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ORIGINAL ARTICLE
Year : 2015  |  Volume : 18  |  Issue : 6  |  Page : 757-761

Nutritional status and laboratory parameters among internal medicine inpatients


1 Department of Internal Medicine, Malatya State Hospital, Malatya 44100, Turkey
2 Department of Internal Medicine, Sakarya University, Medical Faculty, Sakarya, Turkey
3 Department of Internal Medicine, Rize Findikli State Hospital, Rize, Turkey
4 Department of Biostatistics, Sakarya University, Medical Faculty, Sakarya, Turkey

Date of Acceptance19-Mar-2015
Date of Web Publication20-Aug-2015

Correspondence Address:
M V Demir
Department of Internal Medicine, Malatya State Hospital, Malatya 44100
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.158145

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   Abstract 

Background: Malnutrition is a clinical state resulting in prolonged hospital stay, increase in severity of infections and poor wound healing.
Aims: Our aim was to investigate the prevalence and etiologic factors of malnutrition in medical inpatients.
Study Design: A total of 290 consecutively admitted internal medicine patients from February to May 2012 were included. On admission, demographic data, anthropometric measurements, laboratory parameters and nutritional screening test results were recorded.
Methods: Nutritional risk score-2002 for patients under 65 years old, mini nutritional assessment for older patients and subjective global assessment (SGA) tests performed. Relation of demographic characteristics, laboratory parameters, weight and body mass index (BMI) with nutritional status were evaluated.
Results: Mean age was 61 ± 17 years; 145 patients were male. Among 160 patients < 65 years old, 34 were in malnutrition (21%), 41 (26%) were under risk of malnutrition and 85 (53%) were normal. When they were divided into three groups according to SGA, we found significant difference in hemoglobin, low density lipoprotein (LDL), high density lipoprotein, cholesterol, triglyceride, albumin and protein, weight and BMI. Among 130 patients over 65 years old, 47 patients (37%) were in malnutrition, 41 (31%) were under risk of malnutrition and 42 (32%) were normal. There was significant difference in LDL, cholesterol, albumin, protein, weight and BMI between three groups; each 1 g/dl decrease in serum albumin and age older than 65 years old increased malnutrition risk 5.21 and 1.97 times, respectively.
Conclusion: Malnutrition risk is high among internal medicine inpatients and risk seems to be higher among older patients. Nutritional screening of geriatric patients, close follow-up and providing earlier health care would contribute rehabilitation of chronic diseases and decrease re-admissions.

Keywords: Internal medicine inpatients, malnutrition related laboratory parameters, nutritional status


How to cite this article:
Demir M V, Tamer A, Cinemre H, Uslan I, Yaylaci S, Erkorkmaz U. Nutritional status and laboratory parameters among internal medicine inpatients . Niger J Clin Pract 2015;18:757-61

How to cite this URL:
Demir M V, Tamer A, Cinemre H, Uslan I, Yaylaci S, Erkorkmaz U. Nutritional status and laboratory parameters among internal medicine inpatients . Niger J Clin Pract [serial online] 2015 [cited 2022 Jan 19];18:757-61. Available from: https://www.njcponline.com/text.asp?2015/18/6/757/158145


   Introduction Top


Malnutrition comprises various clinical states resulting from low (protein-energy malnutrition, vitamin and mineral deficiencies) or high (obesity) intake of macronutrients.[1] It is associated with prolonged hospital stay, increase in frequency of re-admissions, increase in frequency and severity of infections, poor wound healing, disturbance in walking, falls and fractures.[2]

Inpatient malnutrition prevalence and consequences have been studied extensively. Prevalence varies according to the countries and patient populations. Inpatient malnutrition prevalence was 44% in a study conducted in 1976.[3] Another study reported 44% malnutrition prevalence in 328 inpatients from internal medicine, surgery, orthopedics, and intensive care unit.[4] Yet another study found 46% malnutrition among patients admitted to inpatient clinics for acute disorders.[5]

In this study, our aim was to investigate the prevalence and etiologic factors of malnutrition in Internal Medicine inpatients.


   Methods Top


A total of 290 consecutive patients admitted to the Internal Medicine Clinic at Sakarya Education and Research Hospital from February 2012 to May 2012 have been included in this study. Patients in whom anthropometric measurements or nutrition tests couldn't have been performed, who were pregnant or younger than 18 years were excluded from the study.

