Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ).Clin Nutr 24(1): 75-82 https://doi.org/10.1016/j.clnu.2004.07.015
  17. Luis DA lzaola O, Cuellar L, Terroba MC Cabezas G,Rojo S, Aller R, Sagrado MG (2006): Nutritional assessment: predictive variables at hospital admission related with length of stay. Ann Nutr Metab. 50(4): 394-8 https://doi.org/10.1159/000094362
  18. Putwatana P, Reodecha P, Sirapo-ngam Y, Lertsithichai P, Sumboonnanonda K (2005):Nutrition screening tools and the prediction of postoperative infectious and wound complications: comparison of methods in presence of risk adjustment. Nutrition 21 (6): 691-7 https://doi.org/10.1016/j.nut.2004.10.015
  19. Reilly HM, Martineau JK, Moran A, Kennedy H.(1995): Nutritional screening-Evaluation and implementation of a simple Nutrition Risk Score. Clin Nutr 14(5): 269-73 https://doi.org/10.1016/S0261-5614(95)80063-8
  20. Ruiz-Lopez MD, Artacho R, Oliva P, Moreno-Torres R, Bolanos J, de Teresa C, Lopez MC (2003): Nutritional risk in institutionalized older women determined by the Mini Nutritional Assessment test: what are the main factors- Nutrition 19(9): 767-71 https://doi.org/10.1016/S0899-9007(03)00125-4
  21. Sungurtekin H, Sungurtekin U, Hanci V, Erdem E (2004):Comparison of two nutrition assessment techniques in hospitalized patients. Nutrition 20(5): 428-32 https://doi.org/10.1016/j.nut.2004.01.006
  22. Thomas DR, Zdrowski CD, Wilson MM, Conright KC, Lewis C, Tariq S, Morley JE (2002): Malnutrition in subacute care. Am J Clin Nutr 75(2): 308-13 https://doi.org/10.1093/ajcn/75.2.308
  23. Tomkins A (2001):Nutrition and maternal morbidity and mortality. Br J Nutr 85 Suppl 2: S93-9 https://doi.org/10.1079/BJN2001358
  24. Wong PW. Enriquez A. Barrera R (2001) Nutritional support in critically ill patients with cancer. Crit Care Clin 17(3): 743-67 https://doi.org/10.1016/S0749-0704(05)70206-2