Diagnostic criteria for malnutrition - An ESPEN Consensus Statement

Relationship between Mid-Upper Arm Circumference and Body Mass Index in Inpatients

Introduction

Nutritional screening is a fundamental aspect of the initial evaluation of the hospitalised patient. Body Mass Index (BMI) in association with other parameters is a good marker of malnutrition (<18.5 kg/m²), but it presents the handicap that the great majority of patients cannot be weighed and measured. For this reason it is necessary to find other indicators that can be measured in these patients.

Objectives

1) Analyse the relationship between BMI and Mid-Upper Arm Circumference (MUAC); 2) establish a cut-off point of MUAC equivalent to BMI <18.5 kg/m².

Materials and Methods

The anthropometric data of patients hospitalised over the period 2004–2013 were retrospectively revised. The following variables were collected: weight, height, BMI, MUAC, sex and age.

Results

1373 patients were evaluated, who presented a mean weight of: 65.04±15.51 kg; height: 1.66±0.09 m; BMI: 23.48±5.03 kg/m²; MUAC: 26.95±4.50 cm; age: 56.24±16.77. MUAC correlates suitably to BMI by means of the following equation (simple linear regression): BMI = − 0.042 + 0.873 x MUAC (cm) (R² = 0.609), with a Pearson r value of 0.78 (p<0.001). The area under the curve of MUAC for the diagnosis of malnutrition was 0.92 (95% CI: 0.90–0.94; p<0.001). The MUAC value ≤22.5 cm presented a sensitivity of 67.7%, specificity of 94.5%, and a correct classification of 90%. No significant statistical differences were found in the cut-off point of MUAC for the diagnosis of malnutrition based on sex (p = 0.115) and age (p = 0.694).

Conclusions

1) MUAC correlates positively and significantly with BMI. 2) MUAC ≤ 22.5 cm correlates properly with a BMI of <18.5 kg/m², independent of the age or sex of the patient, although there are other alternatives. MUAC constitutes a useful tool as a marker of malnutrition, fundamentally in patients for whom weight and height cannot be determined.

Preoperative risk factors of malnutrition for cardiac surgery patients

BACKGROUND

Malnutrition (MN) is prevalent in cardiac surgery, but there are no specific preoperative risk factors of MN. The aim of this study is to assess the clinically relevant risk factors of MN for cardiac surgery patients.

MATERIALS AND METHODS

The nutritional state of the patients was evaluated one day prior to surgery using a bioelectrical impedance analysis phase angle (PA). Two groups of patients were generated according to low PA: malnourished and well nourished. Risk factors of MN were divided into three clinically relevant groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. Variables in each different group were entered into separate multivariate logistic regression models.

RESULTS

A total of 712 patients were included in the study. The majority of them were 65-year old men after a CABG procedure. Low PA was present in 22.9% (163) of patients. The analysis of disease-related factors of MN revealed the importance of heart functions (NYHA IV class OR: 3.073, CI95%: 1.416-6.668, p = 0.007), valve pathology (OR: 1.825, CI95%: 1.182-2.819, p = 0.007), renal insufficiency (OR: 4.091, CI95%: 1.995-8.389, p < 0.001) and body mass index (OR: 0.928, CI95%: 0.890-0.968, p < 0.001). Laboratory values related to MN were levels of haemoglobin (OR: 0.967, CI95%: 0.951-0.983, p < 0.001) and C-reactive protein (OR: 1.015, CI95%: 1.002-1.028, p = 0.0279). The lifestyle variables that qualified as risk factors concerned the intake of food (OR: 3.030, CI95%: 1.353-6.757, p = 0.007) and mobility (OR: 2.770, CI95%: 1.067-7.194, p = 0.036).

CONCLUSIONS

MN risk factors comprise three different clinical groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. The patients who are most likely to be malnourished are those with valve pathology, severe imparted heart function, insufficient renal function and high inflammatory markers. Also these patients have decreased mobility and food intake.

Hospital malnutrition in Latin America: A systematic review

BACKGROUND

Disease-related malnutrition is a major public health issue in both industrialised and emerging countries. The reported prevalence in hospitalised adults ranges from 20% to 50%. Initial reports from emerging countries suggested a higher prevalence compared with other regions, with limited data on outcomes and costs.