The inpatient physician or nurse from the nutrition team evaluated all patients on admission. Patients' age, sex and admission diagnoses were recorded. Height and weight of all patients was measured. Admission laboratory results were obtained from patient charts. No additional test was performed for the study. Nutritional risk screening 2002 (NRS-2002) for patients under 65 years old, mini nutritional assessment (MNA) for older patients and subjective global assessment (SGA) tests for all patients were performed. A NRS-2002 total score ≥ 3 were labeled as malnutrition.[6][7][8] Patients were grouped as; those with good nutritional status (≥24), those under risk for malnutrition (17-23) or those with significant malnutrition (< 17) according to MNA evaluation. After recording the parameters of subjective global evaluation, patients were evaluated in three categories: (a) "Nutritional status good/sufficient," (b) "high risk of malnutrition" and (c) "severe malnutrition."

Concordances between NRS-2002 and SGA in patients under 65 years old and between MNA and SGA in patients above 65 years old were documented.

Patients were divided into two groups as under 65 and above 65 years old. Then the relation of demographic characteristics, laboratory parameters (hemoglobin, lymphocytes, serum low density lipoprotein (LDL), high density lipoprotein (HDL), cholesterol, triglyceride, albumin, and protein), weight and body mass index (BMI) to nutritional status was evaluated.

Patients were divided into two groups as normal nutritional status (SGA-A) and malnutrition (SGA B and C) according to their nutritional status. Then relation between the presence of malnutrition and studied parameters were evaluated.

Kolmogorov-Smirnov test was used to evaluate whether the distribution of variables were normal. Accordingly, it was seen that all variables displayed a normal distribution. Therefore, one-way analyses of variance (ANOVA) were used to compare groups. When ANOVA results were significant, Tukey test or Tamhane were used with regard to the results of Levene homogeneity tests in the paired comparison. The continuous variables were presented as the mean ± standard deviation. Cramer V coefficients was used for determining the concordance between SGA and NRS-2002 or MNA. A multivariate logistic regression model was implemented to determine the hematological parameters and other covariates associated with malnutrition. A P < 0.05 was considered significant. Analyses were performed using commercial software (IBM SPSS Statistics 20, SPSS Inc., an IBM Co., Somers, NY, USA).

Ethics statement

This study was conducted according to the guidelines laid down in the declaration of Helsinki and all procedures involving human subjects/patients were approved by the Sakarya University Medicine Faculty Ethics Committee (issue no: B.30.2.SAU.0.20.05.04-050.01.04/5).


   Results Top


A total of 290 patients (mean age 61 ± 17 years; 145 male, 145 male) were included in the study. Demographic characteristics, admission diagnoses, anthropometric measurements, and laboratory parameters are summarized in [Table 1].
Table 1: Demographic characteristics and laboratory parameters of the patients


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Concordance between nutritional screening tests NRS-2002, MNA and SGA were shown statistically [Table 2] and [Table 3].
Table 2: Concordance between SGA and NRS-2002


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Table 3: Concordance between SGA and MNA


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Evaluation of 160 patients under 65 years old according to SGA revealed that 85 patients (53%) were normal, 41 patients (26%) were under risk of malnutrition and 34 patients were in malnutrition (21%). When these patients were separated into three groups according to SGA, we found statistically significant difference in hemoglobin, serum LDL, HDL, cholesterol, triglyceride, albumin and protein, weight and BMI between three groups [Table 4].
Table 4: Comparisons of the hematological and other characteristics between three groups of patients aged <65


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When 130 patients over 65 years old were studied according to SGA, 42 patients (32%) were normal, 41 patients (31%) were under risk of malnutrition development, and 47 patients (37%) were in malnutrition. After separating into three groups, there was statistically significant difference in serum LDL, cholesterol, albumin, protein, weight and BMI between three groups [Table 5].
Table 5: Comparisons of the hematological and other characteristics between three groups of patients with aged >65


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We compared the hematological and other characteristics between the nutritional status groups. We found statistically significant relation between malnutrition risk and serum LDL, cholesterol, albumin, protein, weight and BMI (P > 0.05) [Table 6].
Table 6: Comparisons the hematological and other characteristics between nutritional status groups


