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Nutritional Risk Screening in Hospitalized and Haemodialysis Patients. Brankica Mijandru{i} Sin~i}1, Lidija Orli}1, Dubravka Er`en Juri{i}1, Gordana Ken|el2,.
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Coll. Antropol. 31 (2007) 2: 435–439 Original scientific paper

Nutritional Risk Screening in Hospitalized and Haemodialysis Patients Brankica Mijandru{i} Sin~i}1, Lidija Orli}1, Dubravka Er`en Juri{i}1, Gordana Ken|el2, Elena Gomba~3, Barbara Kveni}3 and Davor [timac1 1 2 3

Department of Internal Medicine, University Hospital Center »Rijeka«, Rijeka, Croatia Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia School of Medicine, University of Rijeka, Rijeka, Croatia

ABSTRACT Malnutrition is an independent risk factor impacting on higher complications and increased length of hospital stay and costs. The aim of this study was to determine the prevalence of nutritional risk among patients on regular haemodialysis (HD) (Group I, N=105) and among the patients at Gastroenterology, Endocrinology, Hematology and Clinical Immunology (Group II, N=652). Cross-sectional nutritional evaluation was done using Nottingham Hospital Screening Tool (NS). The prevalence of nutritional risk was 9% in Group I and 21% in Group II (p=0.0002). We found statistically significant larger quantity of malnourished patients among acute internistic patients than among chronic from the same Group II. Malnutrition among patients on HD didn’t differ statistically to chronic internistic patients. We didn’t found a significantly higher percentage of nutritional risk among elderly patients (65 years and more). Correlation between body mass index (BMI) and NS was significant, but weak (r=–0.32). We can conclude that the prevalence of nutritional risk among HD patients was lower than we had expected. It seems that the screening tool we used is not sensitive enough for HD patients and needs further investigations. Key words: nutritional risk, malnutrition, Nottingham screening tool, haemodialysis

Introduction Clinical nutrition is a fundamental component of general clinical care as well as acute and chronic disease management. Medical awareness of the patients’ nutritional status still seems to be insufficient to current date all over Europe1. Malnutrition is an independent risk factor impacting on higher complications and increased morbidity, mortality, length of hospital stay and costs2–4. Of patients admitted to hospitals, 35–55% are malnourished on admission; 25–30% more become malnourished during stay. Approximately 50% of hospitalized patients are malnourished to some degree5–8. This percentage is even higher in the malignant and old age groups9–12. Malnutrition is a common complication among chronic haemodialysis (HD) patients. It has been suggested that there may be at least two fundamentally different types of malnutrition in patients with chronic renal insufficiency. The first is related to low protein and energy in-

take. The second type of malnutrition is associated with inflammation and cardiovascular disease13. The prevalence of malnutrition among HD patients is more than 50% 4,13–16. Many evaluations of the nutritive status have been used, alone or in combination, to diagnose malnutrition. Some of the methods are too complex, costly and time consuming, or too specialized for implementation on a hospital-wide basis. There is no universally accepted definition of malnutrition. This are the reasons why diagnosis of malnutrition is usually based on the association of recent weight loss, inadequacy of dietary intake, low body mass index (BMI) and the presence of disease damaging nutritional status. The aim of this study was to detect the prevalence of nutritional risk among patients being on chronic HD and among non-malignant internistic patient by using simple screening tool.

Received for publication March 14, 2003

435

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B. Mijandru{i} Sin~i} et al: Nutritional Risk in Patients, Coll. Antropol. 31 (2007) 2: 435–439 TABLE 2 THE MOST FREQUENT DIAGNOSES

Patients and Methods Patients Cross-sectional nutritional evaluation was done among 105 HD outpatients (Group I) and 652 consecutive internistic patients (Group II) at Clinical Hospital Centre Rijeka, Croatia. The number of patients, the distribution of age and gender of Group I and Group II are given in Table 1.

TABLE 1 DEMOGRAPHIC DATA OF THE PATIENTS

Parameters

Group II (N=652)

Total (N=757)

mean

63.5

60.7

61.1

SD

13.5

16.0

15.7

22–88

17–91

17–91

65

65

65

Age (years)

median Gender male

49

349

398

female

56

303

359

N – number of patients, SD – standard deviation, p