METHODS

We performed a systematic literature search for articles on disease-related malnutrition in Latin American countries published between January 1995 and September 2014. Studies reporting data on the prevalence, clinical outcomes, or economic costs of malnutrition in an adult (≥18 years) inpatient population with a sample size of ≥30 subjects were eligible for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria.

RESULTS

We identified 1467 citations; of these, 66 studies including 29 ,474 patients in 12 Latin American countries met the criteria for inclusion. There was considerable variability in methodology and in the reported prevalence of disease-related malnutrition; however, prevalence was consistently in the range of 40%-60% at the time of admission, with several studies reporting an increase in prevalence with increasing duration of hospitalisation. Disease-related malnutrition was associated with an increase in infectious and non-infectious clinical complications, length of hospital stay, and costs.

CONCLUSION

Disease-related malnutrition is a highly prevalent condition that imposes a substantial health and economic burden on the countries of Latin America. Further research is necessary to characterise screening/assessment practices and identify evidence-based solutions to this persistent and costly public health issue.

Undernutrition, risk of malnutrition and obesity in gastroenterological patients: A multicenter study

AIM: To investigate the prevalence of undernutrition, risk of malnutrition and obesity in the Italian gastroenterological population.

METHODS: The Italian Hospital Gastroenterology Association conducted an observational, cross-sectional multicenter study. Weight, weight loss, and body mass index were evaluated. Undernutrition was defined as unintentional weight loss > 10% in the last three-six months. Values of Malnutrition Universal Screening Tool (MUST) > 2, NRS-2002 > 3, and Mini Nutritional Assessment (MNA) from 17 to 25 identified risk of malnutrition in outpatients, inpatients and elderly patients, respectively. A body mass index ≥ 30 indicated obesity. Gastrointestinal pathologies were categorized into acute, chronic and neoplastic diseases.

RESULTS: A total of 513 patients participated in the study. The prevalence of undernutrition was 4.6% in outpatients and 19.6% in inpatients. Moreover, undernutrition was present in 4.3% of the gastrointestinal patients with chronic disease, 11.0% of those with acute disease, and 17.6% of those with cancer. The risk of malnutrition increased progressively and significantly in chronic, acute and neoplastic gastrointestinal diseases in inpatients and the elderly population. Logistical regression analysis confirmed that cancer was a risk factor for undernutrition (OR = 2.7; 95%CI: 1.2-6.44, P = 0.02). Obesity and overweight were more frequent in outpatients.

CONCLUSION: More than 63% of outpatients and 80% of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment.

Effectiveness and efficacy of nutritional therapy: A systematic review following Cochrane methodology

BACKGROUND & AIMS

Disease-related malnutrition has deleterious consequences on patients' outcome and healthcare costs. The demonstration of improved outcome by appropriate nutritional management is on occasion difficult. The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed the Nutrition Education Study Group (ESPEN-NESG) to increase recognition of nutritional knowledge and support in health services.

METHODS

To obtain the best available evidence on the potential effects of malnutrition on morbidity, mortality and hospital stay; cost of malnutrition; effect of nutritional treatment on outcome parameters and pharmaco-economics of nutritional therapy, a systematic review of the literature was performed following Cochrane methodology, to answer the following key questions: Q1) Is malnutrition an independent predictive factor for readmission within 30 days from hospital discharge? Q2) Does nutritional therapy reduce the risk of readmission within 30 days from hospital discharge? Q3) Is nutritional therapy cost-effective/does it reduce costs in hospitalized patients? and Q4) Is nutritional therapy cost effective/does it reduce costs in outpatients?

RESULTS

For Q1 six of 15 identified observational studies indicated that malnutrition was predictive of re-admissions, whereas the remainder did not. For Q2 nine randomized controlled trials and two meta-analyses gave non-conclusive results whether re-admissions could be reduced by nutritional therapy. Economic benefit and cost-effectiveness of nutritional therapy was consistently reported in 16 identified studies for hospitalized patients (Q3), whereas the heterogeneous and limited corresponding data on out-patients (Q4) indicated cost-benefits in some selected sub-groups.

