Importance of Nutrition in  Hospitalized Patients
Defining Malnutrition <ul><li>The World Health Organisation (W.H.O.) defines  MALNUTRITION  as “the cellular imbalance bet...
<ul><li>MALNUTRITION   Remains Very Prevalent in Both  Developed  And  Developing   Countries  Despite Ongoing Awareness C...
<ul><li>MALNUTRITION  Is a Common Problem in Elderly Population at Hospital Admissions. </li></ul>2007 Nov-Dec;22(6):702-9.
<ul><li>The consequences of malnutrition are broad-ranging and ultimately impact on   </li></ul><ul><li>Quality of Life,  ...
<ul><li>Failure to Acknowledge the Risks of Malnutrition Can Seriously Impact on   MORBIDITY   &   MORTALITY  Rates. </li>...
<ul><li>Decreased Food Intake Represents an Independent Risk Factor for  HOSPITAL MORTALITY </li></ul>2009 Jun 30.
<ul><li>It Is Recommended that  NUTRITIONAL SUPPLEMENTS  Be Offered to Malnourished Patients or Those at High Risk of Poor...
<ul><li>It Can Be Recommended That Greater Efforts Should Be Taken to Increase the Use of  Protein Energy Food  and  Oral ...
<ul><li>Sixty-two Trials With 10,187 Randomised Participants Have Been Included in the Review.   </li></ul><ul><li>SUPPLEM...
<ul><li>Fifty-five Trials Were Included (N = 9187 Randomly Assigned Participants).  </li></ul><ul><li>For Patients in Shor...
<ul><li>ORAL NUTRITIONAL SUPPLEMENTS  Can  Improve Nutritional Status  and Seem to  Reduce Mortality  and  Complications  ...
<ul><li>The Study Included 817 Patients 45.9% (N = 375) of Patients Were Malnourished </li></ul><ul><li>In Hospitalized Pa...
Malnutrition in Hospital <ul><li>P.E.M.   in hospitalised patients is usually due to: </li></ul><ul><li>Difficulties with ...
Malnutrition in Hospital <ul><li>P.E.M.   in hospitalised patients is usually due to: </li></ul><ul><li>Nutrient loss can ...
Malnutrition in Hospital <ul><li>P.E.M.   In Hospitalised Patients Is Usually Due To: </li></ul><ul><li>There Is an Increa...
Malnutrition in Hospital <ul><li>P.E.M.   in hospitalised patients is usually due to: </li></ul><ul><ul><li>Severe Sepsis,...
The Vicious Circle of Malnutrition in Hospital Nutritional status that  gets more precarious Increased morbidity and  incr...
Consequences of Malnutrition   <ul><li>Reduced Renal Function </li></ul><ul><li>Impaired Wound Healing </li></ul><ul><li>C...
The Spiral of Events in Malnutrition Weakness & misery Normally Nourished Depression  Depressed organ function Infection  ...
Signs Associated With Malnutrition <ul><li>Hair </li></ul><ul><li>Face </li></ul><ul><li>Eyes </li></ul><ul><li>Lips </li>...
Diagnosing Malnutrition <ul><li>Anthropometric Measures </li></ul><ul><ul><li>Weight, Height </li></ul></ul><ul><ul><li>BM...
Diagnosing Malnutrition <ul><li>Dietary Analysis </li></ul><ul><ul><li>Dietary History </li></ul></ul><ul><ul><li>Recall M...
Diagnosing Malnutrition <ul><li>Laboratory Studies </li></ul><ul><ul><li>Serum Albumin </li></ul></ul><ul><ul><li>Serum Tr...
<ul><li>The Principal Goal of Nutritional Therapy in Critical Illness Is to  Protect Lean Tissue Mass  and Function. </li>...
<ul><li>NUTRITION SUPPLEMENTATION  Is Paramount to the Care of Severely   Injured Patients. </li></ul>Vol. 21, No. 5, 2006...
<ul><li>In Patients After Surgery Nutritional Requirements Are Often Increased to  Support Wound Healing  and  Hypermetabo...
Hypermetabolism
Hypermetabolism <ul><li>Most common causes of Hypermetabolism are </li></ul><ul><li>Fever </li></ul><ul><li>Infections  </...
