BACKGROUND

Critical ill patients are susceptible to protein catabolism associated with increased morbidity. This study assesses the target proteins achieved in patients receiving EN & its effect on clinical outcomes in the critically ill.

METHODS

Retrospective study conducted between January to December 2014 in the ICU of a tertiary care hospital. 47 adult patients in ICU receiving EN for > 3 days were included. The patients were categorized according to percentage of target proteins achieved (Group A >75% & B <75%). Baseline demographics, nutritional status and EN practice parameters were collected and analysed. The length of stay (LOS), ventilator free days and mortality in ICU were evaluated. RESULTS AND DISCUSSION Patients’ mean age was 63 ± 14.8y & body mass index 24.4±4.9. Subjective global assessment revealed that 30(64%) were moderately malnourished & 2(4%) were severely malnourished. An average of 88% & 59% target proteins was achieved in Groups A & B. The average target proteins achieved on the 3rd day was 78% and 50% on the 7th day for Group A. For Group B average target proteins achieved was 56% & 36% on the 3rd & 7th days. Mean feed interruption hours increased to 12.2hours by 7th day. Group B had a higher mean feed initiation time 33.2±40.3hours & interruptions of 35.1±47.5hours when compared with Group A (17.85±29.7 & 11.8±12.7hours). Average LOS & ventilator free days in ICU was less in the Group A (13.9±8.1 & 9.1±7.9). Mortality of 32% observed in Group B where percentage of proteins achieved was least. CONCLUSION Protein metabolism disturbances due to body’s evolutionary metabolic response is observed in the critically ill & negative protein balance secondary to severe disease is associated with poor clinical outcomes. Provision of optimal proteins mitigates protein loss & maybe associated with reduced LOS & mortality in the ICU & thereby improved health care costs.

Evolution of AICNU

Background

Understanding the role of anthropometric measurements is important for maintaining good health and avoiding obesity and malnutrition related medical problems. The purpose of this study was to evaluate the understanding of common anthropometric measurements such as height, weight and waist measurements among adults in an outpatient clinic by comparing their perceived and actual measurements.

Methods

A prospective, non-interventional study conducted in a free standing outpatient clinic from December 2014 to April 2015. All patients and attendants who consented to participate were included. Additionally volunteering healthcare professionals were included to compare perception of healthcare professionals with the non-medical general public. Participants were requested to complete a questionnaire with demographic information such as age, gender and occupation. In addition they were requested to document perceived anthropometric measurements and perceived level of physical fitness. They were also asked their opinion on importance of checking weight and their satisfaction about their current weight. Their actual height, weight and waist measurements were then measured and compared with their perceived measurements using Bland-Altman plots.

Results and Discussion

The study included 185 subjects (120M/65F; mean age–45.12?13.8; 59 healthcare professionals and 126 others). 85.4% of participants were confident about their weight, 71.9% of their height and 27.02% of their waist measurements. Participants underestimated their weight and waist measurement and overestimated their height. Mean differences for weight, height and waist measurements were 2.15kg, -0.18cm and 2 inches respectively. Range of agreement were (95%CI 6.71-11.03) for weight, (95%CI 8.07-8.44) for height and (95%CI 7.53-3.51) for waist measurement. Range of agreement was wide in both healthcare and non-healthcare groups (CI -6.73-4.95 and 10.48-7.81 respectively). On perceived fitness, 16.6% perceived themselves as excellently fit, 54.59% as above average, 7.5% as average and 21.6% as not fit. 87% participants (93.2% healthcare professionals) felt checking weight was important. 51.3% participants were unhappy with their weight, with a positive correlation between unhealthy BMI status and dissatisfaction.

Conclusion

In our study, a discrepancy existed between the actual and perceived anthropometric measurements of participants, irrespective of profession. Participants were generally more aware of their heights and weights than waist measurement. Participants with unhealthy BMI scores were more dissatisfied with their weight status.

Background

Nutrition status screening, assessment and monitoring is essential in the critically ill to reduce morbidity and mortality. Identifying patients’ at risk of malnutrition is usually difficult due to the nature of illness. Traditional screening methods are thought to be often limited due to their subjective nature. Purpose of this study is to determine the correlation of 3 different nutrition screening tools to classify the time consumed in identifying the risk of malnutrition.

