Concordance of the new ESPEN criteria with low phase angle in defining early stages of malnutrition in cardiac surgery. Issue 5 (October 2018)

• Record Type: Journal Article
• Authors: Ringaitiene, Donata; Gineityte, Dalia; Vicka, Vaidas; Sabestinaite, Akvile; Klimasauskas, Andrius; Gaveliene, Edita; Rucinskas, Kestutis; Ivaska, Justinas; Sipylaite, Jurate
• Is Part Of: Clinical nutrition. Volume 37:Issue 5(2018)
• Page Start: 1596
• Page End: 1601
• Publication Date: 2018-10
• Subjects: Malnutrition criteria -- Cardiac surgery -- Phase angle -- Bioelectrical impedance analysis; PA phase angle -- BIA bioelectrical impedance analysis -- Low PA low phase angle -- FFMI fat free mass index -- Euroscore II European system for cardiac operative risk evaluation II -- IQR interquartile range -- OR odds ratio -- CI confidence interval -- BMI body mass index -- CABG coronary artery bypass grafting -- LVEF ejection fraction of the left ventricle -- ESPEN European Society of Clinical Nutrition and Metabolism -- CPB cardiopulmonary bypass -- ROC receiver operating characteristic -- AUC area under the curve -- NYHA New York heart association functional classification; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2017.08.007
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: The aim of this study was to evaluate the incidence of malnutrition (MN) in cardiac surgery patients by implementing the new ESPEN diagnostic criteria and to determine whether these criteria are concordant with the bioelectrical impedance analysis (BIA) provided phase angle (PA) in predicting early stages of malnutrition. Methods: A prospective study was conducted in a tertiary hospital. The nutritional state of the cardiac surgery patients was evaluated one day prior to cardiac surgery using the malnutrition screening tools NRS-2002, MUST and SF-MNA, and bioelectrical impedance analysis. Patients at risk of malnutrition were further studied in accordance with the ESPEN malnutrition diagnostic criteria. A BIA provided PA value of less than the 15th percentile of the age and gender group was set as a theoretical marker of early malnutrition. ROC AUC (receiver operating characteristic area under curve) analysis and other parameters were calculated to determine the concordance between the new ESPEN malnutrition diagnostic criteria and a low PA. Results: The study comprised 549 enrolled cardiac surgery patients. MN or risk of MN in accordance with at least one nutritional status assessment tool was diagnosed in 372 (67.75%) patients. MN, according to the new ESPEN malnutrition diagnostic criteria, was only diagnosed in 31 (5.6%) patients. Low PA was detected in 124 patients (22.6%), providing a higher MN rate. The ROC analysis and other concordance parameters showed that the new ESPEN diagnostic criteria (AUC 0.560, p = 0.042) were not concordant with a low PA. Conclusion: Fewer patients are classified as malnourished by the new ESPEN definition as those identified by the BIA provided PA. Incorporation of the BIA provided PA into the new ESPEN definition may aid to diagnose the early stages of MN in the field of cardiac surgery.