Nitrogen Balance <ul><li>Used to measure degree of catabolism </li></ul><ul><li>Requires 24 hour urine collection of urina...
Determination of Caloric Requirements <ul><li>The  HARRIS-BENEDICT EQUATION  is used to calculate  basal   energy   expend...
Stress Factor & Activity Factor   Patient Status   Stress Factor Elective Operation/minor Surgery    1.0-1.2 Non-stressed ...
Stress Factor & Activity Factor   Patient Activity   Activity Factor Ambulatory  1.25 Bedridden 1.15 Ventilator Support  1...
Clinical Goal <ul><li>Exceed the Resting Energy Expenditure by a factor of 2 </li></ul><ul><li>Increase Protein Stores </l...
Energy Requirements <ul><li>Rule of Thumb Estimates </li></ul><ul><li>Unstressed:  25 kcal/kg/day  </li></ul><ul><li>Stres...
Protein Requirements <ul><li>Mild stress:  0.8 to 1 g/kg/day </li></ul><ul><li>Moderate stress:  1.0- 1.2 g/kg/day </li></...
SLIMFIT  Provides  AMINO FUEL 900
AMINO FUEL 900  contains <ul><li>High Energy Hydrolysed Starches </li></ul>
AMINO FUEL 900  contains <ul><li>High Biological Value Proteins   </li></ul>
AMINO FUEL 900  contains <ul><li>Mono-unsaturated Fatty Acids & Poly-unsaturated Fatty Acids </li></ul>
AMINO FUEL 900  contains <ul><li>  High in Calorie </li></ul>
Nutrient Information * With milk Nutrient Content 40 gms 100 gms Units Carbohydrate Protein Fats Saturated MUFA PUFA Chole...
Amino Fuel 900 Ensure Protein  per Dose Gm. Protein Comparison
Amino Fuel 900 Ensure Price  per Dose Rs. Price Comparison
Flavours <ul><li>Vanilla </li></ul><ul><li>Chocolate </li></ul><ul><li>Raspberry </li></ul><ul><li>Mango </li></ul><ul><li...
How to Prescribe?   <ul><li>ONCE  or  TWICE  Daily or as needed </li></ul><ul><li>4 SCOOPS  (40 gm) in 200 ml of Water or ...
Let  Food  Be Your  Medicine  And  Medicine  Be Your  Food - Hippocrates,  337 BC
THANK YOU
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Importance of nutrition in hospitalized patients

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Importance of nutrition in hospitalized patients

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Importance of nutrition in hospitalized patients

  1. 1. Importance of Nutrition in Hospitalized Patients
  2. 2. Defining Malnutrition <ul><li>The World Health Organisation (W.H.O.) defines MALNUTRITION as “the cellular imbalance between the supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance and specific functions. </li></ul>
  3. 3. <ul><li>MALNUTRITION Remains Very Prevalent in Both Developed And Developing Countries Despite Ongoing Awareness Campaigns. </li></ul>2007 Nov;12(11):494-9.
  4. 4. <ul><li>MALNUTRITION Is a Common Problem in Elderly Population at Hospital Admissions. </li></ul>2007 Nov-Dec;22(6):702-9.
  5. 5. <ul><li>The consequences of malnutrition are broad-ranging and ultimately impact on </li></ul><ul><li>Quality of Life, </li></ul><ul><li>Increase Length of Stay in Hospital & </li></ul><ul><li>Increase the Risk of Unsuccessful Outcomes of Treatment </li></ul>2007 Nov;12(11):494-9.
  6. 6. <ul><li>Failure to Acknowledge the Risks of Malnutrition Can Seriously Impact on MORBIDITY & MORTALITY Rates. </li></ul>2007 Nov;12(11):494-9.
  7. 7. <ul><li>Decreased Food Intake Represents an Independent Risk Factor for HOSPITAL MORTALITY </li></ul>2009 Jun 30.
  8. 8. <ul><li>It Is Recommended that NUTRITIONAL SUPPLEMENTS Be Offered to Malnourished Patients or Those at High Risk of Poor Dietary Intake at Discharge From Hospital . </li></ul>2009 Jun-Jul;24(3):388-94.
