A comparison between oral and nasogastric nutritional supplements in malnourished patients.

There is a common perception that malnutrition is an inevitable manifestation of illness, that oral nutritional supplements are not taken or reduce the consumption of oral diet, and that nasogastric feeding is poorly tolerated. This study assessed the efficacy of supplemental enteral feeding on the nutritional status of malnourished patients, to compare oral supplements (OS) with overnight supplemental nasogastric feeding (NG) on nutritional status and to determine the effect of nutritional supplements on oral diet. Malnourished hospital patients were randomized to one of three groups: control (C), OS, or NG. All patients had access to hospital diet. Supplements were prescribed to meet estimated nutritional needs. Nutritional status was recorded at the start and the end of the feeding period. The total nutritional intake was recorded. Weight gain occurred in 64% of the supplemented patients, whereas 73% of the controls lost weight with mean weight changes of +2.9% OS. +3.3% NG, and -2.5% C. There was no difference in the mean energy intake from food in the three groups. There were no documented complications of OS and three minor complications of NG. Both methods of supplementation allow weight gain without significantly affecting spontaneous oral intake.

The use, efficacy and monitoring of artificial nutritional support in a teaching hospital.

The implementation of circulated guidelines has been audited, by assessing the extent to which nutritional goals were set and achieved and recording the levels of morbidity as a result of complications. Adults receiving artificial nutritional support were studied over a six month period. Nutritional assessment was used to determine adequacy of prescription and efficacy of the support. Energy requirements were retrospectively calculated and compared with prescriptions and actual intakes. Complications and interruptions to the regimens which resulted in lost feeding time were recorded, as were patient outcomes. Nutrient prescriptions were inadequate, delivery of prescriptions was incomplete and thus nutrient supply inadequate.

An evaluation of insulin-like growth factor-1 as an indicator of nutritional status.

This study evaluated the usefulness of insulin-like growth factor-1 (IGF-1) as a marker of nutritional status in 185 hospitalised patients compared with conventional biochemical (albumin) and anthropometric parameters. C-reactive protein (CRP) was used as a biochemical marker of underlying illness. 77 (42%) patients were normally nourished or overweight and 108 (58%) were nutritionally depleted. IGF-1 and albumin were significantly lower in the malnourished patients as a group. However, in the malnourished patients with normal CRP, there was no correlation between albumin or anthropometric measurements and IFG-1. In malnourished patients with a raised CRP, there was no relationship between malnutrition determined by body mass index and anthropometry and either albumin of IGF-1 concentrations. In normally nourished patients with a raised CRP, there was a relationship between albumin and CRP; and IGF-1 and CRP and between albumin and IGF-1. IGF-1 was related to age in all groups of patients. We conclude that neither albumin nor IGF-1 can be reliably used to assess nutritional status.

The nutritional status of patients receiving home enteral feeding.

19 patients receiving home enteral nutrition (HEN) were nutritionally assessed, using anthropometry and blood analysis. Blood was taken for measurement of serum albumin, magnesium, zinc, copper, selenium and vitamins A and E. 8 patients had anthropometric evidence of protein and energy depletion, of whom 6 were severely depleted. 15 patients had biochemical evidence of trace element or vitamin depletion of whom 6 had multiple (>/= 3) depletion. Depletion occurred in all diagnostic categories, even in patients with normal anthropometric measurements, and was independent of duration, volume or method of feeding. We conclude that patients receiving HEN may be at risk of protein energy malnutrition and of developing vitamin or trace element deficiency states regardless of diagnosis, anthropometric measurements or duration of feeding. Therefore close nutritional monitoring of such patients is essential, and it is recommended that patients on HEN are supervised by clinicians with an appropriate interest.

Incidence and recognition of malnutrition in hospital.

OBJECTIVES: To determine incidence of malnutrition among patients on admission to hospital, to monitor their changes in nutritional status during stay, and to determine awareness of nutrition in different clinical units. DESIGN: Prospective study of consecutive admissions. SETTING: Acute teaching hospital. SUBJECTS: 500 patients admitted to hospital: 100 each from general surgery, general medicine, respiratory medicine, orthopaedic surgery, and medicine for the elderly. MAIN OUTCOME MEASURES: Nutritional status of patients on admission and reassessment on discharge, review of case notes for information about nutritional status. RESULTS: On admission, 200 of the 500 patients were undernourished (body mass index less than 20) and 34% were overweight (body mass index > 25). The 112 patients reassessed on discharge had mean weight loss of 5.4%, with greatest weight loss in those initially most undernourished. But the 10 patients referred for nutritional support showed mean weight gain of 7.9%. Review of case notes revealed that, of the 200 undernourished patients, only 96 had any nutritional information documented. CONCLUSION: Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition.