Korean Journal of Community Nutrition (대한지역사회영양학회지)

The Korean Society of Community Nutrition (대한지역사회영양학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Active Nutrition Care on Underweight Elderly Patients Receiving Long-term Enteral Tube Feeding

장기간 경관급식을 공급받는 노인 환자에 대한 적극적 영양관리의 효과

  • Yoon, Hwa-Young (Department of Food Science & Nutrition, The Catholic University of Korea) ;
  • Kim, Hye-Kyeong (Department of Food Science & Nutrition, The Catholic University of Korea)
  • 윤화영 (가톨릭대학교 생활과학부 식품영양학전공) ;
  • 김혜경 (가톨릭대학교 생활과학부 식품영양학전공)
  • Received : 2018.02.07
  • Accepted : 2018.02.21
  • Published : 2018.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: This study was performed to investigate the effect of active nutrition care on feeding and nutritional status of elderly patients receiving long-term enteral tube feeding. Methods: Subjects included 77 elderly patients who had received enteral nutrition more than one week before admission. Nutrition care was provided to patients supplied less calories than required. Feeding intolerance was examined and managed every day and formula was adjusted to meet nutritional requirement during the first 3 months after admission. Patients were classified into under or over 80% of percent ideal body weight (PIBW) and medical records were used to compare changes in weight,, biochemical indices, and nutritional status during the study. Results: Weight, BMI, triglyceride and total cholesterol in blood, hemoglobin, and hematocrit levels were significantly lower in patients under 80% of the PIBW than in those over 80% of the PIBW at admission. The percentage of supply to required calories was also lower in patients under 80% of the PIBW. After 1 month of nutritional care, supplied volume of formula was significantly increased in patients under 80% of the PIBW. Weight, BMI, and PIBW were increased and there were no differences between groups after 6 months. In addition, the concentrations of triglyceride and total cholesterol in blood, hemoglobin, and hematocrit tended to increase in patients under 80% of the PIBW, leading to no difference between groups after 3 months. Conclusions: Personalized active nutrition care is effective to increase weight and improve feeding and nutritional status in underweight elderly patients receiving long-term enteral nutrition.