  9. 9. <ul><li>It Can Be Recommended That Greater Efforts Should Be Taken to Increase the Use of Protein Energy Food and Oral Supplements for Patients With Eating Problems in Order to Prevent or Treat Under Nutrition . </li></ul>2009 May 8;8:20.
  10. 10. <ul><li>Sixty-two Trials With 10,187 Randomised Participants Have Been Included in the Review. </li></ul><ul><li>SUPPLEMENTATION produces a small but CONSISTENT WEIGHT GAIN in older people. </li></ul><ul><li>MORTALITY may be reduced in older people who are undernourished. </li></ul><ul><li>There may also be a beneficial effect on complications </li></ul>2009 Apr 15;(2):CD003288
  11. 11. <ul><li>Fifty-five Trials Were Included (N = 9187 Randomly Assigned Participants). </li></ul><ul><li>For Patients in Short-term Care Hospitals Who Were Given ORAL SUPPLEMENTS , Evidence Suggested </li></ul><ul><li>Fewer Complications & </li></ul><ul><li>Reduced Mortality </li></ul>2006 Jan 3;144(1):37-48.
  12. 12. <ul><li>ORAL NUTRITIONAL SUPPLEMENTS Can Improve Nutritional Status and Seem to Reduce Mortality and Complications for Undernourished Elderly Patients in the Hospital. </li></ul>2006 Jan 3;144(1):37-48.
  13. 13. <ul><li>The Study Included 817 Patients 45.9% (N = 375) of Patients Were Malnourished </li></ul><ul><li>In Hospitalized Patients, MALNUTRITION Ranges Between 30% and 55 % and Is Associated With a Higher Rate of Complications , Prolonged Hospitalization and Increased Cost of Health Services . </li></ul>2009 Mar 21;132(10):377-84 MEDICINA CLINICA
  14. 14. Malnutrition in Hospital <ul><li>P.E.M. in hospitalised patients is usually due to: </li></ul><ul><li>Difficulties with </li></ul><ul><li>Chewing </li></ul><ul><li>Swallowing </li></ul><ul><li>Digesting Food </li></ul><ul><li>Pain </li></ul><ul><li>Nausea and </li></ul><ul><li>Lack of Appetite </li></ul>
  15. 15. Malnutrition in Hospital <ul><li>P.E.M. in hospitalised patients is usually due to: </li></ul><ul><li>Nutrient loss can be accelerated by </li></ul><ul><ul><li>Bleeding </li></ul></ul><ul><ul><li>Diarrhoea </li></ul></ul><ul><ul><li>Malabsorption Disorders & </li></ul></ul><ul><ul><li>Other Factors </li></ul></ul>
  16. 16. Malnutrition in Hospital <ul><li>P.E.M. In Hospitalised Patients Is Usually Due To: </li></ul><ul><li>There Is an Increase the Amount of Nutrients Needed by Patients. </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><li>Some Medications and </li></ul></ul><ul><ul><li>Benign or Malignant Tumours </li></ul></ul>
  17. 17. Malnutrition in Hospital <ul><li>P.E.M. in hospitalised patients is usually due to: </li></ul><ul><ul><li>Severe Sepsis, </li></ul></ul><ul><ul><li>Inflammatory Disease and </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>switch on inflammatory mediators whose job is to mobilise muscle tissue to provide amino acids for an effective acute-phase response. </li></ul></ul>
  18. 18. The Vicious Circle of Malnutrition in Hospital Nutritional status that gets more precarious Increased morbidity and increased major complications Increased mortality Increase in care prolongation Return to compromised home food supply Prolongation / aggravation of malnutrition Unplanned readmission Increased length of stay and decreased access to services