CONCLUSIONS

This result of this review supports the use of nutritional therapy to reduce healthcare costs, most evident from large, homogeneous studies. In general, reports are too heterogeneous and overall of limited quality for conclusions on impact of malnutrition and its treatment on readmissions.

Nutrition Risk Screening in Patients Admitted to an Adult Emergency Department of a Brazilian University Hospital

BACKGROUND

The prevalence of malnutrition in emergency units is high, and data on the nutrition risk of patients admitted in these units are scarce. The aims of this study are to determine the nutrition risk profile of individuals admitted in an emergency unit and to identify clinical, anthropometric, and laboratory attributes according to nutrition risk classification.

MATERIALS AND METHODS

A total of 234 individuals in an emergency unit from 1 university hospital in Brazil were enrolled in this cross-sectional study. The nutrition risk profile was determined using the Nutrition Risk Screening 2002. Sociodemographic, clinical, anthropometric, and laboratory data were collected. Comparisons between individuals "at risk" and "not at risk" and logistic regression analyzes were performed.

RESULTS

The prevalence of nutrition risk at admission was 48.7%. Patients at risk were older ( P = .031), were less educated ( P = .022), had a lower body mass index ( P < .001), had higher concentrations of C-reactive protein (CRP; P = .007), had a higher CRP/serum albumin ratio ( P = .004), had lower concentrations of serum albumin ( P = .002), and had severe weight loss ( P < .001). Altogether, this profile resulted in a longer hospital stay ( P = .004), more complications ( P = .005), and greater use of antibiotics ( P = .024). In regression analyses, low serum albumin (odds ratio [OR], 2.75; 95% confidence interval [CI], 1.23-6.13) and, higher serum CRP (OR, 1.13; 95% CI, 1.00-3.72), use of antibiotics (OR, 13.3; 95% CI, 1.59-111.16) were predictors of long hospital stay.

CONCLUSION

The prevalence of nutrition risk in emergency patients was high and its profile associated with worse clinical, laboratory, and anthropometric outcomes. The use of other laboratory and clinical variables may also be a good strategy for predicting adverse outcomes in emergency units.

Translation and adaptation of the NUTRIC Score to identify critically ill patients who benefit the most from nutrition therapy

INTRODUCTION AND OBJECTIVES

Due to the scarcity of tools to assess the nutritional risk in critically ill patients, the NUTrition Risk in the Critically ill Score (NUTRIC Score) was developed and validated primarily in a limited population to quantify the risk of adverse events that may be modified by aggressive nutrition therapy. The objective of this study was to translate and adapt the NUTRIC Score into Portuguese language for further demonstrate its feasibility and clinical utility in Brazilian Intensive Care Units (ICUs).

METHODS

This translation and adaptation process is part of a study for the validation of NUTRIC Score in Brazil. Translation was performed according to standardized steps: initial translation, synthesis of translations, back-translation, revision and application of the instrument by specialists and evaluation of cultural adaptation. We conducted a pilot study within 50 patients mechanically ventilated for more than 48 h in four ICUs in Southern Brazil to determine the prevalence of patients who were the most likely to benefit from aggressive nutrition therapy.

RESULTS

The translation and adaptation process produced a valid version of NUTRIC Score in the Portuguese language. The translated version was easily introduced into four Brazilian ICUs and the prevalence of patients with high score and likely to benefit from aggressive nutritional intervention (mean age 61.4 ± 15.3 years) was 46% (23 individuals, 95%CI 0.33-0.60).

CONCLUSIONS

The NUTRIC Score has been successfully translated into Portuguese and the prevalence of nutritionally-high risk patients may be around 50% in Brazilian ICUs.

Body mass index, age and in-hospital mortality: The NutritionDay multinational survey

BACKGROUND & AIMS

Several large and long-term prospective studies have assessed the association of body-mass index (BMI) next to age with the risk of death in the general population, but few have examined the association with in-hospital mortality. We investigated the association between BMI, age and in-hospital mortality.

METHODS

We used data collected during 9 consecutive one-day/year surveys (NutritionDay in hospital 2006-2014) conducted in non-critically ill adult patients from 2,183 hospitals across 51 nations from 4 continents. We examined the association of BMI and age with the risk of in-hospital (30-day) death using logistic regression analysis adjusted for multiple confounders.

