[Aid to decision for nutritional support in chronic digestive diseases]

In patients with chronic gastro-intestinal disease, deciding whether or not to provide nutritional support is difficult. The aim of the present study was to develop an objective index to help clinicians to decide which patients should be treated with nutritional support. Two hundred and two patients were studied prospectively. Seventy-one had an inflammatory bowel disease, 51, a malabsorption syndrome, 59, an esophagogastric disorder, and 21, a pancreatic disease. On admission, nutritional status was assessed by anthropometric and biological measurements, and spontaneous oral caloric intake. Clinical assessment of the nutritional condition was performed by an independent observer. Using discriminant analysis, collected data were correlated to the therapeutic outcome of the patient during the 15 days after admission, i. e. whether or not they received nutritional support. Clinical global assessment proved to be the most discriminant variable: 83 p. 100 of the patients were correctly classified. This variable was deleted from further analysis to obtain an objective index, calculated with four variables: mid-arm muscle circumference, body weight, serum albumin, and caloric oral intake expressed as kcal X IBW kg-1 X day-1. The index classified correctly 84 p. 100 of the patients. This study demonstrates that subjective clinical assessment is the best variable to decide whether or not a gastrointestinal patient should receive nutritional support. We suggest that this index might be of help in these situations.