  19. 19. Consequences of Malnutrition <ul><li>Reduced Renal Function </li></ul><ul><li>Impaired Wound Healing </li></ul><ul><li>Constipation, Diarrhoea, Pain </li></ul><ul><li>Respiratory Failure </li></ul><ul><li>Skeletal Muscle Atrophy </li></ul><ul><li>Increased Length of Stay </li></ul><ul><li>Surgery Stress, Increased Metabolic Rate </li></ul><ul><li>Reddish Hair, Atrophy of Tongue Papillae </li></ul>
  20. 20. The Spiral of Events in Malnutrition Weakness & misery Normally Nourished Depression Depressed organ function Infection Decompensated organ failure DEATH MALNUTRITION ANOREX I A Precipitating Cause of Malnutrition Reduced food intake Apathy
  21. 21. Signs Associated With Malnutrition <ul><li>Hair </li></ul><ul><li>Face </li></ul><ul><li>Eyes </li></ul><ul><li>Lips </li></ul><ul><li>Tongue </li></ul><ul><li>Teeth </li></ul><ul><li>Gums </li></ul><ul><li>Glands </li></ul><ul><li>Skin </li></ul><ul><li>Nails </li></ul><ul><li>Muscular & Skeletal systems </li></ul><ul><li>Internal Systems </li></ul><ul><ul><li>Gastrointestinal </li></ul></ul><ul><ul><li>Nervous </li></ul></ul><ul><ul><li>Cardiac </li></ul></ul>
  22. 22. Diagnosing Malnutrition <ul><li>Anthropometric Measures </li></ul><ul><ul><li>Weight, Height </li></ul></ul><ul><ul><li>BMI </li></ul></ul><ul><ul><li>Skinfold Thickness </li></ul></ul><ul><ul><li>Calf & Mid-arm Circumference </li></ul></ul><ul><ul><li>Waist-to-hip Ratio </li></ul></ul>
  23. 23. Diagnosing Malnutrition <ul><li>Dietary Analysis </li></ul><ul><ul><li>Dietary History </li></ul></ul><ul><ul><li>Recall Methods </li></ul></ul><ul><ul><li>Food Diary </li></ul></ul>
  24. 24. Diagnosing Malnutrition <ul><li>Laboratory Studies </li></ul><ul><ul><li>Serum Albumin </li></ul></ul><ul><ul><li>Serum Transferrin </li></ul></ul><ul><ul><li>Retinol-binding Protein </li></ul></ul><ul><ul><li>Prealbumin </li></ul></ul><ul><ul><li>Serum Potassium </li></ul></ul>
  25. 25. <ul><li>The Principal Goal of Nutritional Therapy in Critical Illness Is to Protect Lean Tissue Mass and Function. </li></ul>2003;78:906 –11.
  26. 26. <ul><li>NUTRITION SUPPLEMENTATION Is Paramount to the Care of Severely Injured Patients. </li></ul>Vol. 21, No. 5, 2006 421-429)
  27. 27. <ul><li>In Patients After Surgery Nutritional Requirements Are Often Increased to Support Wound Healing and Hypermetabolism Associated With Surgical Recovery. </li></ul><ul><li>Without Adequate Nutrition, Muscle Wasting , Immune Dysfunction , and Declining Visceral Protein Status Are Observed. </li></ul>2004 Apr 1;61(7):671-82
  28. 28. Hypermetabolism
  29. 29. Hypermetabolism <ul><li>Most common causes of Hypermetabolism are </li></ul><ul><li>Fever </li></ul><ul><li>Infections </li></ul><ul><li>Fractures </li></ul><ul><li>Prolonged Steroid Therapy </li></ul><ul><li>Hyperthyroidism </li></ul><ul><li>Sepsis </li></ul><ul><li>Burns </li></ul><ul><li>Multiple Trauma </li></ul><ul><li>Surgery </li></ul>
  30. 30. Nitrogen Balance <ul><li>Used to measure degree of catabolism </li></ul><ul><li>Requires 24 hour urine collection of urinary urea nitrogen </li></ul><ul><li>Balance= intake- output </li></ul><ul><li>Protein intake/6.25 - (urine urea nitrogen+4) </li></ul><ul><li>Goal is positive 3- 4 grams for growth and repair </li></ul>
