Methods: One hundred and nineteen random patients were screened according to the NRS-2002 system and the energy requirements were calculated. The type of food ordered for the patients and the energy intake were determined. Results: Eighty had an NRS score of 0 2, i.e. not at nutritional risk and 36 a score 3, i.e. at nutritional risk. Among patients with NRS score 3 only 50% were ordered the correct menu. Only 50% of the patients had an energy intake <75% of their requirements. In the group of patients, who took <50% of energy requirement most of the energy came from the main courses and very little from snacks, Table 1. Table 1: The median energy intake from main courses and from snacks Energy intake
% of energy requirement from
% of calculated requirement
median, % of the three main requirement courses
>75% (n = 56) 50 75% (n = 39) <50% (n = 24)
97 64 36
21 11 6
76 54 31
Conclusion: In-patients at nutrtional risk focus should be on ordering the correct type of food for the main courses and especially on increasing the intake from snacks. References  Freil M et al. Reorganisation of a hospital catering systm increases food intake in patients with inadequate intake. Scand J Nutr 2005;50:83 8. Disclosure of Interest: None declared.
P192 SUBJECTIVE GLOBAL ASSESSMENT IS CLINICALLY MORE USEFUL THAN MINI-NUTRITIONAL ASSESSMENT IN HOSPITALISED OLDER ADULTS Y.P. Lim1 , W.S. Lim2 , T.L. Tan2 , L. Daniels3 . 1 Nutrition and Dietetics, 2 Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; 3 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia Rationale: Malnutrition is prevalent among hospitalized older adults. None of the nutritional assessment tools had been evaluated for use in Singapore. The study aimed to compare the use of Subjective Global Assessment (SGA) and Mini-Nutritional Assessment (MNA) on hospitalized older adults in Singapore. Methods: Newly admitted patients aged 60 years, who were not critically or terminally ill, were recruited from the geriatric medicine unit in Tan Tock Seng Hospital (TTSH). Nutritional status was assessed using SGA and MNA upon admission by a singe Dietitian. Nutritional status was analysed against clinical outcomes: length of hospital stay (LOS), discharge to higher level care, readmission at 3-month, modiﬁed Barthel Index (MBI) and mortality at 6-month, before and after adjustment for age, gender, race, depression, dementia, severity of illness, Charlson’s comorbidity index, number of prescribed drugs and admission MBI, using regression analysis.
Results: The sample comprised 281 patients with mean age 81.3±7.6 years; 44% male; 83% Chinese; median LOS 9 days. SGA and MNA were completed in 100% and 84% of patients, respectively. 35% and 23% were identiﬁed as malnourished by SGA and MNA, respectively. SGA-determined malnutrition was associated with LOS 11 days (OR 1.94), readmission at 3-month (OR 2.42), mortality at 6-month (OR 4.30), and MBI < 50 at 6-month (OR 2.08, all p < 0.05). MNA-determined malnutrition was associated with readmission at 3-month (OR 2.15), mortality at 6-month (OR 2.97), and MBI < 50 at 6-month (OR 5.80, all p < 0.05). After adjustment for covariates, only SGA-determined malnutrition remained predictive of LOS 11days (OR 2.45, p < 0.05). Conclusion: SGA has a higher completion rate and is better associated with clinical outcomes than MNA. Therefore SGA is a more useful nutritional assessment tool for assessing the nutritional status of hospitalized older adults in Singapore. Disclosure of Interest: None declared.
P193 EVALUATING THE VALIDITY OF FOUR NUTRITIONAL SCREENING TOOLS IN HOSPITALISED OLDER ADULTS Y.P. Lim1 , W.S. Lim2 , T.L. Tan2 , L. Daniels3 . 1 Nutrition and Dietetics, 2 Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; 3 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia Rationale: Hospitalised older adults are at risk of malnutrition. There are limited nutritional screening tools which are validated in this high risk population in Singapore. The study aimed to compare the diagnostic validity of four nutritional screening tools on hospitalised older adults in Singapore. Methods: Newly admitted patients aged 60 years, who were not critically or terminally ill, were recruited from 3 wards of a geriatric medicine unit in Tan Tock Seng Hospital (TTSH). Nutritional screening was performed by a single Diet Technician on admission using four screening tools: TTSH Nutrition Screening Tool (NST), Nutrition Risk Screening 2002 (NRS 2002), Short Nutrition Assessment Questionnaire (SNAQ), and Mini Nutritional Assessment Short Form (MNA-SF). Nutritional status was assessed using Subjective Global Assessment (SGA) as the reference standard by a single Dietitian. ROC analysis and diagnostic performance of the tools were compared with SGA to determine AUC, sensitivity, speciﬁcity, positive and negative predictive values. Results: The sample comprised 281 patients with the following characteristics: mean age 81.3±7.6 years; 44% male; 83% Chinese; 33% dementia; 35% malnourished. The TTSH NST, NRS, SNAQ and MNA-SF identiﬁed 42%, 37%, 6% and 81% as at risk of malnutrition, respectively. The sensitivity, speciﬁcity, positive and negative predictive values of the screening tools against SGA were: TTSH NST (84%, 79%, 68%, 90%, AUC = 0.87); NRS 2002 (69%, 79%, 64%, 83%, AUC = 0.78); SNAQ (17%, 100%, 100%, 69%, AUC = 0.76); MNA-SF (100%, 27%, 39%, 100%, AUC = 0.16). The optimal cut-off for the TTSH NST remained unchanged even for patients aged >85 years (AUC = 0.85).
