Cross-sectional and prospective studies of nutritional indices after percutaneous gastrostomy

Objective Formal monitoring of nutritional status may be lacking in many pa tients after gastrostomy. We aimed to study nutritional assessment and its problems in patients after gastrostomy in a cross-sectional study, assess p rospectively the changes in nutritional status of patients at 1 month and 6 months after gastrostomy placement, and determine the prognostic value of nutritional indices assessed at the time of gastrostomy placement. Design We used cross-sectional and prospective cohorts. The subjects were i nstitutional and community patients receiving percutaneous gastrostomy in a teaching hospital. Method We studied patients living in the community and in long-term care in stitutions after gastrostomy. In the cross-sectional study, we observed all individuals who received a percutaneous gastrostomy from the Gastrointesti nal Unit, Western General Hospital, Edinburgh from January 1994 to December 1996. In the prospective study, we observed consecutive referrals of patie nts to the Gastrointestinal Unit for percutaneous gastrostomy from March 19 97 to June 1998. Nutritional status was assessed using: weight (kg), height or stature estimated from knee-height (m), mid-upper arm circumference and triceps skinfold thickness. Body mass index, arm-muscle circumference and corrected arm-muscle area were calculated. A blood sample was taken to asse ss micronutrient status. Results In the cross-sectional study, 215 patients were identified who had received a percutaneous gastrostomy during the 3-year period 1994-1996. The weight and height measurements obtained in patients after gastrostomy were not as successful as upper-arm anthropometry. Of the 55 who were alive, tr aceable and agreed to take part in the study, 8% were under-nourished by co rrected arm-muscle area at a median of 16 months after gastrostomy placemen t, whilst 57% had biochemical evidence of macro- or micronutrient deficienc y. In the prospective study, 54 out of 87 patients referred for percutaneou s gastrostomy agreed to participate. Using corrected arm-muscle area, 14% o f patients were undernourished at the time of gastrostomy placement. Change s in nutritional status at 1 month and 6 months post gastrostomy were mixed across the patient groups. Patients with a depleted corrected arm-muscle a rea less than or equal to 21.4 cm(2) (less than or equal to 21.6 cm(2) for women) at the time of gastrostomy had significantly poorer survival than pa tients with corrected arm-muscle area of > 21.6 cm(2) (log-rank test 9.05; P = 0.003, relative risk 4.7). All patients in whom corrected arm-muscle ar ea had increased at the 1-month follow-up survived to 6 months post gastros tomy. Conclusions Assessment of nutritional status may be difficult in gastrostom y-fed patients. Upper-arm anthropometry is more often successful than other assessment methods and gives prognostic information. Lippincott Williams & Wilkins.