Impact of nutritional support on nutritional status and nitrogen balance in surgical patients of a developing country
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Abstract
To assess the nutritional status, its change after surgery and impact of nutritional support on urinary nitrogen losses (UNL) and nitrogen balance (NB) based on changing serum albumin levels in a developing country, 89 patient (58 M) aged 39 yrs ±15 were studied. Nutritional assessment was done at admission and 2 weeks postoperatively. UNL and NB was assessed on postoperative day one (D1), two (D2), four (D4), six (D6), eight (D8) and eleven (D11) respectively. Malnutrition varied from 27 (30.3%) using body mass index to 78 (87%) by triceps skin fold thickness. Patients with falling or static serum albumin levels (Group I) showed a significant decrease (‘p’ = 0.001) in their nutritional parameters compared to those with increasing albumin (Group II). Postoperatively till D2 both groups had similar negative NB but Group II improved earlier to become positively balanced by D11 (‘p’ < 0.001). Regression analysis of nitrogen intake (Ni) on UNL on each day revealed negative association till D2 to become positively associated from D4 onwards being significant on D4 (‘p’ = 0.001) & D6 (‘p’ = 0.05*). There is a significant nutritional depletion after surgery especially in patients with falling/static serum albumin levels and NB improves earlier in patients with rising albumin levels. Increasing Ni helps in decreasing UNL.
- Heymsfield, S.B., Tighe, A. and Wang, Z.-M. (1994) Nutritional assessment by anthropometric and biochemical methods. In: Shils, M.E., Olson, J.A. and Shike, M., Eds., Modern Nutrition in Health and Disease, Lea and Febiger, Malvern, 812-841.
- “BAPEN-Malnutrition Advisory Group: Guidelines for detection and management of malnutrition, Essex: BAPEN, 2000.
- Singh, H., Watt, K., Veitch, R., Cantor, M. and Duerksen, D. R., (2006) Malnutrition is prevalent in hospitalised medical patients: Are house staff identifying the mal-nourished patients?” Nutrition, 22, 352-354.
- Bavelaar, J.W., Otter, C.D., van Bodegraven, A.A., Thijs, A., VanBokhorst de Vander Scueren, M.A. (2008) Di-agnosis and treatment of a (disease-related) in hospital malnutrition: The performance of medical and nursing staff. Clinical Nutrition, 27, 431-438.
- Ben-Ishay, O., Gertsenzon, H., Mashiach, T., Kluger, Y., Chermesh, I. (2011) Malnutrition in Surgical Wards: A plea for Concern. Gastroenterology Research and Practice, 840512.
- Norman, K., Pichard, C., Lochs, H. and Pirlich, M. (2008) Prognostic impact of disease-related malnutrition. Clinical Nutrition, 27, 5-15.
- Soeters, P.B., Reijven, P.L., van Bokhorst-de van der Schueren, M.A., Schols, J.M., Halfens, R.J., Meijers, J.M. and van Gemert, W.G. (2008) A rational approach to nu-tritional assessment. Clinical Nutrition, 27, 706-716.
- Michael, L.C., Karen S., Stacy, J.B. and Marhew, W.L. (2006) Nitrogen balance, protein loss and the open ab-domen. Critical Care Medicine, 35, 127-131.
- ASPEN Board of Directors and the Clinical Guidelines Task Force (2002) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Journal of Parenteral and Enteral Nutrition, 26, 1SA-138SA
- Bistrian, B.R., Blackburn, G.L., Vitale, J., Cochran, d. and Naylor, J. (1976) Prevalence of malnutrition in general medical patients. Journal of the American Medical Asso-ciation, 235, 1567-1570.
- Gopalan, C., Rama, B.V, Sastri, S.C., Balasubramaniam, B.S., Narasinga, R., Deosthale, Y.G. and Pant, K.C. (2002) Nutritive Value of Indian Foods.
- Hawk, P.B. and Oser, B.L. (1976) Urinary Creatinine excretion and lean body mass. The American Journal of Clinical Nutrition, 29, 1359.
- Herendon, D.N. (1981) Nutritional assessment in surgical patients. In: Yaraborough, M.F. and Curreri, P.W. Eds., Contemporary Issues in Clinical Nutrition, 1-11.