S. Giryes, E. Leibovitz, Z. Matas, S. Fridman, D. Gavish, B. Shalev, Z. Ziv-Nir, Y. Berlovitz and M. Boaz
Background: Depending on the definition used, malnutrition is prevalent among 20¨C50% of hospitalized patients. Routine nutritional screening is necessary to identify patients with or at increased risk for malnutrition. The Nutrition Risk Screening (NRS 2002) has been recommended as an efficient tool to identify the risk of malnutrition in adult inpatients.
Objectives: To utilize the NRS 2002 to estimate the prevalence of malnutrition among newly hospitalized adult patients, and to identify risk factors for malnutrition.
Methods: During a 5 week period, all adult patients newly admitted to all inpatient departments (except Maternity and Emergency) at Wolfson Medical Center, Holon, were screened using the NRS 2002. An answer of yes recorded for any of the Step 1 questions triggered the Step 2 screen on which an age-adjusted total score ¡Ý 3 indicated high malnutrition risk.
Results: Data were obtained from 504 newly hospitalized adult patients, of whom 159 (31.5%) were identified as high risk for malnutrition. Malnutrition was more prevalent in internal medicine than surgical departments: 38.6% vs. 19.1% (P < 0.001). Body mass index was within the normal range among subjects at high risk for malnutrition: 23.9 ¡À 5.6 kg/m2 but significantly lower than in subjects at low malnutrition risk: 27.9 ¡À 5.3 kg/m2 (P < 0.001). Malnutrition risk did not differ by gender or smoking status, but subjects at high malnutrition risk were significantly older (73.3 ¡À 16.2 vs. 63.4 ¡À 18.4 years, P < 0.001). Total protein, albumin, total cholesterol, low density lipoprotein-cholesterol, hemoglobin and %lymphocytes were all significantly lower, whereas urea, creatinine and %neutrophils were significantly higher in patients at high malnutrition risk.
Conclusions: Use of the NRS 2002 identified a large proportion of newly hospitalized adults as being at high risk for malnutrition. These findings indicate the need to intervene on a system-wide level during hospitalization.
N. Shapira
The “Israeli Paradox“ (1996) of low national health rankings despite adequate diet – attributed to high dietary n-6 polyunsaturated fatty acids (PUFA) – coincided with long-observed dichotomies between women’s worse international status vs. men’s advantage. This raised the assumption of a gender link to high n-6 risk as an explanation for both national phenomena. Israeli women’s disadvantage was shown by worse international rankings, i.e., life expectancy (LE), 11th vs. men’s 3rd-best/22 countries (2000), and 14th vs. 6th/34 (2010) all-cause and all-cancer mortality both 15th vs. 2nd-best/22 (2000), and 15th vs. 6th/22 and 12th vs. 2nd-best/22 (2010). Breast cancer mortality rates were +21.8%, vs. prostate -30.4%, compared to Eur-A (27 country) averages (2005). Gender gaps/ratios were smaller than European Union-15, i.e., LE at birth by 34.4–26.4% (2000–2010), respectively, and at 65 years 45.9–35.3% all-cause mortality by 43.3–33.4%, and all-cancer 65.2–58.7%. The Israeli diet was mostly close to guidelines, but n-6 intake (10–12% kcal) was much higher than both recommended and traditional “Mediterranean diet“ levels. Research showing females’ greater potential for conversion of PUFA to long-chain PUFA (LCPUFA) may suggest their potentially increased production of n-6 eicosanoids with known pro-inflammatory/oxidative/carcinogenic potential. An “N-6 Gender Nutrition Paradox“ hypothesis is suggested here, for the first time, associating women’s higher risk and lead in the national “paradox“ with greater potential for n-6 conversion to pro-inflammatory/oxidative/carcinogenic eicosanoids compared to men. This may also exacerbate women’s risk associated with genetic predisposition (i.e., BRCA) and/or sociopolitical stress. Global abandonment of traditional diets/foods together with increasing n-6 consumption and western disease rates emphasize the importance of considering gender in nutritional epidemiology and preventive strategies.