Method

A sample of 44 patients expected to stay >24 hrs in ICU were assessed using the institution’s routine nutrition screening method; Subjective Global Assessment (SGA) & the NUTrition Risk in Critically ill (NUTRIC) score (age, APACHE II, SOFA, number of comorbidties, and days from hospital to ICU admission). Biochemical parameters, nutrient delivery, average length of stay (ALOS) in the ICU were also noted. GOS (Glasgow Outcome Scale) & Karnofsky performance status scale were the outcome scales used. Descriptive statistics & bivariate correlation were the statistical methods utilized.

Results

At risk of malnutrition was observed in 31.8% (n=14) using SGA, 27.3% (n=12) routine nutrition screening & 27.3% (n=12) NUTRIC score. There was significant correlation between all three tools (?*=0.05). Standard ALOS of <4.5 days (ICU) was seen in 18.2 %. Nutrient delivery of >75% was achieved among 72.7%. Only 6.8% had significant GOS (score 5) & 2.3% met the karnofsky performance status outcome (score 100).Time taken to complete routine nutrition screening, SGA & NUTRIC score, on an average was (approximately) 5, 7 and 15 minutes respectively.

Conclusion

On application of these tools, NUTRIC score is a more elaborate tool which includes various variables available in the ICU and is thought to be a superior score, by following it one may identify malnutrition appropriately. However the time taken for this new scoring system is higher. No significant difference in correlation was found between the traditional methods of nutrition screening and the NUTRIC score. Hence we had no added advantage of NUTRIC over traditional tools.

As a part of nutrition week, participants from AICNU 2015 who are leaders in their respective fields have taken the initiative to share the knowledge from attending AICNU 2015 with those who could not. The first such knowledge sharing session is happening in Chennai.

Knowledge sharing initiative – Key Learnings of AICNU-2015

Date :         9-9-2015 , (Wednesday)

Time :         1.00 PM

Venue:      Harmony Hall,

The Residency

49, G.N. CHETTY ROAD,

T.NAGAR, CHENNAI-600 017. TEL; 28253434,

Nutrition Week 2015 is celebrated from 1st September 2015 to 7th September 2015. The theme for this year is “Better Nutrition – Key to Development”.

Department of Dietitics, Apollo Group, has come up with a presentation for the common public to spread the awareness about balanced nutrition – as a part of the Nutrition Week 2015.

Download the AICNU Nutrition Week 2015 Flyer here

Comparative study of the nutritional status of a geriatric population of an urban housing complex and an old age home

Ms. B G Hazarika*, Ms. M Roy Chowdhury, Ms. S M Das

Department of Dietetics

Apollo Gleneagles Hospitals,Kolkata

Aim: To assess the nutritional status of a geriatric population in an urban community (kolkata).

Background: Elderly population contributed to 7% of total population of India in 2001and it will raise to 9% by 2016. In 2010,100 million people were aged above 60 years and by 2020 it will be 177 million. Ageing process is as such complex and multi-factorial. Chronic morbidities like diabetes and hypertension are becoming common health problems among the geriatric population.

Ageing is often accompanied by the occurrence of illness, which may increase the risk of nutritional deficiency. There is a need to compress the period of morbidity experienced by the elderly to minimize the occurrence of nutritional deficiency and improve well-being. Altered nutritional status is associated with the pathogenesis of a number of common diseases of the elderly. Thus it would appear that nutritional modulation represents one possible approach to successful ageing.

Method: Mini nutritional assessment (MNA) of Nestle Nutrition Institute was used to determine the screening score.

Results: Comparative scoring of the two facilities were surveyed. In the housing complex  about 55% female and 60% male were well nourished whereas in the old age home only about 5% of female and 7.28% of male were well nourished. 30% of female & 33% of male were at risk of malnourished in housing complex, whereas the percentage in the old age home was 33% & 92.8% respectively. Percentage of malnourished individuals in the housing complex was 15% for female & 7% for male. In the old age home mainly all the female population (62%) was malnourished.

Conclusion: Malnutrition prevailed among the members of the old age home. Psychological stress was common, which may be a factor of HTN. Sedentary lifestyle and over- eating may be a contributing factor towards the development of diabetes in the residence of the housing complex. In our study, the percentage of diabetes in housing complex and in old age home was 41% and 29% respectively, and that of hypertension it was 69% and 71%. It was observed that BMI above, 30 increased the prevalence of diabetes and hypertension. Counselling was done to improve the nutritional status of both the facilities. Continuous periodic contact sessions are carried out to bridge the nutritional gap and improve the quality of life of the geriatric population.

