Korean J Community Nutr.  2018 Feb;23(1):48-59. 10.5720/kjcn.2018.23.1.48.

Effect of Active Nutrition Care on Underweight Elderly Patients Receiving Long-term Enteral Tube Feeding

• Yoon HY
• Kim HK

• KMID: 2406773
• DOI: http://doi.org/10.5720/kjcn.2018.23.1.48

Abstract

OBJECTIVES
This study was performed to investigate the effect of active nutrition care on feeding and nutritional status of elderly patients receiving long-term enteral tube feeding.
METHODS
Subjects included 77 elderly patients who had received enteral nutrition more than one week before admission. Nutrition care was provided to patients supplied less calories than required. Feeding intolerance was examined and managed every day and formula was adjusted to meet nutritional requirement during the first 3 months after admission. Patients were classified into under or over 80% of percent ideal body weight (PIBW) and medical records were used to compare changes in weight,, biochemical indices, and nutritional status during the study.
RESULTS
Weight, BMI, triglyceride and total cholesterol in blood, hemoglobin, and hematocrit levels were significantly lower in patients under 80% of the PIBW than in those over 80% of the PIBW at admission. The percentage of supply to required calories was also lower in patients under 80% of the PIBW. After 1 month of nutritional care, supplied volume of formula was significantly increased in patients under 80% of the PIBW. Weight, BMI, and PIBW were increased and there were no differences between groups after 6 months. In addition, the concentrations of triglyceride and total cholesterol in blood, hemoglobin, and hematocrit tended to increase in patients under 80% of the PIBW, leading to no difference between groups after 3 months.
CONCLUSIONS
Personalized active nutrition care is effective to increase weight and improve feeding and nutritional status in underweight elderly patients receiving longterm enteral nutrition.

Keyword

enteral feeding; elderly patients; feeding status; malnutrition

MeSH Terms

Aged*
Cholesterol
Enteral Nutrition*
Hematocrit
Humans
Ideal Body Weight
Malnutrition
Medical Records
Nutritional Requirements
Nutritional Status
Thinness*
Triglycerides
Cholesterol

Figure

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  Fig. 1 The protocol of the study

Reference

1. Statistics Korea. Prospective statistics of Korean population 2015~2065 [internet]. Statistics Korea;2016. cited 2017 Sep 25. Available from: http://www.kostat.go.kr/.

2. Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010; 5:207–216.

3. Chapman IM. Weight loss in older persons. Med Clin North Am. 2011; 95(3):579–593.

4. Chung SS. Nutrition support methods in elderly patients. J Clin Nutr. 2014; 6(1):7–10.

5. Silver AJ, Morley JE, Strome LS, Jones D, Vickers L. Nutritional status in academic nursing homes. J Am Geriatr Soc. 1988; 36(6):487–491.

6. Mitchell H, Porter J. The cost-effectiveness of identifying and treating malnutrition in hospitals: a systemic review. J Hum Nutr Diet. 2016; 29(2):156–164.

7. Hebuterne X, Bozzetti F, Villares JM, Pertkiewicz M, Shaffer J, Staun M, et al. Home enteral nutrition in adults: a European multicentre survey. Clin Nutr. 2003; 22(3):261–266.

8. Dorner B, Posthauer ME, Friedrich EK, Robinson GE. Enteral nutrition for older adults in nursing facilities. Nutr Clin Pract. 2011; 26(3):261–272.

9. Lee JH, Cho KH, Rhee BA, Lee SH, Choue R. A study on nutritional status, biochemical parameters, lipid and electrolytes concentrations according to the duration of enteral nutrition tubefeeding. Korean J Nutr. 2002; 35(5):512–523.

10. Park CM. Nutritional support in critically ill surgical patients. J Korean Soc Parenter Enter Nutr. 2013; 5(1):15–19.

11. McClave SA, Sexton LK, Spain DA, Adams JL, Owens NA, Sullins MB. . Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. Crit Care Med. 1999; 27(7):1252–1256.

12. Seol E, Suh YS, Ju DL, Bae HJ, Lee HJ. Nutritional screening tool for in-hospital patients. J Clin Nutr. 2016; 8(1):2–10.

13. Hedberg AM, Garcia N, Trejus IJ, Weinmann-Winkler S, Gabriel ML, Lutz AL. Nutritional risk screening: development of a standardized protocol using dietetic technicians. J Am Diet Assoc. 1988; 88(12):1553–1556.

