[Home ] [Archive]    
:: Main :: Current Issue :: Archive :: Search :: Submit :: Contact ::
:: Volume 7, Issue 3 (Jul-Sep 2020) ::
Nutr Food Sci Res 2020, 7(3): 9-14 Back to browse issues page
Current Nutritional Statuses and Gastrointestinal Complications in Critically Ill Patients Admitted to ICUs in Iran: A Cross-Sectional Study
Sahar Rafiee , Zahra Safari , Nafiseh Shokri-Mashhadi
Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract:   (970 Views)
Background and Objectives: Adequate nutrition is closely linked to clinical outcomes. Therefore, this study was carried out to assess nutritional statuses of the ICU patients in Isfahan, Iran.
Materials and Methods: In this cross-sectional study, 55 critically ill adult patients receiving enteral nutrition for a minimum of seven days were participated. Nutritional screening, including acute physiology and chronic health evaluation (APACHE) score, nutrition risk in critically (NUTRIC) score and nutritional assessments of laboratory data, energy and protein balance, was carried out. Moreover, gastrointestinal problems was assessed.
Results: In total, 55 patients (35 men and 20 women) with the median [IQR] age of 49 [18–77] years and the median [IQR] weight of 75 (55–100) kg were included in this study. The average of albumin concentrations were 3 g/dl ±0.7 in ICU inpatients, indicating decreased albumin levels compared to normal ranges (3.5–5 g/dl). During inpatient period, nutrition screening showed a median range of NUTRIC score of 3 (2–5) and APACHE score of 23 (18–27). In addition, median range of weight decreased to 71 (50–96) kg. Median intakes of energy and proteins for seven days seemed inadequate (1920 [1200–2740] and 86 [49–129], respectively). After gastrointestinal assessment, 20% of the participants had nausea and vomiting, 10% had obstipation, 5% had diarrhea and 20% had enteral feeding intolerance (assessed by GRV > 250 mL at repeated regular (6 h) measurements).
Conclusions: Results have suggested that although imbalanced energy, insufficient protein intakes, and gastrointestinal complications are common in ICU patients especially in women, risk assessment of malnutrition has shown no critical results. Therefore, designing and providing more sensitive methods for the screening of nutrition and assessment of nutritional adequacy is essential to prevent malnutrition in societies.
Keywords: Intensive care unit, Malnutrition, Nutrition assessment, Gastrointestinal complication
Full-Text [PDF 492 kb]   (435 Downloads)    
Article type: Research | Subject: nutrition
Received: 2020/03/2 | Accepted: 2020/05/13 | Published: 2020/08/10
1. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN Journal of parenteral and enteral nutrition. 2012;36(3):275-83. [DOI:10.1177/0148607112440285]
2. Barker, L.A., B.S. Gout, and T.C. Crowe, Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. International journal of environmental research and public health, 2011. 8(2): p. 514-527. [DOI:10.3390/ijerph8020514]
3. Soeters, P.B., et al., A rational approach to nutritional assessment. Clin Nutr, 2008. 27(5): p. 706-16. [DOI:10.1016/j.clnu.2008.07.009]
4. Banks M, Ash S, Bauer J, Gaskill D. Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities. Nutrition & Dietetics. 2007;64(3):172-8. [DOI:10.1111/j.1747-0080.2007.00179.x]
5. Moghadam AD, et al. Evaluation of nutritional quality and microbial contamination of enteral feeding solutions in hospitalized patients referred to neurosurgical ICU of Poursina Hospital in Rasht. Pejouhandeh. 2010. 15(5 (77)): p.Pe213-Pe219
6. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical nutrition (Edinburgh, Scotland). 2003;22(3):235-9. [DOI:10.1016/S0261-5614(02)00215-7]
7. Stratton RJ, King CL, Stroud MA, Jackson AA, Elia M. 'Malnutrition Universal Screening Tool' predicts mortality and length of hospital stay in acutely ill elderly. The British journal of nutrition. 2006;95(2):325-30. [DOI:10.1079/BJN20051622]
8. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clinical nutrition (Edinburgh, Scotland). 2008;27(1):5-15. [DOI:10.1016/j.clnu.2007.10.007]
9. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krahenbuhl L, Meier R, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clinical nutrition (Edinburgh, Scotland). 2008;27(3):340-9. [DOI:10.1016/j.clnu.2008.03.012]
10. Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clinical nutrition (Edinburgh, Scotland). 2012;31(3):345-50. [DOI:10.1016/j.clnu.2011.11.001]
11. Alvarez-Hernandez J, Planas Vila M, Leon-Sanz M, Garcia de Lorenzo A, Celaya-Perez S, Garcia-Lorda P, et al. Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES Study. Nutricion hospitalaria. 2012;27(4):1049-59.