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We performed multiple logistic regression analysis of malnutrition and associated parameters in all patients. It revealed that each 1 g/dl decrease in serum albumin increased malnutrition risk 5.21 times; age older than 65 years old increased malnutrition risk 1.97 times [Table 7].
Table 7: A multivariate logistic regression model of the hematological parameters and other covariates associated with malnutrition


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   Discussion Top


Malnutrition is a prevalent clinical disorder especially among inpatients and geriatric population. It has well-proven negative effects on patient morbidity and mortality but is usually underestimated by the clinician and when diagnosed, mostly not appropriately treated.[2],[9]

Nutritional risk screening-2002 in general and MNA in elderly are useful tests in the evaluation of malnutrition. Detsky et al. developed a method providing good correlation between subjective criteria and objective measurements in 1987.[6] This index, that is, subjective global evaluation is an important method because of simplicity and providing predictive efficacy comparable to objective measurements.[7],[10],[11] In studies comparing SGA with classical methods, SGA was reported to have 80% positive predictive value.[7] We applied MNA for patients above 65 years old, NRS-2002 for younger patients and SGA for all patients in our study. We statistically evaluated the results of SAG, MNA, and NRS-2002 for standardization purposes. We also studied the data of all patients according to SGA.

In published studies, malnutrition prevalence on admission was reported to be 40% while nutritional status was worsening further in 78% of patients during ongoing admission.[3] In our country, these rates vary between 3.9% and 52% according to the admitting clinic.[12][13][14] Our study included 290 patients admitted to internal medicine clinic. We found that 127 patients (44%) were in normal nutritional status, 82 patients (28%) were under malnutrition risk, and 81 patients (28%) were in malnutrition. Taking into account that our patients were admitted to Internal Medicine clinic, our rates of malnutrition were high. This might be related to admission of oncologic patients in late stages of their diseases or admission of already progressed malnutrition cases to our clinic.

Studies on malnutrition prevalence among geriatric patients reported that malnutrition prevalence was 2-32% among "healthy" elderly living in their own homes, 15% among home-bound patients, 23-62% among inpatients and 85% in nursing home residents.[15][16][17] In a study conducted in 1999, severe malnutrition prevalence was found to be 16% among 369 patients over 70 years old who were admitted to internal medicine clinic and mortality rate has been found to be 2.8 times higher in this group.[6] Our results revealed 68% and 47% malnutrition prevalence among patients over 65 years old and under 65 years old, respectively. We also found that malnutrition risk was 1.97 times higher in patients over 65 years old.

In studies investigating parameters associated with malnutrition risk, Hemoglobin level, lymphocyte count, serum total cholesterol and albumin levels and BMI were studied.[18][19][20][21] When we separated patients above and under 65 y/o into three groups according to SGA, we found statistically significant relation between malnutrition risk and serum LDL, cholesterol, albumin, protein, weight and BMI (P > 0.05). In addition, we found a significant relation between malnutrition and hemoglobin levels when we further analyzed the parameters in patients under 65 years old (P > 0.05).

Albumin is one of the most frequently used parameters in the evaluation of nutritional status. There is a close association between serum albumin levels and mortality among both normal population and patients admitted to hospital.[22][23][24] In our study, we found that albumin and protein levels were significantly lower in patients with malnutrition compared to patients with normal nutritional status. Moreover, we found that malnutrition risk increased 5.21 times for every 1 gr/dl decrease in serum albumin levels.

Determination of nutritional status and providing nutritional support are the responsibilities of physicians. Malnutrition risk is high in all patients admitted to internal medicine clinic and this risk seems to be higher especially among patients older than 65 years. We suggest nutritional screening of geriatric patients especially with chronic disease. Close follow-up and providing earlier health care would greatly contribute rehabilitation of chronic diseases and decrease re-admission rates in this patient population.

