Hello George,

I think that one of the most reliable screening tools to assess malnutrition is the 'Malnutrition Universal Screening Tool' ('MUST'). Also, Onodera's prognostic nutritional index (OPNI) is an easily calculated scoring system for malnutrition.

Hi Charalampos,

Thank you for your answer.

It is indeed a good idea to use these screening tools in malnourishment. However I am not sure whether they would be reliable in the assessment of patients post Intestinal transplantation.

Especially the OPNi score doesn't look promising, as it takes into account peripheral lymphocytes, which I would not trust in patients following Alemtuzumab administration.

The MUST score could be probably better in our patients.

However, I was actually thinking of using biochemical markers such as Magnesium or Phosphate for a reliable assessment, as Intestinal transplant patients may present with malnutrition that is not depicted in their BMI.

Do you have any suggestions?

Hello George,

I agree that on this occasion the OPNI score would might not be so reliable; I think that the most useful way to assess tge nutritional status in your patients would be a combination of albumin, pre-albumin, possibly with the addition of lepton, along with anthropometric parameters, such as triceps skin fold thickness and mid-arm circumference. I think that magnesium levels when it comes to intestinal transplantation would be an endangered option, since its levels could be significantly altered in cases of malabsorption. Concerning phosphate, I think that it would be most useful in the monitoring of a possible re-feeding syndrome in malnourished patients.

I hope that I was of some help tou you.

We have a paper in press for Journal of the American College of Nutrition (JACN) that might help to address this question a bit. We have also reviewed available data from cohort studies in Canada,US and Germany to find normative data about % body fat.

please find enclosed the abstract; the paper will come out hopefully soon. I hope that this information might be useful for you.

please do not forget to vote whether this reply was helpful.

CF

Title: Nutritional status in sick children and adolescents is not accurately reflected by BMI-SDS

Gerhard Fusch*, PhD, Preeya Raja*, BSc, MSc, Nguyen Quang Dung**, MD, PhD, Nadina Karaolis-Danckert, Ronald Barr, MBChB, MD, Christoph Fusch*, MD, PhD, FRCPC

ABSTRACT

Background: Nutritional status provides helpful information of disease severity and treatment effectiveness. BMI standard deviation scores (BMI-SDS) provide an approximation of body composition and thus are frequently used to classify nutritional status of sick children and adolescents. However, the accuracy of estimating body composition in this population using BMI-SDS has not been assessed. Thus, this study aims to evaluate the accuracy of nutritional status classification in sick infants and adolescents using BMI-SDS, upon comparison to classification using percent body fat (%BF) reference charts.

Design: BMI-SDS was calculated from anthropometric measurements and %BF was measured using DXA for 393 sick children and adolescents (5 months – 18 years). Subjects were classified by nutritional status (underweight, normal weight, over weight and obese), using two methods: (1) BMI-SDS, based on age- and gender-specific percentiles, and (2) %BF reference charts (standard). Linear regression, and a correlation analysis were conducted to compare agreement between both methods of nutritional status classification. %BF reference value comparisons were also made between three independent sources based on German, Canadian and American study populations.

Results: Correlation between nutritional status classification by BMI-SDS and %BF agreed moderately (r2 = 0.75, 0.76 in boys and girls, respectively). The misclassification of nutritional status in sick children and adolescents using BMI-SDS was 27% when using German %BF references. Similar rates observed when using Canadian and American %BF references (24%, 23% respectively).

Conclusions: Using BMI-SDS to determine nutritional status in a sick population is not considered as an appropriate clinical tool for identifying individual underweight or overweight children or adolescents. However, BMI-SDS may be appropriate for longitudinal measurements or for screening purposes in large field studies. When accurate nutritional status classification of a sick patient is needed for clinical purposes, nutritional status will be assessed more accurately using methods that accurately measure %BF, such as DXA.

We perform nutritional assessment on every diabetic patient with/without End-Stage Renal Failure prior transplantation. Our results showed that following factors have sensitive predictive value: weight loss, nutritional risk screening score, incidence/severity of gastroperesis.

Postoperatively, all patients postoperatively receive Early Enteral Nutrition (EEN).

Based on final assessment score patients are divided into two EEN groups; either jejunal feeding (NJ) or oral feeding.

We achieved excellent results.

I will be uploading soon, maybe today, an investigation done in   Chronic Psychiatrict Wards of the center I am,   the one   I assume it can  also be  applied in Long term Care Facitlities, it  implies doing dietary, clinical and anthropometrics...