Body Composition in 995 Acutely ill or Chronically ill Patients at Hospital Admission: A controlled population Study

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Abstract

Objective To determine if fat-free mass and fat mass in acutely ill and chronically ill patients differed from healthy controls at hospital admission and if prevalence of malnutrition differed by body mass index (BMI) or fat-free mass percentile.Subjects/Setting 995 consecutive patients 15 to 100 years of age admitted to the hospital were measured in the hospital admission center and compared with 995 healthy age- and height-matched subjectsDesign Cross-sectional study. Fat-free mass, fat mass, and percentage fat mass were determined by 50 kHz bioelectrical impedance analysis. Prevalence of malnutrition was determined by BMI <20 kg/m2 or fat-free mass in the 10th percentile.Statistical Analysis Analysis of variance was used to examine differences between acutely ill and chronically ill patients and controls and between age groups.Results Fat-free mass was significantly lower in patients than controls (P<.05), and the difference with age in fat-free mass in patients was greater than the age-related difference in the controls. A higher percentage fat mass was found in spite of lower BMI in chronically ill patients older than 55 years. Among participants, 25% of acutely ill and 37.3% of chronically ill patients fell below fat-free mass in the 10th percentile, compared with 15.6% of acutely ill and 18.9% of chronically ill patients falling below BMI ≤20 kg/m2.Applications/Conclusion Weight and BMI do not evaluate body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass. In spite of minimal differences in BMI between patients and controls, we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls. The objective measurement of body composition, as part of a comprehensive nutritional assessment, helps to identify subjects who have low fat-free mass or high fat mass. J Am Diet Assoc. 2002;102:944–948,953–955.

Section snippets

Patients

All adult patients admitted to the hospital admission center (which serves to admit both critically ill and noncritically ill patients) for medical or surgical reasons and subsequently hospitalized were eligible for inclusion. Every tenth patient was included in the study during a 3-month period. Included were 995 patients; 2 patients refused to participate in the study. Excluded were 35 patients with edema, burns, or treated with peritoneal dialysis or hemodialysis, and 26 patients with

Results

The anthropometric and bioelectrical impedance characteristics of the controls and acutely ill and chronically ill patients are shown in Table 1 (men) and Table 2 (women). The number of acutely ill subjects was highest in the youngest age group and lowest in the oldest age group, compared with the lowest number of chronically ill subjects in the youngest age group. Height was minimally different between controls and patients and was lower in older age groups compared with younger age groups in

Discussion

The purpose of a nutritional assessment is to identify patients with depleted body tissues and increased risks for complications. This study evaluated fat-free mass and fat mass in acutely ill and chronically ill patients at hospital admission compared with age- and height-matched healthy controls and found lower fat-free mass in chronically ill patients and higher percentage fat mass in patients than controls. Furthermore, the study showed that BIA was more sensitive in determining the risk of

Applications

Weight and BMI do not evaluate the body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass. In spite of minimal differences in BMI between patients and controls, fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls. The objective measurement of body composition, as part of a comprehensive nutritional assessment, helps to identify subjects who have low fat-free mass or high fat mass.

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