ORIGINAL ARTICLEValue of body mass index in the detection of severe malnutrition: influence of the pathology and changes in anthropometric parameters
Introduction
There is a growing awareness that malnutrition must be recognized in hospitalized patients because malnutrition in these patients is still frequent and affects outcome and costs. Furthermore, recent reports of disease-related malnutrition have demonstrated that too few patients receive appropriate nutritional support.1., 2., 3., 4. There is no universally accepted definition of malnutrition, 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.5 BMI is a simple tool which can be universally used, and when <20, is admitted as a marker of malnutrition. However, whereas it is well known that overt fluid retention is a limiting factor in the interpretation of BMI, little is known about the value of BMI in the detection of malnutrition in various clinical conditions where changes in body composition may vary according to the nature of pathology. It should be important to determine in what conditions BMI may be used as a single tool or must be associated with other anthropometric or biological parameters to recognize malnutrition.
The primary objective of this study was to estimate the prevalence of severe malnutrition in homogenous groups of patients hospitalized in a rehabilitative care hospital for different medical causes. The second objective was to assess the sensitivity of low BMI with a cutoff of 20 in the diagnosis of severe malnutrition in these patient populations. The diagnosis of severe malnutrition was based on sharp decrease in two anthropometric parameters reflecting muscular and fat masses. We chose to measure mid-arm circumference (MAC) and triceps skinfold thickness (TST) and to calculate mid-arm muscle circumference (MAMC) because these parameters can be measured with a minimum of equipment, effort and time and are more frequently used in surveys of nutritional status of patient populations and they can be evaluated according to sex- and age-specific standards of reference. Sensitivity of BMI was assessed regarding each parameter and the association of them.
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Patients and methods
The departments of Liver and Digestive Diseases, Cardiovascular Disease, Neurological Diseases and Internal Medicine of Albert Chenevier hospital participated in the study. 1052 patients consecutively admitted into our hospital from January 1, 2001 to December 31, 2001 were enrolled. Hospital Albert Chenevier is a rehabilitative medical institution and receives patients from other hospitals in the area of Paris after medical or surgical treatment. All these patients require long-term care and
Statistical analysis
Results of quantitative variables are given as mean±SD. Comparison of quantitative variables among several groups were performed using ANOVA. When ANOVA showed a statistically significant difference, comparisons between two groups were performed using Bonferroni Dunn's test. Comparisons of qualitative variables were performed using X2 test. Correlations was calculated according to the least-square regression analysis. Multivariate analysis was done using a stepwise logistic regression model.
Results
The demographic characteristics of the population are shown in Table 1. The three groups of cirrhotic patients were younger than the other groups (P<10−4) except NAP and TAP when compared with DNP. HFP and EP were older than the other groups (P<10−4). Males were predominant in all the groups except in HFP and EP groups.
All anthropometric values differed significantly among the eight groups (Table 2). Patients with hip fracture (HFP) and cancer patients (CP) showed the lowest values of BMI (HFP
Prevalence of malnutrition
Patients included in this study had various pathologies exposing them to a high risk of malnutrition. It is well known that liver cirrhosis, advanced cancers, hip fracture and age are major causes of malnutrition in hospitalized patients.9., 10., 11., 12., 13. Patients with recent cardiac surgery, cardiovascular diseases and acute stroke are also exposed to malnutrition.14., 15., 16., 17. Our study shows that the prevalence of malnutrition and changes in body composition are different according
Acknowledgements
The authors thank Mme Valérie Miranda for efficient secretarial assistance.
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