12. Brito PA, de Vasconcelos Generoso S, Correia MI. Prevalence of pressure ulcers in hospitals in Brazil and association with nutritional status--a multicenter, cross-sectional study. Nutrition (Burbank, Los Angeles County, Calif). 2013;29(4):646-9. [DOI:10.1016/j.nut.2012.11.008]
13. Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition (Burbank, Los Angeles County, Calif). 2001;17(7-8):573-80. [DOI:10.1016/S0899-9007(01)00573-1]
14. Leandro-Merhi VA, de Aquino JL, Sales Chagas JF. Nutrition status and risk factors associated with length of hospital stay for surgical patients. JPEN Journal of parenteral and enteral nutrition. 2011;35(2):241-8. [DOI:10.1177/0148607110374477]
15. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN Journal of parenteral and enteral nutrition. 2016;40(2):159-211. [DOI:10.1177/0148607115621863]
16. Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clinical nutrition (Edinburgh, Scotland). 2009;28(4):387-400. [DOI:10.1016/j.clnu.2009.04.024]
17. Higgins PA, Daly BJ, Lipson AR, Guo S-E. Assessing nutritional status in chronically critically ill adult patients. Am J Crit Care. 2006;15(2):166-77. [DOI:10.4037/ajcc2006.15.2.166]
18. Moreno JP, de la Mata Navazo S, Arteta EL-H, Hernani MT, Martínez FG, Sánchez MIG, et al. Influence of nutritional status on clinical outcomes in hospitalised children. Anales de Pediatría (English Edition). 2019;91(5):328-35. [DOI:10.1016/j.anpede.2019.09.003]
19. Ordoñez AM, Schieferdecker MEM, Cestonaro T, Neto JC, Campos ACL. Nutritional status influences the length of stay and clinical outcomes in hospitalized patients in internal medicine ward. Nutricion hospitalaria. 2013;28(4):1313-20.
20. Sauer A. Hospital malnutrition: Assessment and intervention methods. Online). www. abbottNutritionHealthInstitute. org yang diakses pada tanggal; 2011.
21. Saleh WA, Khalil PB, Ouaijan K, Abillama F, Akiki S, Ahmad N, et al. Evaluation of nutrition support practices: Results from a nationwide survey. Clinical Nutrition. 2018;37(6):1976-9. [DOI:10.1016/j.clnu.2017.09.001]
22. De Luis D, Izaola O, Velicia M, Antolín GS, Pajares FG, Terroba M, et al. Impact of dietary intake and nutritional status on outcomes after liver transplantation. Revista Espanola de Enfermedades Digestivas. 2006;98(1):6. [DOI:10.4321/S1130-01082006000100002]
23. Samadi M, Zeinali F, Habibi N, Ghotbodin-Mohammadi S. Intake of dietary supplements and malnutrition in patients in intensive care unit. International journal of preventive medicine. 2016;7. [DOI:10.4103/2008-7802.186224]
24. Mahan LK, Escott-Stump S, Raymond JL, Krause MV. Krause's food & the nutrition care process: Elsevier Health Sciences; 2012.
25. Azadbakht L, Abbasi S, Hajishafiee M, Feizi A, Mohajeri G, Nemani F, et al. Determinants of malnutrition in critically ill patients admitting to ICU in Iran. Progress in Nutrition. 2019;21(1-S):220-6.