RESULTS

Crude mortality rates were 3.6% (95%CI, 3.5-3.7) and 2.1% (95%CI, 2.0-2.3) in the overall cohort (N = 97,344) and in those assessed within 72 hours since admission (N = 32,363), respectively. BMI and age were independently associated with the risk of death (no interaction observed), which decreased with BMI and increased with age. In the overall cohort, compared to normal weight status (BMI 18.5-24.9 kg/m²), death odds ratios for underweight (BMI < 18.5), overweight (BMI 25.0-29.9) and obesity (BMI ≥30) were 1.35 (95%CI, 1.20-1.53), 0.87 (95%CI, 0.77-0.97) and 0.73 (95%CI, 0.62-0.86), respectively. In patients assessed within 72 hours since admission, the associations were comparable: for underweight, 1.48 (95%CI, 1.11-1.96); for overweight, 0.80 (95%CI, 0.65-0.97); for obesity, 0.75 (95%CI, 0.58-0.96).

CONCLUSION

In adult hospitalized patients BMI and age are independent predictors of in-hospital mortality. Low body weight is confirmed being a risk factor for death as in the general population, while overweight and obesity appear protective conditions. In the hospital setting, the use of normal weight status as reference low-risk category could also be challenged.

Macronutrient intake and food sources in the very old: analysis of the Newcastle 85+ Study

Food and nutrient intake data are scarce in very old adults (85 years and older) - one of the fastest growing age segments of Western societies, including the UK. Our primary objective was to assess energy and macronutrient intakes and respective food sources in 793 85-year-olds (302 men and 491 women) living in North-East England and participating in the Newcastle 85+ cohort Study. Dietary information was collected using a repeated multiple-pass recall (2×24 h recalls). Energy, macronutrient and NSP intakes were estimated, and the contribution (%) of food groups to nutrient intake was calculated. The median energy intake was 6·65 (interquartile ranges (IQR) 5·49-8·16) MJ/d - 46·8 % was from carbohydrates, 36·8 % from fats and 15·7 % from proteins. NSP intake was 10·2 g/d (IQR 7·3-13·7). NSP intake was higher in non-institutionalised, more educated, from higher social class and more physically active 85-year-olds. Cereals and cereal products were the top contributors to intakes of energy and most macronutrients (carbohydrates, non-milk extrinsic sugars, NSP and fat), followed by meat and meat products. The median intakes of energy and NSP were much lower than the estimated average requirement for energy (9·6 MJ/d for men and 7·7 MJ/d for women) and the dietary reference value (DRV) for NSP (≥18 g/d). The median SFA intake was higher than the DRV (≤11 % of dietary energy). This study highlights the paucity of data on dietary intake and the uncertainties about DRV for this age group.

Underrecognition of Malnutrition in Advanced Cancer: The Role of the Dietitian and Clinical Practice Variations

INTRODUCTION

Malnutrition (MN) often goes unrecognized due to ineffective screening techniques. Published standards for multidisciplinary care exist but no consensus on best nutritional assessment for hospitalized patients. Malnutrition is common in cancer and adversely affects clinical outcomes. The Cleveland Clinic Nutrition Therapy Department used in-house criteria to classify MN in hospitalized patients. This study aimed to evaluate the registered dietitian (RD)'s role, the use of these criteria in the acute care palliative medicine unit (ACPMU), and investigate MN prevalence and severity among admitted patients with cancer.

METHODS

Electronic medical records were reviewed for newly admitted patients with cancer to the ACPMU with a first time RD consult and completed nutritional therapy assessment. Physician (MD) assessments were derived from admission notes. Cox regression model assessed the association of MN prevalence and severity with survival. McNemar's test determined whether a prevalence difference existed between RD and MD.

RESULTS

Variations existed in criteria used to identify MN. Seventy percent had MN, with the majority (61%) classed as moderate to severe. Prevalence (hazard ratio [HR]: 1.88; P = .002) and severity (HR: 1.22; P = .006) were associated with significantly increased mortality. Evaluations by RD and MD were highly congruent, but MDs underrecorded nutritional status.

