Prsentation PowerPoint

1
Forum   Dénutrition dans les Hôpitaux
Suisses   Berne, le 24 juin 2004
Déficit nutritionnel lors dobésité  un
problème à domicile et à lhôpital
R. Darioli Unité de Cardiologie
Préventive CHUV-PMU CH-1001 Lausanne/Suisse
1/rdarjuin04
2
Are malnutrition and obesity mutually exclusive ?
2/rdarjuin04
3
Definition of obesity

• Obesity is an excess of body fat which is
  frequently associated with non-fatal debilitating
  conditions such as osteoarthritis, or life
  threatening chronic diseases such as Coronary
  Heart Disease, diabetes, and certain cancers .
• Obesity is a complex condition, one with serious
  social and psychological dimensions, that affects
  virtually all age and socioeconomic groups and
  threatens to overwhelm both developed and
  developing countries

International Association for the Study of
Obesity / http//www.iotf.org/
3/rdarjuin04
4
Definition of Malnutrition

• Malnutrition results from imbalance between the
  body's needs and the intake of nutrients, which
  can lead to syndromes of deficiency, dependency,
  toxicity, or obesity.
• Malnutrition includes undernutrition, in which
  nutrients are undersupplied, and overnutrition,
  in which nutrients are oversupplied

4/rdarjuin04
5
Definition of Malnutrition
Undernutrition can result from - inadequate
intake, - malabsorption - abnormal systemic
loss of nutrients due to diarrhea, hemorrhage,
renal failure, or excessive sweating -
infection - addiction to drugs.
5/rdarjuin04
6
Definition of obesity

• Classification BMI (kg/m²) Risk of comorbidities
• Underweight lt 18,5  Low (but risk of other
  clinical problems)
• Normal 18,5 - 24.9  Average
• Underweight (Pre-obese) 25 - 29,9
• Obesity gt 30 Increased
•   - Obese Class I 30 - 34,9 Moderate
•   - Obese Class II 35 - 39,9 Severe
•   - Obese Class III gt 40 Very severe

7
Warning underrecognition of the nutritional
status in ambulatory care
8
Reported Consumption of Foods in Servings by
Dietary Pattern Cluster
8/rdarjuin04
JH. Ledikwe et al J Am Ger Soc 2004 52 589
9
Adjusted Odds Ratios Associated with Being in the
Low-Nutrient-Dense Food Pattern Cluster

• Cluster Low-Nutr-Dense Cluster
  High-Nutr-Dense Pattern (n107) Pattern
  (n72) Odds Ratio (95 CI)
  Odds Ratio
• BMIgt30kg/m2 2.03 (0.98-4.20) 1.0
• Waist circumf.gtNIH 2.33 (1.16-4.69) 1.0
• Dietary intake
•  - Folate lt400 mg/d 8.86 (2.90-27.05) 1.0
•  - Vitamin B6lt1.7/1.5 mg/d 16.58
  (5.28-52.03) 1.0
•  - Magnesiumlt420 /320 mg/d 10.82
  (2.78-42.02) 1.0
•  - Zinc lt11/lt8 mg/d 6.00 (2.33-15.45) 1.0
• Plasma nutrient biomarkers
•   - Vit B12 lt350 pg/mL 2.15 (0.93-4.96) 1.0

JH. Ledikwe et al J Am Ger Soc 2004 52 589
9/rdarjuin04
10

• Moderate loss 1.60 (1.04-2.47) 1.47 (1.01-2.14)

• Large loss 2.41 (1.58-3.66) 2.78 (1.98-3.92

11
Distribution of BMI among the Participants to the
Lausanne Health Promotion Program
P lt 0.001
Overweight 25 / 38
Proportion ()
Underweight 3 / 1.5
lt 18.5
18.5-24.9
25-29.9
30-34.9
35-39.9
gt 40
BMI (kg/m²)
R. Darioli et al Med Hyg 200462 399
12
(No Transcript)
13
Prevalence of Metabolic Syndrome among the
Participants to the Lausanne Health Promotion
Program
P lt 0.001
Prevalence ()
Age (years)
13/rdarjuin04
R. Darioli et al Med Hyg 200462 399
14
Prevalence of Excess of Fat Mass according to the
Presence or not of Metabolic Syndrome among the
Participants to the Lausanne Health Promotion
Program
Excess of FM if gt 90th percentile
P lt 0.001
Prevalence of excess of Fat mass ()
Age (years)
R. Darioli et al Med Hyg 200462 399
15
Influence of Overweight on ICU Mortality A
Prospective Study

• Background
• Obese patients develop protein energy
  malnutrition in response to metabolic stress
  despite excess body fat stores and large lean
  body stores.
• The metabolic response to severe trauma appears
  to be different in obese and nonobese subjects.
• That was demonstrated by Jeevanandam et al, who
  showed that obese trauma patients catabolized
  more proteins and less fat than nonobese trauma
  patients.

Goulenok C et al Chest. 20041251441-1445
16
Influence of Overweight on ICU Mortality A
Prospective Study

• Study objective
• Overweight patients seem to have a poorer outcome
  and a higher risk of complications during their
  stay in the ICU.
• This prospective study was performed in order to
  examine the relationship between body mass index
  (BMI) and mortality among these patients.
• Methods
• All patients hospitalized in the ICU over a
  1-year period were included except those dying or
  being discharged from the hospital within 24 h of
  admission.
• Overweight patients were defined as those having
  a BMI gt 75th percentile of this selected ICU
  population.
• Among the 813 included patients 215 (26) were
  obese

16/rdarjuin04
Goulenok C et al Chest. 20041251441-1445
17
Influence of Overweight on ICU Mortality A
Prospective Study
Multivariate Analysis
Variables OR p Value 95 CI Age 1.01 0.098 0.991.
02 LOS in ICU 1.02 0.11 0.991.04 SAPS II
1.08 lt 0.0001 1.071.10 BMI gt 27
kg/m² 1.83 0.017 1.102.86
for each additional point
Goulenok C et al Chest. 20041251441-1445
17/rdarjuin04
18
Summary

• Obesity clearly influences the prognosis of
  patients hospitalized in the ICU.
• Surprisingly, overweight was not taken into
  consideration by the usual scoring systems such
  as APACHE (acute physiology and chronic health
  evaluation) or SAPS II, probably because height
  and weight are not routinely recorded in ICU.
• Thus, the usual prognostic scores that are
  designed to predict the mortality of ICU patients
  may neglect an important parameter that may lead
  to an underestimation of mortality in the
  specific population of obese patients, as
  reflected by an observed mortality that is higher
  than the predicted mortality.

Goulenok C et al Chest. 20041251441-1445
18/rdarjuin04
19
CONCLUSION

• Obesity is frequently associated to malnutrition
  disorders
• This clinical condition is largely
  underrecognized in daily clinical practice in
  outpatients, as well in hospital
• Among them, patients with metabolic syndrome are
  highly vulnerable to develop complications
  associated to undernutrition requiring specific
  care and hospitalization
• In regard to consequences of a such metabolic
  disorders, there is a need to develop a combined
  strategy including prevention and disease
  management as a continuum.

19/rdarjuin04
20
Its time to act
Prevention
Thanks for your attention !