The abstracts selected for poster presentation are as follows:

Background

In critically ill patients, early enteral nutrition (EN)within 24 to 72 hours is recommended. Although vasopressor-dependent shock after resuscitation is not a contraindication for EN initiation, feasibility and safety of very early (within 6 hours) EN initiation soon after resuscitation are unknown.

Objective
To evaluate the feasibility, safety, tolerance, and adequacy of very EN delivery in critically ill patients within 6 hours of intensive care unit (ICU) admission.

Material and methods

Prospectively collected data from a total of 308 medical and surgical patients admitted to the ICU for at least 3 days were analyzed. The patients in whom EN was initiated within 6 hours of ICU admission (n = 166) were compared with those in whom EN was initiated after 6 hours (n = 142). Comparisons were made between groups in the percentage of target calories and proteins delivered on day 3, percentages of patients achieving target calories and proteins on day 3, incidence of feed intolerance, ICU length of stay (LOS), hospital LOS, ICU/hospital discharge, and mortality.

Results

No significant differences were seen in percentage of calories (71.62% vs 71.83%; P = .09) and proteins (71.85% vs 68.89%; P = .2) delivered on day 3 between patients receiving EN within 6 hours and after 6 hours of admission. Similar number of patients achieved target calories (66.3% vs 67.6%; P = .8) and target proteins (66.9% vs 62.7%; P = .5) on day 3 in both groups. There were no significant differences between the groups for ICU LOS (11.41 days vs 11.72 days; P = .7) and hospital LOS (20.7 days vs 17.96 days; P = .1). A total of 77.1%
patients were discharged in the group in whom EN was initiated within 6 hours and 67.6% patients were discharged in the group where EN was initiated after 6 hours (P = .07). The mortality rate was 22.9% and 32.4%, respectively (P = .07), in these groups. Overall incidence of EN interruption was 20.13% without significant difference between the 2 groups (b6 hours, 16.2%; N6 hours, 24.7%; P = .087).

Conclusion

Initiation of EN within 6 hours of ICU admission is feasible and safe and can be implemented routinely in all ICU patients.

Patients’ attitude towards nutritional therapy in a comprehensive sleep clinic: time for a wakeup call?

Ms. Hema Deenadayalan*, Ms. Lakshmi Ranganathan, Ms. Mary Isabel,
Dr. Nagarajan Ramakrishnan

Nithra Institute of Sleep Sciences, Chennai, India

Background: Nutritional therapy is an integral component of patient care. Its goal is to aid the medical management with appropriate diet, thereby preventing complications from incorrect eating habits. Hence, it is important that, even in outpatient clinics, registered dietitians provide formal counselling and dietary treatment. It is also essential that patients understand the importance of diet treatment for compliance. The purpose of this study was to assess the attitudes of patients towards the dietary treatment in an outpatient setting.

Methods: This is a retrospective study done in a free standing outpatient Sleep clinic, from October 2013 to March 2014. All new patients who presented to the Clinic were included and details like their BMI, diagnosis and prescribed treatment were collected. Patients who were advised diet modifications were monitored for follow up visits.

Results: In the study period, 181 new patients presented to the clinic for sleep problems (140 Males/ 41 Females, Age 47.4±16.12). Of these 181, 125 patients were advised to see the dietitian for diet treatment and weight reduction by the sleep specialist. All these 125 patients were overweight or obese (48.8% – overweight, 45.6% – obese and 5.6% – extremely obese). 120 out of 125 patients (96%) presented to the initial diet counselling and only 26 of them (21.6%) presented to a follow up session. Others (94) quoted lack of time (55.3%) and being unable to follow the prescribed diet guidelines (44.7%) as reasons for not presenting for follow up.

Conclusion: A significant number of overweight and obese patients accept initial diet counselling as prescribed by the Physician. However, a significant number of them do not follow up quoting lack of time and inability to comply as the primary reasons. The results suggest a lack of knowledge among healthcare seekers towards the role of nutritional therapy for wellness and disease management.