CONCLUSION

Malnutrition was prevalent and clinically important, even in those on nutritional support. Variations in MN identification were common. Physicians underrecorded MN but were accurate for prevalence and severity when recorded. The data confirm the RD's important role in MN assessment. Comparable clinical practice and better communication between physicians and dietitians should improve cancer care and optimize quality of life.

Nutritional issues for older adults: addressing degenerative ageing with long-term studies

The ageing process is influenced by a variety of factors, including extrinsic, malleable lifestyle variables. The present paper deals with the epidemiological evidence for the role of dietary patterns and key nutritional concerns in relation to survival and ageing-related disorders that present themselves in later life. Healthful dietary patterns appear to be most relevant in old age. Specific nutritional concerns are related to vitamin D, vitamin B12 and protein malnutrition. An important challenge to further expand the knowledge base is currently addressed by the NuAge project, acknowledging the complexity of the ageing process and integrating different dimensions of research into human healthy ageing. In the meantime, reversing poor adherence to existing guidelines for a healthy diet remains a first challenge in public health nutritional practices.

Effects on Weight, Blood Lipids, Serum Fatty Acid Profile and Coagulation by an Energy-Dense Formula to Older Care Residents: A Randomized Controlled Crossover Trial

OBJECTIVES

Dietary intake in frail old adults is often lower than estimated needs. The aim of this study was to evaluate the effects of an energy-dense oral supplement on nutritional status, food intake, and physical function in residents living in care residential homes.

DESIGN

Randomized controlled intervention trial with a crossover design.

SETTING

Five care residential homes in the southern Stockholm area.

PARTICIPANTS

Older people living at care residential homes: age 65 or older, malnourished or at risk of malnutrition according to Mini Nutritional Assessment-Short Form (MNA-SF).

INTERVENTION

Energy-dense formula (oleic and linoleic acid emulsion enriched with protein and micronutrients) (Calogen Extra, Nutricia) 30 mL distributed 3 times daily for 6 weeks.

MEASUREMENTS

Body weight, 3-day food and fluid record, appetite rating, and physical function (ie, Short Physical Performance Battery, grip strength, and peak expiratory flow). Biochemical indicators of nutritional status, blood lipids, and serum phospholipid fatty acid (FA) profile.

RESULTS

Twenty-eight participants completed the 2 phases of the crossover study; group A (n = 14, 87 ± 6 years, 50% women) and group B (n = 14, 82 ± 8 years, 71% women). The intervention periods combined resulted in significantly (P < .05) increased energy intake (238 ± 544 kcal), weight gain (1.4 ± 3.7 kg), improved appetite, relative reduction of saturated FA and increase in polyunsaturated FA, increased apoliporotein A, and reduced serum fibrinogen (-0.9 ± 1.5 g/L).

CONCLUSION

Distribution of an oleic and linoleic acid based fat emulsion enriched with protein and micronutrients (Calogen Extra) 3 times daily to old people in care residential homes improved nutritional status, had positive effects on fatty acid profile and blood lipids, and a potential antithrombotic effect. CLINICALTRIALS.

GOV IDENTIFIER

NCT01259999.

Improving food intake in persons living with dementia

Persons living with dementia have many health concerns, including poor nutritional states. This narrative review provides an overview of the literature on nutritional status in persons diagnosed with a dementing illness or condition. Poor food intake is a primary mechanism for malnutrition, and there are many reasons why poor food intake occurs, especially in the middle and later stages of the dementing illness. Research suggests a variety of interventions to improve food intake, and thus nutritional status and quality of life, in persons with dementia. For family care partners, education programs have been the focus, while a range of intervention activities have been the focus in residential care, from tableware changes to retraining of self-feeding. It is likely that complex interventions are required to more fully address the issue of poor food intake, and future research needs to focus on diverse components. Specifically, modifying the psychosocial aspects of mealtimes is proposed as a means of improving food intake and quality of life and, to date, is a neglected area of intervention development and research.

[Nutritional status assessment in Geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology NutritionWork Group]

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics.

Nutritional and Functional Status in Geriatric Day Hospital Patients - MNA Short Form Versus Full MNA

OBJECTIVES

The aims of this study were to determine the prevalence of malnutrition in patients of a geriatric day hospital using the Mini Nutritional Assessment short form (MNA-SF) and the full MNA, to compare both tools, and to examine the relationship between nutritional and functional status.

