MALNUTRITION IN TUBEFED NURSING-HOME PATIENTS WITH PRESSURE SORES

This study compares the nutritional status and dietary intake of 14 tubefed nursing home patients with pressure sores (age: 70 +/- 5 years, mean +/- SEM) to 12 tubefed patient-controls without sores (age: 60 +/- 7 years). Patients tended to have higher calorie intake (32 +/- 3 kcal/kg) than patient-controls (26 +/- 2 kcal/kg, p = 0.11). Protein intake was significantly higher in patients (1.4 +/- 0.2 g/kg) than patient-controls (0.9 +/- 0.1 g of protein per kg, p < 0.05). Despite increased calorie and protein intake, biochemical measures of nutritional status were worse in the patients. Serum albumin was lower in patients (33 +/- 1 g/L) than in patient-controls (37 +/- 1 g/L, p < 0.05) as was level of hemoglobin (patients: 117 +/- 5; patient-controls: 132 +/- 5 g/L, p < 0.05). Patients with stage IV (severe) sores had lower serum cholesterol levels (3.46 +/- 0.31 mmol/L, n = 5) than patients with stage II/III (milder) sores (4.58 +/- 0.23 mmol/L, n = 9, p < 0.05). Plasma zinc was low in both patients (11.2 +/- 0.6-mu-mol/L) and patient-controls (11.5 +/- 0.7-mu-mol/L, p = NS). Pressure sore surface area was positively correlated with calorie intake per kilogram of body weight (r = +0.59, p < 0.04) and negatively correlated with body mass index (r = -0.70, p < 0.03), hemoglobin (r = -0.55, p < 0.07) and serum cholesterol (r = -0.57, p < 0.05). Thus, tubefed nursing home patients with pressure sores are malnourished despite receiving a diet high in calories and protein. Their low body weight, hypoalbuminemia, anemia, and hypocholesterolemia suggest greatly increased requirements for calories and protein. Because most of the patients in this malnourished, chronically ill population tolerated tubefeeding well, increased provision of calories and protein via the enteral route seems a potentially achievable goal.