Type-1 diabetics, mainly those with severe diabetic complications, suffer from chronic malnutrition. The ideal is to improve their nutritional status prior to major elective surgery.
However, it is important to know their baseline nutritional profile to target their specific needs before and after surgery. We started with nutritional assessment prior to pancreas transplantation in combination with Early Enteral Nutrition. But we found it difficult to assess this specific group of the patients.
hi dear Elijiah
what are measurements for nutritional status?
do you mention the anthropocentric and biochimical indicator?
This question is too broad as the age of the patient [pediatric or adult] and co-morbidities are important in deciding the protocol for assessment. For instance using the Subjective Global Assessment or the NRS-2000 [appropriate for surgical patients as recommended by ESPEN] would be appropriate for adult patients. Then again the inflammatory status of the patient [hs CRP] , serum albumin, prealbumin and appropriate clinical chemistry would be important i nadding specific information. Assessing physical stamina using handgrip dynanometer would be appropriate in the older patient. Lastly and most important, the incremental weight loss over a period of time [week, month] is sometimes more than enough to decide on a nutrition support plan [Blackburn et al JPEN 1977;1:17].
Thanks for your comments and suggestions. Very helpful.
To be more specific, our target group is type-1 diabetic patient who is candidate for panaceas or kidney transplantation. Unfortunately albumin is not very sensitive marker in these patients as majority of them has End-Stage Renal failure and they are on some kind of haemodialysis. As we know this have a negative impact on Albumin levels. Unfortunately, pro-albumin is test is not available in our hospital.
In additional our nutritional assessment includes Nutrition Risk Scree Score.
Do you have any experience with this specific group of patients?
Hi Elijah, to better refine your issue- would you classify this patient as end stage renal failure on maintenance dialysis awaiting transplantation? If so, this patient group is prone to malnutrition because of uremia-induced inflammation. Albumin is considered as a useful criteria [< 40g/L] along with BMI. I am recommending 3 papers for your reading which discusses the role of inflammation in protein energy wasting and 2 screening tools specific for the ESRD population.
1. Fouque, D., Kalantar-Zadeh, K., Kopple, J.D., Cano, N., Chauveau, P., Cuppari, L., Franch, H., Guarnieri, G., Ikizler, T.A., Kaysen, G., Lindholm, B., Massy, Z., Mitch, W., Pineda, E., Stenvinkel, P., Trevinho-Becerra, A. &Wanner, C. (2008) A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease. Kidney Int.73, 391–398.
2. Kalantar- Zadeh, K., Kleiner, M., Dunne, E., Lee, G.H. &Luft, F.C. (1999) A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol. Dial. Transplant14, 1732-1738.
3. Kalantar-Zadeh, K., Kopple, J.D., Block, G. & Humphreys, M.H. (2001) A Malnutrition Inflammation Score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am. J. Kidney Dis.38(6), pp. 1251-1263.
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