DESIGN

Cross-sectional study.

SETTING

Geriatric day hospital.

PARTICIPANTS

190 patients (72.1% female, median 80 years) aged 65 years or older.

MEASUREMENTS

In consecutively admitted geriatric day hospital patients nutritional status was assessed by MNA-SF and full MNA, and agreement between both tools calculated by Cohen´s kappa. Basic activities of daily living (ADL), instrumental activities of daily living (IADL) and short physical performance battery (SPPB) were determined and related to MNA categories (Chi2-test, Mann-Whitney-U-test).

RESULTS

36.3 % and 44.7% of the patients were at risk of malnutrition, 8.9 % and 5.8 % were malnourished according to MNA-SF and full MNA, respectively. Agreement between both MNA forms was moderate (κ=0.531). No significant associations between MNA-SF and ADL, IADL and SPPB, and between full MNA and SPPB were observed. According to full MNA, the proportion of patients with limitations in ADL and IADL significantly increased with declining nutritional status (ADL: 2.1 vs. 8.2 vs. 18.2 %, p=0.044; IADL: 25.5 vs. 47.1 vs. 54.5 %, p=0.005) with a simultaneous decrease of the proportion of patients without limitations. Well-nourished patients reached significantly higher ADL scores than patients at risk of malnutrition (95 (90-100) vs. 95 (85-100), p=0.005) and significantly higher IADL scores than patients at risk or malnourished (8 (6-8) vs. 7 (5-8) vs. 6 (4-8), p=0.004).

CONCLUSION

The high prevalence of risk of malnutrition and the observed association between functional status and nutritional status according to full MNA call for routine nutritional screening using this tool in geriatric day hospital patients.

Clinical Guide for the Use of Metabolic Carts: Indirect Calorimetry--No Longer the Orphan of Energy Estimation

Critically ill patients often require nutrition support, but accurately determining energy needs in these patients is difficult. Energy expenditure is affected by patient characteristics such as weight, height, age, and sex but is also influenced by factors such as body temperature, nutrition support, sepsis, sedation, and therapies. Using predictive equations to estimate energy needs is known to be inaccurate. Therefore, indirect calorimetry measurement is considered the gold standard to evaluate energy needs in clinical practice. This review defines the indications, limitations, and pitfalls of this technique and gives practice suggestions in various clinical situations.

Nutritional Risk in Major Abdominal Surgery: Protocol of a Prospective Observational Trial to Evaluate the Prognostic Value of Different Nutritional Scores in Pancreatic Surgery

BACKGROUND

The influence of patients' preoperative nutritional status on their clinical outcome has already been proven. Therefore, patients with malnutrition are in need of additional therapeutic efforts. However, for pancreatic surgery, evidence suggesting the adequacy of existing nutritional assessment scores to estimate malnutrition associated with postoperative outcome is limited.

OBJECTIVE

The aim of the observational trial "Nutritional Risk in Major Abdominal Surgery (NURIMAS) Pancreas" is to prospectively assess and analyze different nutritional assessment scores for their prognostic value on postoperative complications in patients undergoing pancreatic surgery.

METHODS

All patients scheduled to receive elective pancreatic surgery at the University Hospital of Heidelberg will be screened for eligibility. Preoperatively, 12 nutritional assessment scores will be collected and patients will be assigned either at risk or not at risk for malnutrition. The postoperative course will be followed prospectively and complications according to the Clavien-Dindo classification will be recorded. The prognostic value for complications will be evaluated for every score in a univariable and multivariable analysis corrected for known risk factors in pancreatic surgery.

RESULTS

Final data analysis is expected to be available during Spring 2016.

CONCLUSIONS

The NURIMAS Pancreas trial is a monocentric, prospective, observational trial aiming to find the most predictive clinical nutritional assessment score for postoperative complications. Using the results of this protocol as a knowledge base, it is possible to conduct nutritional risk-guided intervention trials to prevent postoperative complications in the pancreatic surgical population.

TRIAL REGISTRATION

germanctr.de: DRKS00006340; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006340 (Archived by WebCite at http://www.webcitation.org/6bzXWSRYZ).