Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients

Buzby, Gordon P.; Knox, Linda S.; Crosby, Lon O.; Eisenberg, John M.; Haakenson, Clair; McNeal, George E; Page, Carey P.; Peterson, Osler L.; Reinhardt, George F.; Williford, William O.

doi:10.1093/ajcn/47.2.366

Cited by 306 publications

(168 citation statements)

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“…7 We used the Nutritional Risk Index as a screening tool for nutritional risk, because previous experiences support its use in the acute setting and because the score provides information about both protein-energy stores and the severity of disease. 13,[16][17][18] Our choice of the 75th percentile of the distribution of hospital stays as the threshold to identify prolonged length of stay was arbitrary, although sensible. A common threshold to define a prolonged hospital stay in relation to nutritional risk has never been identified, although a recent review of prevalence studies provided a weighted mean length of stay of 17 days in the presence of malnutrition.…”

Section: Discussionmentioning

confidence: 99%

“…Nutrition-related risk of complications was assessed with the use of the Nutritional Risk Index, as previously proposed by Buzby and colleagues. 13 The Nutritional Risk Index score is based on the patient's serum albumin concentration and the ratio of actual to usual weight (defined as the stable weight in the last six months), two parameters that have been shown to reflect disease severity and affect the prognosis of patients in hospital. 7,14 The score is derived as follows: (1.519 × serum albumin level, g/L) + (41.7 × actual/usual weight).…”

Section: Data Collectionmentioning

confidence: 99%

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Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients

Caccialanza¹,

Klersy²,

Cereda³

et al. 2010

Canadian Medical Association Journal

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Background:Comprehensive evaluations of the nutritional parameters associated with length of hospital stay are lacking. We investigated the association between malnutrition and length of hospital stay in a cohort of ambulatory adult patients. Methods:From September 2006 to June 2009, we systematically evaluated 1274 ambulatory adult patients admitted to hospital for medical or surgical treatment. We evaluated the associations between malnutrition and prolonged hospital stay (> 17 days [> 75th percentile of distribution]) using multivariable log-linear models adjusted for several potential nutritional and clinical confounders recorded at admission and collected during and at the end of the hospital stay.Results: Nutritional factors associated with a prolonged hospital stay were a Nutritional Risk Index score of less than 97.5 (relative risk [RR] 1.64, 95% confidence interval [CI] 1.31-2.06) and an in-hospital weight loss of 5% or greater (RR 1.60, 95% CI 1.30-1.97). Sensitivity analysis of data for patients discharged alive and who had a length of stay of at least three days (n = 1073) produced similar findings (adjusted RR 1.51, 95% CI 1.20-1.89, for Nutritional Risk Index score < 97.5). A significant association was also found with in-hospital starvation of three or more days (RR 1.14, 95% CI 1.01-1.28).Interpretation: Nutritional risk at admission was strongly associated with a prolonged hospital stay among ambulatory adult patients. Another factor associated with length of stay was worsening nutritional status during the hospital stay, whose cause-effect relationship with length of stay should be clarified in intervention trials. Clinicians need to be aware of the impact of malnutrition and of the potential role of worsening nutritional status in prolonging hospital stay. Previously published at www.cmaj.ca Abstract

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients

Caccialanza¹,

Klersy²,

Cereda³

et al. 2010

Canadian Medical Association Journal

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“…Infectious and non-infectious complications and date of discharge were recorded. Complications were categorized according to definitions given by Buzby et al (1988) and Gaynes and Horan (1999).…”

Section: Methodsmentioning

confidence: 99%

Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study

García²,

et al. 2010

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Background/Objectives: The prevalence of malnutrition in hospitals is high. No nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate nutritional risk in hospitalized patients using four nutritional screening tools. Subjects/Methods: Four nutritional screening tools were evaluated: nutritional risk screening (NRS-2002), the malnutrition universal screening tool (MUST), the subjective global assessment (SGA) and the mini nutritional assessment (MNA). Patients were assessed within the first 36 h after hospital admission. Date of admission, diagnosis, complications and date of discharge were collected. To compare the tools, the results were reorganized into: patients at risk and patients with a good nutritional status. The statistical analysis included the w 2 -test to assess differences between the tests and the k statistic to assess agreement between the tests.

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“…The Nutritional Risk Index (18,19) is derived from the serum albumin concentration and the ratio of actual to usual weight with the equation Nutritional Risk Index -(1.489 X serum albumin, g/L) -I-41.7 X (present weight/usual weight) (7) A Nutritional Risk Index > 100 indicates that the patient is not malnourished, 97.5-100 mild malnourishment, 83.5 to < 97.5 moderate malnourishment, and < 83.5 severe malnourishment. The usual weight was defined as the stable weight ^ 6 mo before admission.…”

Section: Assessment Methods For Malnutritionmentioning

confidence: 99%

Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications

Naber¹,

Schermer²,

Bree³

et al. 1997

The American Journal of Clinical Nutrition

342

177

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The prevalence of malnutrition and its predictive value for the incidence of complications were determined in 155 patients hospitalized for internal or gastrointestinal diseases. At admission, 45% of the patients were malnourished according to the Subjective Global Assessment (physical examination plus questionnaire), 57% according to the Nutritional Risk Index [(1.5 X albumin) + (41.7 X present/usual weight)], and 62% according to the Maastricht Index [(20.68 -(0.24 X albumin) -(19.21 X transthyretin (prealbumin) -(1.86 X lymphocytes) -(0.04 X ideal weight)]. Crude odds ratios for the incidence of any complication in malnourished compared with well-nourished pa tients during hospitalization were 2.7 (95% Cl: 1

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Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients

Cited by 306 publications

References 0 publications

Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients

Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients

Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study

Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications

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