Nutritional Epidemiology I Conclusion: The TTSH NST has the best diagnostic performance among the four screening tools. It is a valid tool with good diagnostic value to detect malnutrition in the hospitalised older adults who are at high risk of malnutrition. Disclosure of Interest: None declared.
Nutritional Epidemiology I P194 REFERRAL AND SURVIVAL OF PATIENTS IDENTIFIED AS CANDIDATES FOR INTESTINAL TRANSPLANTATION. A 4-YEAR PROSPECTIVE FOLLOW-UP FROM A SINGLE CENTRE A.U. Murugananthan1 , P. Paskaran1 , D.A.J. Lloyd1 , J.M.D. Nightingale1 , S.J. Middleton2 , S.M. Gabe1 . 1 Lennard-Jones Intestinal Failure Unit, St Mark’s Hospital, London, 2 Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge, United Kingdom Rationale: Current Intestinal Transplantation (ITx) criteria may not select adult Home Parenteral Nutrition (HPN) patients with a poor prognosis. 3 year mortality is comparable in those meeting ITx criteria and those that do not.1 We present 4 year data on (i) HPN patients at St Mark’s Hospital meeting ITx criteria, (ii) patients referred for ITx and (iii) mortality rates. Methods: Patients receiving HPN in 2005 were identiﬁed and annually reviewed for 4 years for eligibility for ITx based on fulﬁlment of 1 or more of the following approved criteria (Medicare): (1) advanced PN-associated liver disease (PNALD), (2) thrombosis of 2 or more major veins, (3) frequent CVC sepsis (2 or more episodes in the last 12 months, fungaemia or septic shock), (4) frequent severe dehydration, and (5) patient request/quality of life. Results: 123 patients were reviewed in 2005, 122 in 2006, 117 in 2007 and 103 in 2008, the fall representing death, HPN discontinuation or ITx. 32 patients (26%) fulﬁlled 1 or more ITx criteria in 2005, 35 patients (29%) in 2006, 32 patients (27%) in 2007 and 37 (36%) in 2008. Annual ITx referral rates were 6 (19%), 8 (23%), 8 (25%) and 8 (22%) respectively. Overall 4 year survival in this cohort was 90% with 2 deaths in those eligible for ITx and 10 in those that were not. Conclusion: 4 year survival of HPN patients in this cohort is more favourable than quoted ITx survival ﬁgures of 50% at 5 years. 2 We demonstrate that at our institution patients meeting ITx criteria do not have a higher mortality than those that do not. Our ﬁndings differ to a recent multicentre survey3, perhaps as this is a single cohort of patients and includes only adults. Current ITx guidelines do not appear to select adult HPN patients with high mortality. References  Paskaran P et al. Clinical Nutrition 2008;3:158.  Intestinal Transplant Registry. www.lhsc.on.ca/itr.  Pironi et al. Gastroenterology 2008;135:61 71. Disclosure of Interest: Nil
107 P195 OBESITY: A REPORT OF PORTUGUESE SITUATION C. Sousa Guerreiro1 , J. Sousa1 , A. Moreira1 , M. Cebola1 , L. Mendes1 . 1 Dietetics, ESTeSL, Lisbon, Portugal Rationale: According to WHO, obesity is a global problem of the world, so prevention and management strategies applicable to all regions of the world should be developed. This study was realized in a Portuguese community project called “Medical Social Solidarity (SMS)”. In this project the nutritional status of the Portuguese population was evaluated, especially in less developed areas of the country, and a personalized nutritional counseling was provided. Methods: During the period between October 2006 and January 2009, in 12 undeveloped areas of Portugal, 3170 subjects (68% adults and 32% children) were evaluated in respect to body mass index, percentage of fat and abdominal circumference. In overweight people or with a high abdominal circumference or high percentage of fat, a nutritional counseling done by voluntary dietitians was provided. Results: In these results, adult population (mean age 56.5±16) presented a BMI mean of 29.9±5.02 kg/m2 . According to BMI, 86% of population was overweight, only 14% had a normal weight for height, and 0.5% was undernourished. Regarding to fat mass, men (32% of population) presented 30% of their weight as fat, and women 37%. Finally the abdominal circumference mean was also high in both genders (96.3±14.9 cm in women and 104.9±10.9 cm in men). Regarding to children (mean age = 14.9±2.1 years), 35% of population presented overweight (24.8% was in pre-obesity stage and 10.8% was obese). Mean percentage of fat was also high (23.4±9.6) and abdominal circumference was 81.3±13.2 cm. Conclusion: These results shows that obesity affects all ages and socioeconomic groups of population. Programs and actions like SMS are URGENT in countries like Portugal, where obesity is a real health problem disease. Disclosure of Interest: None Declared.
P196 UNDELIVERED CALORIES IN ENTERAL NUTRITION: WHERE’S THE PROBLEM? D.B.V. Villacorta1 , S.M.M. Reis1 , F.C. Marin1 , D.F. Ferreira1 , S. Toscano1 , E. Koterba2 , A. Nunes2 , D.C. Magnoni1 , C. Cukier1 . 1 Nutritional Time, 2 ICU, Sao Camilo Santana Hospital, S˜ ao Paulo, Brazil Rationale: Fasting time caused by interruptions in enteral feeding is a common cause of inadequate calorie intake. General procedures as diagnosis exams, surgeries, as far as gastrointestinal impairments are related with fasting long-time and diminished enteral diet infusions. The aim of this study was to deﬁne the main causes of fasting, emphasizing what issues need more attention to avoid loss of calories. Methods: 658 patients were evaluated daily by a nutritional team during 2008 in a general hospital in S˜ ao Paulo, Brazil. All patients had been receiving enteral nutrition in controlled continuous infusion, it was collected some