Protein-energy malnutrition reduces the quality of life, lengthens the time in hospital and dramatically increases mortality. Currently there is no simple and objective method available for assessing nutritional status and identifying malnutrition. The aim of this work is to develop a novel assistance system that supports the physician in the assessment of the nutritional status. Therefore, three subject groups were investigated: the first group consisted of 688 healthy subjects. Two additional groups consisted of 707 patients: 94 patients with primary diseases that are known to cause malnutrition, and 613 patients from a hospital admission screening. In all subjects bioimpedance spectroscopy measurements were performed, and the body composition was calculated. Additionally, in all patients the nutritional status was assessed by the subjective global assessment score. These data are used for the development and validation of the assistance system. The basic idea of the system is that nutritional status is reflected by body composition. Hence, features of the nutritional status, based on the body composition, are determined and compared with reference ranges, derived from healthy subjects' data. The differences are evaluated by a fuzzy logic system or a decision tree in order to identify malnourished patients. The novel assistance system allows the identification of malnourished patients, and it can be applied for screening and monitoring of the nutritional status of hospital patients.
Background: Fluid management is a central aspect of haemodialysis (HD). Body composition monitor (BCM)-measured overhydration (OH) can improve fluid management strategies, but there remains uncertainty about its use in subjects with high body mass index (BMI). This study explored whether the observed tendency for HD patients with high BMI to complete dialysis fluid depleted according to BCM is associated with an artefact in the BCM models, or with systematic differences in the prescription and delivery of treatment. Methods: To isolate the effect of BMI from effects relating to treatment, BCM measurements were made on 20 healthy subjects with high BMI. Mean OH was compared with a previously reported cohort of healthy subjects with normal BMI. To further explore BCM-measured OH in HD patients, measurements were made pre- and post-dialysis on 10 patients with high BMI alongside relative blood volume monitoring. Body shape was classified to assess associations between shape and OH. Results: The mean OH for healthy subjects with high BMI was -0.1 litres, which was not different from that of healthy subjects with normal BMI. Median BCM-measured OH for HD patients was 1.8 and -1.8 litres pre- and post-dialysis respectively, while blood volume and blood pressure were maintained. Body shape correlated with OH in control subjects but not HD patients. Conclusions: We found no evidence of systematic bias in BCM-measured OH with high BMI in healthy subjects. BCM-measured post-dialysis fluid depletion in asymptomatic patients with high BMI appears to result from greater tolerance of ultrafiltration and ability to maintain blood volume.
Protein-Energie-Mangelernährung bei Patienten reduziert die Lebensqualität, verlängert die Krankenhausverweildauer und erhöht drastisch die Mortalität. Aktuell existiert kein einfaches und objektives Verfahren zur Bestimmung des Ernährungsstatus und damit zur Erkennung von Mangelernährung. Mithilfe einer Bioimpedanzmessung kann mit einem neu entwickelten Expertensystem Mangelernährung bei Patienten erkannt werden. Die Funktionsweise des Expertensystems orientiert sich an der technischen Fehlerdiagnose.Protein-energy-malnutrition reduces the quality of life, lengthens the time in hospital and increases the mortality dramatically. Currently there is no simple and objective method available for assessing the nutritional status and thus identifying malnutrition. A newly developed expert system detects patients with malnutrition via a bioimpedance measurement. The system is based on the technical fault diagnosis.Schlagwörter: Mangelernährung, Bioimpedanzspektroskopie, Fehlerdiagnose
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