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Effect of nutritional support on routine nutrition assessment parameters and body composition in intensive care unit
1Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC.
Objectives:
To determine whether routine nutrition assessment parameters and body composition change after nutritional support in intensive care unit (ICU) patients and whether the changes, if any, are related to cumulative energy and fluid balances.
Design:
A prospective study.
Setting:
A university teaching hospital.
Patients:
Forty-five mechanically ventilated medical and surgical patients admitted to the ICU who received nutritional support for 7 days (group 1) and 9 patients of this group who received nutritional support for 3 weeks or longer (group 2).
Interventions:
Enteral and parenteral nutritional support prescribed on the basis of metabolic cart measurements of energy expenditure.
Outcome Measures:
Routine nutrition assessment, including determinations of weight, serum albumin and prealbumin, and lymphocyte count and body composition, including measurements of body cell mass, extracellular fluid and body fat, determined from bioelectric impedance analysis.
Results:
In group 1 patients, weight, albumin and prealbumin levels, and extracellular mass changed, but there was no change in lymphocyte count, body cell mass or body fat. Changes in weight and extracellular mass were slightly related to cumulative fluid balance; changes in albumin and prealbumin levels were not related to cumulative energy or fluid balance. The findings were similar for group 2 patients.
Conclusions:
Changes in routine nutrition assessment parameters and body composition are slightly affected by fluid balance but not by energy balance; thus, they are not specific indicators of the adequacy of nutritional support in ICU patients. Improved nutrition assessment parameters are required to better monitor the response to nutritional support in critically ill patients.