Concordance of the new ESPEN criteria with low phase angle in defining early stages of malnutrition in cardiac surgery

Donata Ringaitiene; Dalia Gineityte; Vaidas Vicka; Akvile Sabestinaite; Andrius Klimasauskas; Edita Gaveliene; Kestutis Rucinskas; Justinas Ivaska; Jurate Sipylaite

doi:10.1016/j.clnu.2017.08.007

Concordance of the new ESPEN criteria with low phase angle in defining early stages of malnutrition in cardiac surgery

Clin Nutr. 2018 Oct;37(5):1596-1601. doi: 10.1016/j.clnu.2017.08.007. Epub 2017 Aug 12.

Authors

Donata Ringaitiene¹, Dalia Gineityte², Vaidas Vicka³, Akvile Sabestinaite⁴, Andrius Klimasauskas⁵, Edita Gaveliene⁶, Kestutis Rucinskas⁷, Justinas Ivaska⁸, Jurate Sipylaite⁹

Affiliations

¹ Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania. Electronic address: dringaitiene@yahoo.com.
² Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania. Electronic address: d.gineityte@santa.lt.
³ Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania. Electronic address: Vaidas.Vicka@mf.stud.vu.lt.
⁴ Vilnius University, Faculty of Medicine, Vilnius 01513, Lithuania. Electronic address: akvile.sabestinaite@gmail.com.
⁵ Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania. Electronic address: andrius.klimasauskas@santa.lt.
⁶ Vilnius University, Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Vilnius 08406, Lithuania. Electronic address: edita.gaveliene@santa.lt.
⁷ Vilnius University, Faculty of Medicine, Vilnius 01513, Lithuania; Vilnius University, Faculty of Medicine, Clinic of Cardiovascular Diseases, Heart Surgery Center, Vilnius 08406, Lithuania. Electronic address: kestutis.rucinskas@santa.lt.
⁸ Vilnius University, Faculty of Medicine, Vilnius 01513, Lithuania; Vilnius University, Clinic of Ear, Nose and Throat Diseases, Vilnius, 01513, Lithuania. Electronic address: Justinas.Ivaska@santa.lt.
⁹ Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania. Electronic address: jurate.sipylaite@santa.lt.

PMID: 28843445
DOI: 10.1016/j.clnu.2017.08.007

Abstract

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.

Keywords: Bioelectrical impedance analysis; Cardiac surgery; Malnutrition criteria; Phase angle.

MeSH terms

Aged
Body Mass Index
Cardiac Surgical Procedures / statistics & numerical data*
Electric Impedance
Female
Heart Diseases / complications
Heart Diseases / surgery
Humans
Male
Malnutrition / diagnosis*
Malnutrition / epidemiology*
Middle Aged
Nutrition Assessment
Nutritional Status
Prospective Studies
ROC Curve
Tertiary Care Centers