  31. 31. Determination of Caloric Requirements <ul><li>The HARRIS-BENEDICT EQUATION is used to calculate basal energy expenditure ( BEE ) in kilocalories per day: </li></ul><ul><li>Males: BEE = 66 + (13.7 x wgt in kg) + (5 x height in cm) - (6.7 x age in years) </li></ul><ul><li>Females: BEE = 665 + (9.6 x wgt in kg) + (1.8 x height in cm) - (4.7 x age in years) </li></ul><ul><li>Total Energy Expenditure = BEE X Activity Factor X Stress Factor </li></ul>
  32. 32. Stress Factor & Activity Factor Patient Status Stress Factor Elective Operation/minor Surgery 1.0-1.2 Non-stressed on Vent 1.0-1.2 Congestive Heart Failure 1.1-1.2 Fever 1.13 Peritonitis 1.05-1.25 Long Bone Fracture 1.15-1.3 Mild to Moderate Infection 1.2-1.4 Multiple Trauma/major Surgery 1.3-1.55 Chi/stressed Ventilator Dependent  1.4-1.6 Sepsis 1.5-1.75 Liver Failure/cancer 1.5 Burns 1.25-2.0
  33. 33. Stress Factor & Activity Factor Patient Activity Activity Factor Ambulatory 1.25 Bedridden 1.15 Ventilator Support 1.10
  34. 34. Clinical Goal <ul><li>Exceed the Resting Energy Expenditure by a factor of 2 </li></ul><ul><li>Increase Protein Stores </li></ul><ul><li>Maintain Lean Body Mass </li></ul><ul><li>Achieve Nitrogen Balance </li></ul>
  35. 35. Energy Requirements <ul><li>Rule of Thumb Estimates </li></ul><ul><li>Unstressed: 25 kcal/kg/day </li></ul><ul><li>Stressed: 35 kcal/kg/day </li></ul>
  36. 36. Protein Requirements <ul><li>Mild stress: 0.8 to 1 g/kg/day </li></ul><ul><li>Moderate stress: 1.0- 1.2 g/kg/day </li></ul><ul><li>Severe stress: 1.2- 2.0 g/kg/day </li></ul><ul><li>Acute renal failure: 1.0- 1.5 g/kg/day </li></ul><ul><li>ESRD: 0.5-0.6 if not on dialysis </li></ul><ul><li>Hemodialysis: 1.1- 1.5 g/kg/day </li></ul><ul><li>Liver failure: 0.5 g/kg/day with encephalopathy. May increase if patient tolerates. </li></ul>
  37. 37. SLIMFIT Provides AMINO FUEL 900
  38. 38. AMINO FUEL 900 contains <ul><li>High Energy Hydrolysed Starches </li></ul>
  39. 39. AMINO FUEL 900 contains <ul><li>High Biological Value Proteins </li></ul>
  40. 40. AMINO FUEL 900 contains <ul><li>Mono-unsaturated Fatty Acids & Poly-unsaturated Fatty Acids </li></ul>
  41. 41. AMINO FUEL 900 contains <ul><li> High in Calorie </li></ul>
  42. 42. Nutrient Information * With milk Nutrient Content 40 gms 100 gms Units Carbohydrate Protein Fats Saturated MUFA PUFA Cholesterol Fiber Energy Moisture 19.63 12.86 7.34 3.82 2.57 0.95 1.19 240 200 (400)* 49.08 32.16 18.34 9.54 6.42 2.38 2.97 600 500 (1000)* gms gms gms         mg k/cals 3 - 4 %
  43. 43. Amino Fuel 900 Ensure Protein per Dose Gm. Protein Comparison
  44. 44. Amino Fuel 900 Ensure Price per Dose Rs. Price Comparison
  45. 45. Flavours <ul><li>Vanilla </li></ul><ul><li>Chocolate </li></ul><ul><li>Raspberry </li></ul><ul><li>Mango </li></ul><ul><li>Pineapple </li></ul><ul><li>Lemon </li></ul>
  46. 46. How to Prescribe? <ul><li>ONCE or TWICE Daily or as needed </li></ul><ul><li>4 SCOOPS (40 gm) in 200 ml of Water or Milk </li></ul><ul><li>PRESENTATION </li></ul><ul><li>200gm Powder </li></ul><ul><li>400gm Powder </li></ul>
  47. 47. Let Food Be Your Medicine And Medicine Be Your Food - Hippocrates, 337 BC
  48. 48. THANK YOU

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