14. Lee JW, Lee MS, Kim JH, Son SM, Lee BS. Nutritional assessment. 2nd ed. Paju: Kyomunsa;2006. p. 204–221.

15. Shikora SA, Blackburn GL. Nutritional support: theory and therapeutics. London: Springer;1997. p. 464–481.

16. Mueller C, Compher C, Ellen DM. A.S.P.E.N. clinical guidelines: nutritional screening, assessment, and intervention in adults. J Parenter Enteral Nutr. 2011; 35(1):16–24.

17. Martindale RG, McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary. Crit Care Med. 2009; 37(5):1757–1761.

18. Perissinotto E, Pisent C, Sergi G, Grigoletto F, Enzi G. ILSA Working Group. Anthropometric measurements in the elderly: age and gender differences. Br J Nutr. 2002; 87(2):177–186.

19. Park EK, Lee JH, Lim HS. Degree of enteral tube feeding in the intensive care unit and change in nutritional status. J Korean Diet Assoc. 2001; 7(3):217–226.

20. Kim H, Choi SH, Ham YJ. Nutritional status and indicators of intensive care unit patients on enteral feeding. J Korean Acad Fundam Nurs. 2009; 16(1):21–29.

21. Kim H, Shin JA, Shin JY, Cho OM. Adequacy of nutritional support and reasons for underfeeding in neurosurgical intensive care unit patients. Asian Nurs Res. 2010; 4(2):102–110.

22. Reid CL. Frequency of under-and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet. 2006; 19(1):13–22.

23. Adam S, Batson S. A study of problems associated with the delivery of enteral tube feed in critically ill patients in five ICUs in the UK. Intensive Care Med. 1997; 23(3):261–266.

24. Spain DA, McClave SA, Sexton LK, Adams JL, Blanford BS, Sullins ME, et al. Infusion protocol improves delivery of enteral tube feeding in the critical care unit. J Parenter Enteral Nutr. 1999; 23(5):288–292.

25. Mackenie SL, Zygun DA, Whitmore BL, Doig CJ, Hameed SM. Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit. J Parenter Enteral Nutr. 2005; 29(2):74–80.

26. Sullivan DH, Walls RC, Bopp MM. Protein-energy undernutrition and the risk of mortality within one year of hospital discharge: a follow-up study. J Am Geriatr Soc. 1995; 43(5):507–512.

27. Tayback M, Kumanyika S, Chee E. Body weight as a risk factor in the elderly. Arch Intern Med. 1990; 150(5):1065–1072.

28. Galanos AN, Pieper CF, Cornoni-Huntley JC, Bales CW, Fillenbaum GG. Nutrition and function: is there a relationship between body mass index and the functional capabilities of community-dwelling elderly? J Am Geriatr Soc. 1994; 42(4):367–373.

29. Peck A, Cohen CE, Mulvihill MN. Long-term enteral feeding of aged demented nursing home patients. J Am Geriatr Soc. 1990; 38(11):1195–1198.

30. Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med. 2006; 144(1):37–48.

31. Torun B. Protein-energy malnutrition. In : Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, editors. Modern Nutrition in Health and Disease. 10th ed. LWW;2005. p. 881–908.

32. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity [internet]. 2011. cited 2017 Dec 10. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf.

33. Buzina R, Bates CJ, Beek J, Brubacher G, Chandra RK, Hallberg L, et al. Workshop on functional significance of mild-to-moderate malnutrition. Am J Clin Nutr. 1989; 50(1):172–176.

34. Wang J, Hong Z. Low plasma total cholesterol concentration: a sensitive evaluation marker in hospitalized patients with nutritional deficiency malnutrition. J Food Nutr Res. 2014; 2(9):551–555.

35. Onder G, Landi F, Volpato S, Fellin R, Carbonin P, Gambassi G, et al. Serum cholesterol levels and in-hospital mortality in the elderly. Am J Med. 2003; 115(4):265–271.

36. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; 22(4):415–421.

37. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature: what does it tell us? J Nutr Health Aging. 2006; 10(6):466–485.

38. Chung SH, Sohn CM. Nutritional status of hospitalized geriatric patients using by the mini nutritional assessment. Korean J Community Nutr. 2005; 10(5):645–653.