Jomyaku Keicho Eiyo

Malnutrition causes decrease in body mass, immunodeficiency, delay in wound healing, and organ dysfunction. To prevent these events, malnutrition should be detected as soon as possible. Nutrition and Electrolyte Support Team (NEST) have adopted body composition measure apparatus by multiple-frequency bioelectrical impedance analysis (BIA) as nutritional assessment because the apparatus is non-invasive, and relatively simple and not expensive. However, some of patients who are managed by NEST do not have accurate measurements of multiple-frequency BIA. On the basis of this knowledge, we investigated the differences between patients who were measureable and immeasurable in multiple-frequency BIA. About 11% of patients who were managed by NEST were immeasurable in multiple-frequency BIA. Immeasurable group shows higher body mass index, white blood cell counts and serum levels of urea nitrogen, and lower serum albumin levels compared with measureable group. These findings suggest that immeasurable group tends to be edematous and dehydration in blood vessels. Nutritional assessment of patients who are immeasurable in multiple-frequency BIA is future consideration.

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Objective: To examine the utility of a Desire to Eat (DETEA) scale as a tool for nutritional assessment in elderly inpatients at an acute hospital.
Subjects and Methods: The study included 116 elderly patients (mean age, 84.5 ± 7.0 years) who were admitted to an acute geriatric hospital and who received nutritional intervention from a nutritional support team (NST). The desire to eat in these patients was assessed before and after the nutritional intervention, using a DETEA questionnaire and was graded in a 4-point scale. The correlations between DETEA scores and nutrition-related indices (total energy intake, body mass index [BMI], and serum albumin and C-reactive protein (CRP) levels) were assessed before the intervention. Additionally, the correlations between changes in the DETEA score and nutrition-related indices were assessed after the nutritional intervention.
Results: Both DETEA scores and serum albumin levels increased after the intervention by the NST. A significant correlation was observed between the changes in the DETEA score and serum albumin level after the intervention. Patients with a high DETEA score before the intervention had a high total energy intake and BMI at the end of the intervention.
Multiple regression analysis showed that the increase in the serum albumin level was independently associated with the increase in the DETEA score and BMI, and the decrease in the CRP level.
Conclusion: The DETEA score was associated with nutrition-related indices before and after the intervention by the NST. The DETEA scale is an important tool for nutritional assessment in elderly inpatients at an acute geriatric hospital.

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【Aim】We investigated the predictive factor among clinical parameters on admission in the patients hospitalized with worsening heart failure.
【Patients and Methods】The subjects were 147 patients worsening heart failure who had been admitted from December 2011 to December 2012 to Saiseikai Matsusaka General Hospital. We categorized them into two groups, survival group and death group. We studied the relationship among age, physical measurement and blood biochemical examination on admission and outcome in heart failure patients.
【Results】In-hospital mortality rate in our subjects was 13.6% (20 of 147). In the clinical parameters, multivariate analysis revealed that Onodera's prognostic nutritional index(PNI) value was most reliable predictive factor for mortality of heart failure patients. Also estimated glomerular filtration rate(eGFR) value was found to be related with death. We tried to determine those cut off values of PNI and eGFR value by receiver-operating characteristic curve. The former was 40, and the latter was 36. Kaplan-Meier analysis showed that eGFR value was more powerful predictor than PNI value at long-term prognosis.
【Conclusion】We concluded that PNI value was the most powerful predictive factor for in-hospital mortality, and eGFR was more powerful predictor at long-term prognosis among clinical parameters in heart failure patients.Therefore, the early intervention though nutrition therapy may improve the outcome in heart failure patients to PNI value <40.

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