26. Lamb CA, Parr J, Lamb EI, Warren MD. Adult malnutrition screening, prevalence and management in a United Kingdom hospital: cross-sectional study. British journal of nutrition. 2009;102(4):571-5. [DOI:10.1017/S0007114509236038]
27. Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the "modified NUTRIC" nutritional risk assessment tool. Clinical nutrition. 2016;35(1):158-62. [DOI:10.1016/j.clnu.2015.01.015]
28. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition-an ESPEN consensus statement. Clinical nutrition. 2015;34(3):335-40. [DOI:10.1016/j.clnu.2015.03.001]
29. Jung YT, Park JY, Jeon J, Kim MJ, Lee SH, Lee JG. Association of Inadequate Caloric Supplementation with 30-Day Mortality in Critically Ill Postoperative Patients with High Modified NUTRIC Score. Nutrients. 2018;10(11):1589. [DOI:10.3390/nu10111589]
30. Vallejo KP, Martínez CM, Adames AAM, Fuchs-Tarlovsky V, Nogales GCC, Paz RER, et al. Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study. Critical care. 2017;21(1):227. [DOI:10.1186/s13054-017-1805-z]
31. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2019;38(1):48-79. [DOI:10.1016/j.clnu.2018.08.037]
32. Bae H-J, Lee H-J, Han D-S, Suh Y-S, Lee Y-H, Lee H-S, et al. Prealbumin levels as a useful marker for predicting infectious complications after gastric surgery. Journal of Gastrointestinal Surgery. 2011;15(12):2136-44. [DOI:10.1007/s11605-011-1719-z]
33. Efstratiadis G, Sarigianni M, Gougourelas I. Hypomagnesemia and cardiovascular system. Hippokratia. 2006;10(4):147.
34. Robinson MK, Trujillo EB, Mogensen KM, Rounds J, McManus K, Jacobs DO. Improving nutritional screening of hospitalized patients: the role of prealbumin. Journal of Parenteral and Enteral Nutrition. 2003;27(6):389-95. [DOI:10.1177/0148607103027006389]
35. Vincent J-L, Dubois M-J, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003;237(3):319-34. [DOI:10.1097/01.SLA.0000055547.93484.87]
36. Limaye C, Londhey V, Nadkart M, Borges N. Hypomagnesemia in critically ill medical patients. J Assoc Physicians India. 2011;59(1):19-22.
37. Mouw DR, Latessa RA, Sullo EJ. What are the causes of hypomagnesemia? Clinical Inquiries, 2005 (MU). 2005.
38. Hansen B-A, Bruserud Ø. Hypomagnesemia in critically ill patients. Journal of intensive care. 2018;6(1):21. [DOI:10.1186/s40560-018-0291-y]
39. Martin KJ, González EA, Slatopolsky E. Clinical consequences and management of hypomagnesemia. Journal of the American Society of Nephrology. 2009;20(11):2291-5. [DOI:10.1681/ASN.2007111194]
40. Edington J, Boorman J, Durrant E, Perkins A, Giffin C, James R, et al. Prevalence of malnutrition on admission to four hospitals in England. Clinical Nutrition. 2000;19(3):191-5. [DOI:10.1054/clnu.1999.0121]
41. Braunschweig C, Gomez S, Sheean PM. Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days. Journal of the American Dietetic Association. 2000;100(11):1316-22. [DOI:10.1016/S0002-8223(00)00373-4]
42. Dvir D, Cohen J, Singer P. Computerized energy balance and complications in critically ill patients: an observational study. Clinical Nutrition. 2006;25(1):37-44. [DOI:10.1016/j.clnu.2005.10.010]
43. Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Critical care medicine. 2004;32(2):350-7. [DOI:10.1097/01.CCM.0000089641.06306.68]
44. Villet S, Chiolero RL, Bollmann MD, Revelly J-P, Cayeux M-C, Delarue J, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clinical Nutrition. 2005;24(4):502-9. [DOI:10.1016/j.clnu.2005.03.006]
45. Weijs PJ, Wischmeyer PE. Optimizing energy and protein balance in the ICU. Current Opinion in Clinical Nutrition & Metabolic Care. 2013;16(2):194-201. [DOI:10.1097/MCO.0b013e32835bdf7e]
46. Nguyen T, Frenette A-J, Johanson C, MacLean RD, Patel R, Simpson A, et al. Impaired gastrointestinal transit and its associated morbidity in the intensive care unit. Journal of Critical Care. 2013;28(4):537.e11-.e17. [DOI:10.1016/j.jcrc.2012.12.003]
Send email to the article author

Add your comments about this article
Your username or Email:


XML     Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Rafiee S, Safari Z, Shokri-Mashhadi N. Current Nutritional Statuses and Gastrointestinal Complications in Critically Ill Patients Admitted to ICUs in Iran: A Cross-Sectional Study. Nutr Food Sci Res. 2020; 7 (3) :9-14
URL: http://nfsr.sbmu.ac.ir/article-1-392-en.html

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Volume 7, Issue 3 (Jul-Sep 2020) Back to browse issues page
Nutrition and Food Sciences Research
Persian site map - English site map - Created in 0.05 seconds with 30 queries by YEKTAWEB 4343