Abstract
Background:
Several guidelines recommend systematic screening for malnutrition in elderly inpatients for early dietary intakes assessment and treatment, but data demonstrating the efficacy of such interventions are scarce. The aim of this study was to evaluate a critical medical pathway for the detection and management of malnutrition in elderly inpatients.
Methods:
In a 3-month prospective controlled study, 694 recently admitted inpatients were assigned to an intervention group (critical medical pathway; n=465) or a standard care control group (n=229). Nutritional status was assessed at the time of admission with a Mini Nutritional Assessment. A renutrition program tailored to the initial dietary assessment results was applied in the intervention group. The efficacy of the program was verified by measuring the evolution of serum insulin-like growth factor 1 (IGF-I) between admission and 3 weeks later.
Results:
In the intervention group at baseline, 23% were malnourished, 51% were at risk and 26% were eunourished. Serum IGF-I increased in the intervention group (from 84±45 μg/l to 95±50 μg/l, P<0.0001; mean±s.d., n=209), but remained stable in the controls (from 79±43 μg/l to 81±35 μg/l, P=0.4; n=99), with a statistically significant between group difference (P<0.01).
Conclusion:
Early malnutrition assessment and targeted renutrition program in elderly inpatients were associated with an increase in serum IGF-I. It remains to be determined whether such variations are clinically relevant.
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References
Guigoz Y . The Mini Nutritional Assessment (MNA) review of literature - What does it tell us? J Nutr Health Aging 2006; 10: 466–485.
Sullivan D, Sun S, Walls R . Protein-energy undernutrition among elderly hospitalized patients: a prospective study. JAMA 2002; 281: 2013–2019.
Correia MI, Waitzberg DL . The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003; 22: 235–239.
Mainous M, Deitch E . Nutrition and infection. Surg Clin N Am 1994; 74: 659–676.
Heymsfield SB, Bethel RA, Ansley JD, Gibbs DM, Felner JM . Nutter DO. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J 1978; 95: 584–594.
Milne AC, Potter J, Vivanti A, Avenell A . Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2009, CD003288.
Commitee of Ministers. Resolution ResAP(2003)3 on food and nutritional care in hospitals. 12 Nov 2003 (available at https://wcd.coe.int/ViewDoc.jsp?Ref=ResAP(2003)3&Language=lanEnglish&Site=CM&BackColorInternet=9999CC&BackColorIntranet=FFBB55&BackColorLogged=FFAC75).
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M . ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415–421.
Russell MK, Andrews MR, Brewer CK, Rogers JZ, Seidner DL . Standards for specialized nutrition support: adult hospitalized patients. Nutr Clin Pract 2002; 17: 384–391.
Guigoz Y, Vellas B . The Mini Nutritional Assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Programme 1999; 1: 3–11. ; discussion 2–11.
Kondrup J, Johansen N, Plum LM, Bak L, Larsen IH, Martinsen A et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 2002; 21: 461–468.
Chumlea W, Baumgartner R . Status of anthropometry and body composition data in elderly subjects. Am J Clin Nutr 1989; 50: 1158–1166.
Charlson ME, Pompei P, Ales KL, MacKenzie CR . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.
Petitpierre NJ, Trombetti A, Carroll I, Michel JP, Herrmann FR . The FIM instrument to identify patients at risk of falling in geriatric wards: a 10-year retrospective study. Age Ageing 2010; 39: 326–331.
Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP . Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1998; 128: 801–809.
Fiatarone MA, Evans WJ . The etiology and reversibility of muscle dysfunction in the aged. J Gerontol 1993; 48, Spec No 77–83.
Chandra RK . The relation between immunology, nutrition and disease in elderly people. Age Ageing 1990; 19: S25–S31.
Arora NS . Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis 1982; 126: 5–8.
Johansen N, Kondrup J, Plum LM, Bak L, Norregaard P, Bunch E et al. Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr 2004; 23: 539–550.
Roberts M, Potter J, McColl J, Reilly J . Can prescription of sip-feed supplements increase energy intake in hospitalised older people with medical problems? Br J Nutr 2003; 90: 425–429.
Gazzotti C, Arnaud-Battandier F, Parello M, Farine S, Seidel L, Albert A et al. Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial. Age Ageing 2003; 32: 321–325.
Pepersack T, Corretge M, Beyer I, Namias B, Andr S, Benoit F et al. Examining the effect of intervention to nutritional problems of hospitalised elderly: a pilot project. J Nutr, Health Aging 2002; 6: 306–310.
Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MA . Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 2005; 82: 1082–1089.
Pinchcofsky GD, Kaminski MV Jr. . Increasing malnutrition during hospitalization: documentation by a nutritional screening program. J Am Coll Nutr 1985; 4: 471–479.
Teale JD, Marks V . The measurement of insulin-like growth factor I: clinical applications and significance. Ann Clin Biochem 1986; 23 (Pt 4), 413–424.
Burgess EJ . Insulin-like growth factor 1: a valid nutritional indicator during parenteral feeding of patients suffering an acute phase response. Ann Clin Biochem 1992; 29 (Pt 2), 137–144.
Minuto F, Barreca A, Adami GF, Fortini P, Del Monte P, Cella F et al. Insulin-like growth factor-I in human malnutrition: relationship with some body composition and nutritional parameters. JPEN J Parenter Enteral Nutr 1989; 13: 392–396.
Unterman TG, Vazquez RM, Slas AJ . Martyn PA, Phillips LS. Nutrition and somatomedin. XIII. Usefulness of somatomedin-C in nutritional assessment. Am J Med 1985; 78: 228–234.
Campillo B, Paillaud E, Bories PN, Noel M, Porquet D, Le Parco JC . Serum levels of insulin-like growth factor-1 in the three months following surgery for a hip fracture in elderly: relationship with nutritional status and inflammatory reaction. Clin Nutr 2000; 19: 349–354.
Milne AC, Avenell A, Potter J . Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 2006; 144: 37–48.
Volkert D, Berner YN, Berry E, Cederholm T, Coti Bertrand P, Milne A et al. ESPEN guidelines on enteral nutrition: geriatrics. Clin Nutr 2006; 25: 330–360.
Fiatarone M, ONeill E, Ryan N . Exercise training and nutritionnal supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 1769–1775.
Holyday M, Daniells S, Bare M, Caplan GA, Petocz P, Bolin T . Malnutrition screening and early nutrition intervention in hospitalised patients in acute aged care: a randomised controlled trial. J Nutr Health Aging 2012; 16: 562–568.
Gueorguieva R, Krystal JH . Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Arch Gen Psychiatry 2004; 61: 310–317.
Acknowledgements
We thank the Geneva University Hospitals for their financial support. We thank Rosemary Sudan and Katy Giroux for editorial assistance.
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Contributors: AT participated to study design, data collection, statistical analysis and interpretation and writing of the paper. JC coordinated the study, contributed to study design, data interpretation and writing of the paper. FH contributed to the statistical analysis and critical revision of the manuscript. RR participated in the study design, data statistical analysis and interpretation and writing of the paper.
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Trombetti, A., Cheseaux, J., Herrmann, F. et al. A critical pathway for the management of elderly inpatients with malnutrition: effects on serum insulin-like growth factor-I. Eur J Clin Nutr 67, 1175–1181 (2013). https://doi.org/10.1038/ejcn.2013.166
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DOI: https://doi.org/10.1038/ejcn.2013.166
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