Nutritional status and assessment of patients on home parenteral nutrition: Anthropometry, bioelectrical impedance, or clinical judgment?

The optimal method of assessing protein energy nutritional status in patien ts receiving home parenteral nutrition (HPN) is unknown. We evaluated prote in energy nutritional status in 47 outpatients (23 male; 24 female) on HPN by measuring anthropometry, plasma proteins, and lymphocyte counts and comp ared these with the results of subjective clinical assessment and bioelectr ical impedance measurements. Sixteen of the 47 patients (34%) were underwei ght (body mass index <5th percentile of the reference) and 21 (45%) were be low the 5th percentile of the reference for both triceps skinfold thickness and midarm muscle circumference. Plasma proteins were subnormal in 1-5 pat ients (2-11%). Lymphocyte counts were subnormal in 19 patients (40%). Clini cal assessment classified 23 patients (49%) as well nourished and 24 (51%) as moderately malnourished. Moderately malnourished patients had a signific antly lower body mass index than well-nourished patients (P = 0.02). Clinic al assessment did not correlate with bioelectrical impedance analysis. Fat- free mass determined by bioelectrical impedance analysis resulted in values up to 9.4 kg lower and 8 kg higher than fat-free mass obtained by anthropo metry. Weighing combined with a subjective clinical assessment is sufficien t for evaluation of protein calorie nutritional status in patients on HPN. Nutrition 1999,15:1-6. (C) Elsevier Science Inc. 1999.