 
   References Top

1.
Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools. Nutrition 2000;16:50-63.  Back to cited text no. 1
    
2.
Covinsky KE, Martin GE, Beyth RJ, Justice AC, Sehgal AR, Landefeld CS. The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients. J Am Geriatr Soc 1999;47:532-8.  Back to cited text no. 2
    
3.
Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. JAMA 1976;235:1567-70.  Back to cited text no. 3
[PUBMED]    
4.
Lamb CA, Parr J, Lamb EI, Warren MD. Adult malnutrition screening, prevalence and management in a United Kingdom hospital: Cross-sectional study. Br J Nutr 2009;102:571-5.  Back to cited text no. 4
    
5.
Martínez Olmos MA, Martínez Vázquez MJ, Martínez-Puga López E, del Campo Pérez V, Collaborative Group for the Study of Hospital Malnutrition in Galicia (Spain). Nutritional status study of inpatients in hospitals of Galicia. Eur J Clin Nutr 2005;59:938-46.  Back to cited text no. 5
    
6.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al.What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987;11:8-13.  Back to cited text no. 6
    
7.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415-21.  Back to cited text no. 7
    
8.
Bauer JM, Kaiser MJ, Anthony P, Guigoz Y, Sieber CC. The Mini Nutritional Assessment – its history, today's practice, and future perspectives. Nutr Clin Pract 2008;23:388-96.  Back to cited text no. 8
    
9.
Simon AR. Virtual clinical nutrition university: Malnutrition in the elderly, epidemiology and consequences. Eur E J Clin Nutr Metab 2009;4:e86-9.  Back to cited text no. 9
    
10.
Barone L, Milosavljevic M, Gazibarich B. Assessing the older person: Is the MNA a more appropriate nutritional assessment tool than the SGA? J Nutr Health Aging 2003;7:13-7.  Back to cited text no. 10
    
11.
Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The mini nutritional assessment. Clin Geriatr Med 2002;18:737-57.  Back to cited text no. 11
    
12.
Nursal TZ, Noyan T, Atalay BG, Köz N, Karakayali H. Simple two-part tool for screening of malnutrition. Nutrition 2005;21:659-65.  Back to cited text no. 12
    
13.
Sungurtekin H, Gürses E, Hancı V, Sungurtekin U. Hospitalize hastalarda malnütrisyonun nütrisyonel risk indeksi ile saptanması. Türk Anesteziyoloji ve Reanimasyon Derneği Dergisi 2003;31:368-72..  Back to cited text no. 13
    
14.
Korfali G, Gündogdu H, Aydintug S, Bahar M, Besler T, Moral AR, et al.Nutritional risk of hospitalized patients in Turkey. Clin Nutr 2009;28:533-7.  Back to cited text no. 14
    
15.
Seiler WO. Clinical pictures of malnutrition in ill elderly subjects. Nutrition 2001;17:496-8.  Back to cited text no. 15
    
16.
Niedert KC. Position of the American Dietetic Association: Liberalized diets for older adults in long term care. J Am Diet Assoc 2005;105:1955-65.  Back to cited text no. 16
    
17.
Crogan NL, Pasvogel A. The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci 2003;58:159-64.  Back to cited text no. 17
    
18.
Landi F, Onder G, Gambassi G, Pedone C, Carbonin P, Bernabei R. Body mass index and mortality among hospitalized patients. Arch Intern Med 2000;160:2641-4.  Back to cited text no. 18
    
19.
Segall L, Covic A, Mardare N, Ungureanu S, Marian S, Busuioc M, et al.Nutritional status evaluation in maintenance hemodialysis patients. Rev Med Chir Soc Med Nat Iasi 2008;112:343-50.  Back to cited text no. 19
    
20.
Mitrache C, Passweg JR, Libura J, Petrikkos L, Seiler WO, Gratwohl A, et al.Anemia: An indicator for malnutrition in the elderly. Ann Hematol 2001;80:295-8.  Back to cited text no. 20
    
21.
Payette H, Rola-Pleszczynski M, Ghadirian P. Nutrition factors in relation to cellular and regulatory immune variables in a free-living elderly population. Am J Clin Nutr 1990;52:927-32.  Back to cited text no. 21
    
22.
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al.The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619-36.  Back to cited text no. 22
    
23.
Rothschild MA, Oratz M, Schreiber SS. Albumin synthesis 1. N Engl J Med 1972;286:748-57.  Back to cited text no. 23
[PUBMED]    
24.
Sullivan DH. What do the serum proteins tell us about our elderly patients? J Gerontol A Biol Sci Med Sci 2001;56:M71-4.  Back to cited text no. 24
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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