Keywords

References

  1. Statistics Korea. Prospective statistics of Korean population 2015-2065 [internet]. Statistics Korea; 2016 [cited 2017 Sep 25]. Available from: http://www.kostat.go.kr/.
  2. Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging 2010; 5: 207-216.
  3. Chapman IM. Weight loss in older persons. Med Clin North Am 2011; 95(3): 579-593. https://doi.org/10.1016/j.mcna.2011.02.004
  4. Chung SS. Nutrition support methods in elderly patients. J Clin Nutr 2014; 6(1): 7-10. https://doi.org/10.15747/jcn.2014.6.1.7
  5. Silver AJ, Morley JE, Strome LS, Jones D, Vickers L. Nutritional status in academic nursing homes. J Am Geriatr Soc 1988; 36(6): 487-491. https://doi.org/10.1111/j.1532-5415.1988.tb04017.x
  6. Mitchell H, Porter J. The cost-effectiveness of identifying and treating malnutrition in hospitals: a systemic review. J Hum Nutr Diet 2016; 29(2): 156-164. https://doi.org/10.1111/jhn.12308
  7. Hebuterne X, Bozzetti F, Villares JM, Pertkiewicz M, Shaffer J, Staun M et al. Home enteral nutrition in adults: a European multicentre survey. Clin Nutr 2003; 22(3): 261-266. https://doi.org/10.1016/S0261-5614(03)00005-0
  8. Dorner B, Posthauer ME, Friedrich EK, Robinson GE. Enteral nutrition for older adults in nursing facilities. Nutr Clin Pract 2011; 26(3): 261-272. https://doi.org/10.1177/0884533611405794
  9. Lee JH, Cho KH, Rhee BA, Lee SH, Choue R. A study on nutritional status, biochemical parameters, lipid and electrolytes concentrations according to the duration of enteral nutrition tubefeeding. Korean J Nutr 2002; 35(5): 512-523.
  10. Park CM. Nutritional support in critically ill surgical patients. J Korean Soc Parenter Enter Nutr 2013; 5(1): 15-19.
  11. McClave SA, Sexton LK, Spain DA, Adams JL, Owens NA, Sullins MB et al. Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. Crit Care Med 1999; 27(7): 1252-1256. https://doi.org/10.1097/00003246-199907000-00003
  12. Seol E, Suh YS, Ju DL, Bae HJ, Lee HJ. Nutritional screening tool for in-hospital patients. J Clin Nutr 2016; 8(1): 2-10. https://doi.org/10.15747/jcn.2016.8.1.2
  13. Hedberg AM, Garcia N, Trejus IJ, Weinmann-Winkler S, Gabriel ML, Lutz AL. Nutritional risk screening: development of a standardized protocol using dietetic technicians. J Am Diet Assoc 1988; 88(12): 1553-1556.
  14. Lee JW, Lee MS, Kim JH, Son SM, Lee BS. Nutritional assessment. 2nd ed. Paju: Kyomunsa; 2006. p. 204-221.
  15. Shikora SA, Blackburn GL. Nutritional support: theory and therapeutics. London: Springer; 1997. p. 464-481.
  16. Mueller C, Compher C, Ellen DM. A.S.P.E.N. clinical guidelines: nutritional screening, assessment, and intervention in adults. J Parenter Enteral Nutr 2011; 35(1): 16-24. https://doi.org/10.1177/0148607110389335
  17. Martindale RG. McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary. Crit Care Med 2009; 37(5): 1757-1761. https://doi.org/10.1097/CCM.0b013e3181a40116
  18. Perissinotto E, Pisent C, Sergi G, Grigoletto F, Enzi G, ILSA Working Group. Anthropometric measurements in the elderly: age and gender differences. Br J Nutr 2002; 87(2):177-186. https://doi.org/10.1079/BJN2001487
  19. Park EK, Lee JH, Lim HS. Degree of enteral tube feeding in the intensive care unit and change in nutritional status. J Korean Diet Assoc 2001; 7(3): 217-226.
  20. Kim H, Choi SH, Ham YJ. Nutritional status and indicators of intensive care unit patients on enteral feeding. J Korean Acad Fundam Nurs 2009; 16(1): 21-29.
  21. Kim H, Shin JA, Shin JY, Cho OM. Adequacy of nutritional support and reasons for underfeeding in neurosurgical intensive care unit patients. Asian Nurs Res 2010; 4(2): 102-110. https://doi.org/10.1016/S1976-1317(10)60010-2
  22. Reid CL. Frequency of under-and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet 2006; 19(1): 13-22. https://doi.org/10.1111/j.1365-277X.2006.00661.x
  23. Adam S, Batson S. A study of problems associated with the delivery of enteral tube feed in critically ill patients in five ICUs in the UK. Intensive Care Med 1997; 23(3): 261-266. https://doi.org/10.1007/s001340050326
  24. Spain DA, McClave SA, Sexton LK, Adams JL, Blanford BS, Sullins ME et al. Infusion protocol improves delivery of enteral tube feeding in the critical care unit. J Parenter Enteral Nutr 1999; 23(5): 288-292. https://doi.org/10.1177/0148607199023005288
  25. Mackenie SL, Zygun DA, Whitmore BL, Doig CJ, Hameed SM. Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit. J Parenter Enteral Nutr 2005; 29(2): 74-80.
  26. Sullivan DH, Walls RC, Bopp MM. Protein-energy undernutrition and the risk of mortality within one year of hospital discharge: a follow-up study. J Am Geriatr Soc 1995; 43(5): 507-512. https://doi.org/10.1111/j.1532-5415.1995.tb06097.x
  27. Tayback M, Kumanyika S, Chee E. Body weight as a risk factor in the elderly. Arch Intern Med 1990; 150(5): 1065-1072. https://doi.org/10.1001/archinte.1990.00390170095021
  28. Galanos AN, Pieper CF, Cornoni-Huntley JC, Bales CW, Fillenbaum GG. Nutrition and function: is there a relationship between body mass index and the functional capabilities of community-dwelling elderly? J Am Geriatr Soc 1994; 42(4): 367-373.
  29. Peck A, Cohen CE, Mulvihill MN. Long-term enteral feeding of aged demented nursing home patients. J Am Geriatr Soc 1990; 38(11): 1195-1198. https://doi.org/10.1111/j.1532-5415.1990.tb01498.x
  30. Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 2006; 144(1): 37-48. https://doi.org/10.7326/0003-4819-144-1-200601030-00008
  31. Torun B. Protein-energy malnutrition. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ editor. Modern Nutrition in Health and Disease. 10th ed. LWW; 2005. p.881-908.
  32. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity [internet]. 2011 [cited 2017 Dec 10]. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf.
  33. Buzina R, Bates CJ, Beek J, Brubacher G, Chandra RK, Hallberg L et al. Workshop on functional significance of mild-to-moderate malnutrition. Am J Clin Nutr 1989; 50(1): 172-176. https://doi.org/10.1093/ajcn/50.1.172
  34. Wang J, Hong Z. Low plasma total cholesterol concentration: a sensitive evaluation marker in hospitalized patients with nutritional deficiency malnutrition. J Food Nutr Res 2014; 2(9): 551-555. https://doi.org/10.12691/jfnr-2-9-4
  35. Onder G, Landi F, Volpato S, Fellin R, Carbonin P, Gambassi G et al. Serum cholesterol levels and in-hospital mortality in the elderly. Am J Med 2003; 115(4): 265-271. https://doi.org/10.1016/S0002-9343(03)00354-1
  36. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22(4): 415-421. https://doi.org/10.1016/S0261-5614(03)00098-0
  37. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature: what does it tell us? J Nutr Health Aging 2006; 10(6): 466-485.
  38. Chung SH, Sohn CM. Nutritional status of hospitalized geriatric patients using by the mini nutritional assessment. Korean J Community Nutr 2005; 10(5): 645-653.