Filomena Pietrantonio*
Manerbio Hospital, Italy
*Corresponding author: Filomena Pietrantonio, Internal Medicine Unit, Manerbio Hospital, Manerbio (BS), ASST-Garda, Italy
Submission: February, 26, 2018; Published: April 19, 2018
Turning the Spotlight on Nutritional Status
Evaluation: Is it a Newsworthy Idea?
Editorial
Mortality rates among adults has been declining in most
countries for decades. Lower rates of death from infectious
diseases was the early driver of this improvement, but there have
been subsequent declines in mortality from cardiovascular disease
and some cancers. The hazardous effects of behavioral and dietary
risk factors on non-communicable diseases and the metabolic
and physiological conditions that mediate their effects, have been
established in prospective cohort studies and randomized trials.
This knowledge, together with data from risk-factor surveillance has
helped to establish the mortality and disease burden attributable to
these risk factors [1]. Recent reviews of the literature on nutrition
and hospitalization in patients with non-communicable diseases
have highlighted the relationship between obesity, socio-economic
status, nutrition, morbidity and mortality, length of hospital
stay and related costs. Evidence from the literature shows that
although much research has been dedicated to exploring obesity’s
relationship to risk factors and socioeconomic status, very few
studies have been carried out examining obesity in hospitalized
patients. Genetic and environmental risk factors are well known.
In 2010 a Danish study [2] showed that obesity (OB) is a stable
phenomenon in the United States and is on the rise in Europe
and Asia, equally affecting both men and women. In a subsequent
review, Brisbois [3] identified seven early markers of OB, including
smoking during pregnancy, weight gain during pregnancy, maternal
Body Mass Index (BMI), childhood obesity and father’s job. This
data clearly demonstrates the need for early prevention campaigns.
A clear relationship between income-obesity and health policies
has been demonstrated in developing countries. In fact, with a
Gross National Product (GNP) growth of over 2500$, the increase
in obesity affects the lower classes of the population [4]. These
data suggests a need for appropriate policies and prevention
campaigns. Moreover, consideration of certain determinants of
socio-economic status such as wealth, education and employment
help pinpoint more vulnerable social groups. Belonging to more
disadvantaged social categories favors becoming obese and the
obese condition prevents moving up in social status [5,6]. Obesity
has been considered an indirect cause of a higher mortality rates,
even if recent meta-analyses could not unequivocally confirm this
statement [7].
In obese hospitalized patients, on the other hand, longer stays
in Intensive Care Units (ICUs) and greater risk of complications
have been demonstrated [8]. Indeed, in critical patients evidence
exists of increased complication rates, mainly in the Intensive Care
Unit. Out of 62,045 patients admitted to the ICU, longer duration
of respiratory support and higher inpatient related costs were
identified in obese subjects [9]. A study conducted by Wigfield et
al. [10] concluded that more frequent complications were only
seen in morbidly obese patients (BMI> 40) . Further studies have
been performed aimed at assessing nutritional status, on the
basis of evidence that increased mortality and greater morbidity
and length of hospital stay depends on malnutrition, to which
obese patients are equally subject both in terms of micronutrient
deficiencies and inadequate muscle mass, representing the so
called obesity paradox. Preventive measures could therefore
reduce costs for national health systems [11]. Consequently, the
assessment of nutritional status on admission to the hospital
is key. The nutritional status evaluation tests (Malnutrition
Universal Screening Tool-MUST, Mini Nutritional Assessment-MNA,
Subjective Global Assessment-SGA) have similar validity and the
choice depends on the type of institution, the type of patients and
the available resources [12,13,14]. Together with the evaluation of
nutritional status, careful examination of each patient’s habitual
diet in the 6-12 months prior to admission is essential and should
be assessed using validated questionnaires in order to standardize
the data indicating that the costs of malnutrition are indeed rising
[15,16]. This phenomenon is mainly due to:
Editorial
Novel Techniques in
Nutrition and Food Science C
CRIMSON PUBLISHERS
Wings to the Research
102
Copyright © All rights are reserved by Filomena Pietrantonio.
Volume 1 - Issue - 5
Abbreviations: OB: Obesity; BMI: Body Mass Index; GNP: Gross National Product; ICUs: Intensive Care Units; MUST: Malnutrition Universal Screening
Tool, MNA: Mini Nutritional Assessment; SGA: Subjective Global Assessment
ISSN: 2640-9208