Evaluation of clinical, laboratory, and electrophoretic profiles for diagnosis of malnutrition in hospitalized dogs

Abstract

Malnutrition is a major factor associated with increased rates of mortality and readmission, longer hospital stays, and greater health care spending. Recognizing malnourished or at-risk animals allows for nutritional intervention and improved prognosis. This study evaluated the association between clinical, laboratory, and electrophoretic variables and the nutritional status (NS) of hospitalized dogs in order to generate a profile of the sick dog and to facilitate the diagnosis of malnutrition. We divided 215 dogs into groups according to the severity of the underlying disease and we determined the clinical NS based on the assessment of the body condition score and the muscle mass score. The NS was classified as clinically well nourished, clinical moderate malnutrition, or clinical severe malnutrition. Statistical analyses were conducted by using the chi-square test or Fisher's exact test; the Kruskal-Wallis test was used for continuous variables. A strong association was found between malnutrition and the severity of the underlying disease. In hospitalized dogs, low body mass index values, anemia, low hemoglobin concentrations, high fibrinogen concentrations, decreased albumin fraction, and increased gammaglobulin fraction (in electrophoresis) were associated with malnutrition, reinforcing the classification of poor NS. However, the skin and coat characteristics, the total number of lymphocytes, blood glucose, cholesterol, and total protein concentration were not found to be good predictors of NS. Key words: Critical patients, nutritional status, undernutrition ResumoA desnutrição é um dos principais fatores relacionados ao aumento das taxas de morbimortalidade, de reinternação, maior tempo de hospitalização e gastos com cuidados na saúde. Reconhecer o animal desnutrido ou em risco permite a intervenção nutricional e melhora do prognóstico. O presente trabalho avaliou a relação dos resultados clínicos, laboratoriais e eletroforéticos com o estado nutricional (EN) de cães hospitalizados, de maneira a traçar o perfil do cão enfermo, facilitando o diagnóstico de desnutrição. Foram estudados 215 cães, divididos de acordo com a gravidade da doença de base e com o EN clínico, através da avaliação do escore de condição corporal e do escore de massa muscular. O EN foi classificado como clinicamente bem nutrido, desnutrição clínica moderada e desnutrição clínica severa. A análise estatística foi baseada no teste Qui-quadrado ou teste exato de Fisher. No caso de variáveis contínuas, o teste utilizado foi o de Kruskal-Wallis. Houve forte associação entre desnutrição e gravidade da doença de base. Foi observado em cães hospitalizados, que os baixos valores de índice

Clinical determination of the nutritional status of companion animals

“…In 2015, a study evaluated the BMI of 215 hospitalized dogs and observed a reduction in values in patients with severe clinical malnutrition but not in patients with moderate or subclinical malnutrition; therefore, the authors suggested that a low BMI reinforces the diagnosis of malnutrition but does not allow its early identification (Fabretti et al, 2015). Another study evaluated the BMI and BCS of 30 Labrador retriever dogs and showed disagreement in the interpretation of these techniques in 46.7% of the cases (Gama et al, 2016).…”

“…Another study evaluated the BMI and BCS of 30 Labrador retriever dogs and showed disagreement in the interpretation of these techniques in 46.7% of the cases (Gama et al, 2016). In summary, most studies show that the classification of NS based on BMI alone is not the best option because it does Clinical determination of the nutritional status of companion animals not reflect fat distribution and other factors, such as muscle or plasma volume, that affect this index directly (Muller et al, 2008;Fabretti et al, 2014Fabretti et al, , 2015Gama et al, 2016).…”

“…In addition, in critically ill patients, weight may be significantly altered due to water volume depletion or overload (Liu et al, 2012;Brunetto & Carcioffi, 2015). In accordance with the lack of specificity of BMI, some researchers consider it significant as an indicator of malnutrition only when its value is very low (Fabretti et al, 2015). It is noteworthy that WSAVA and the American Animal Hospital Association do not cite this method in their NS assessment guides (Baldwin et al, 2010;Freeman et al, 2011).…”

“…In veterinary and human medicine, approximately 50% of hospitalized patients are malnourished, and nutritional status (NS) usually worsens during hospitalization, especially in dogs and cats with critical illnesses (Mauldin & Davidson, 2007;Maicá & Schweigert, 2008;Saker & Remillard, 2010). In one study, malnutrition rates close to 60% were observed in 215 hospitalized dogs, and the severity of malnutrition was strongly associated with the severity of the underlying disease (Fabretti, Fonseca, Coelho, Silva, & Pereira, 2015).…”

“…However, in both human and veterinary medicine, the classification of patients as well-nourished or malnourished remains subjective, with no welldefined cutoff limits to characterize NS (Maicá & Schweigert, 2008;Eirmann, 2016;Michel, 2015Michel, , 2017. Thus, the classification is often based on the subjective interpretation of clinical case information (Fabretti et al, 2015;Michel, 2017). To circumvent these limitations, it is suggested that several methods of evaluating NS are used simultaneously (Maicá & Schweigert, 2008;Eirmann, 2016).…”