O magnésio (Mg) é um íon intracelular, co-fator essencial de mais de 300 reações enzimáticas, envolvido principalmente nas reações de geração de energia (ATP). Sua deficiência tem sido associada a complicações durante a gravidez, como préeclâmpsia, eclâmpsia, restrição do crescimento fetal intrauterino e mortalidade fetal. Deste modo, este estudo observacional de corte transversal teve como objetivo avaliar o estado nutricional em Mg de mulheres saudáveis no terceiro trimestre gestacional atendidas no pré-natal do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 52 gestantes saudáveis, entre a 26ª e 42ª semana gestacional, com média de idade de 28,1 (5,9) anos, que realizavam pré-natal no HU/USP. Elas foram submetidas a avaliação antropométrica (peso e altura), dietética (Mg), por meio do recordatório alimentar de 24 h e registro alimentar de 3 dias, e bioquímica (Mg plasmático, eritrocitário e urinário). Foi observado que todas as gestantes tinham inadequação no consumo alimentar de Mg. Das gestantes, 38,5% apresentaram baixa excreção urinária de Mg, porém a concentração de Mg nos outros parâmetros, plasma e eritrócito, não mostrou deficiência deste mineral. Foram observadas correlações significativas entre a ingestão alimentar de Mg e as seguintes variáveis: pressão arterial sistólica (r = - 0,297; p = 0,032), Mg eritrocitário (r = 0,285; p = 0,041) e tendência a ser significativa com a pressão arterial diastólica (r = -0,247; p = 0,078). As gestantes atendidas no HU/USP apresentaram inapropriado consumo alimentar do Mg, que se refletiu em alterações na excreção urinária deste mineral, porém sem afetar os demais compartimentos biológicos estudados. / Magnesium (Mg) is an intracellular ion, an essential co-factor for over 300 enzymatic reactions, involved mainly in energy (ATP) generation. Its deficiency has been associated to complications during pregnancy such as preeclampsia, eclampsia, restriction to intrauterine fetal growth and fetal mortality. So, this observational cross-section study aimed to evaluate the nutritional status concerning Mg in healthy women in the third trimester of pregnancy received prenatal care at the University Hospital of the University of São Paulo (HU/USP). The sampling comprised 52 healthy pregnant women between the 26th and the 42nd week of pregnancy, with a mean age of 28.1 (5.9) years, who received prenatal care at the HU/USP. They were submitted to anthropometric (weight and height), dietary (Mg), through the food recall 24 h and food record of 3 days, and biochemical (plasma, erythrocytic and urinary Mg) evaluations. It was observed that all pregnant women presented an inadequate Mg intake from food. An amount of 38.5% of the pregnant women showed low urinary Mg excretion, but Mg concentrations within the other parameters, that is, plasma and erythrocytic Mg, did not show deficiency of this mineral. Significant correlations were observed between Mg intake from food and the following variables: systolic blood pressure (r = - 0.297; p = 0.032), erythrocytic Mg (r = 0.285; p = 0.041) and a trend to be significant with diastolic blood pressure (r = - 0.247; p = 0.078). The pregnant women assisted at HU/USP presented inadequate intake of Mg from food, which was reflected in alterations in the urinary excretion of this mineral, although it was not affected in the other biological compartments studied.

Objetivo: Avaliar o estado nutricional e o risco de doença cardiovascular (DCV) de mulheres no climatério. Metodologia: Estudo transversal, cuja população foi composta por 200 mulheres de 35 a 65 anos, agrupadas de acordo com a fase do climatério: pré-menopausa (PRÉ), perimenopausa (PERI) e pós-menopausa (PÓS). As mulheres do grupo PÓS foram divididas em dois grupos: sem terapia de reposição hormonal (S/TRH) e com TRH oral por no mínimo 12 meses (C/TRH). O estado nutricional foi avaliado segundo o índice de massa corporal (IMC) e o percentual de gordura corporal (%GC); o risco de DCV foi avaliado segundo a relação cintura/quadril (RCQ). O nível de significância utilizado nas análises foi alfa=5%. Resultados: A prevalência de pré-obesidade + obesidade, segundo o IMC, foi 65,4% (PRÉ), 70,9% (PERI) e 67,4% (PÓS), porém não houve diferença significativa entre os grupos. Comparado ao grupo C/TRH, houve maior proporção de mulheres obesas no grupo S/TRH (p=0,04), 21,4% e 48,4%, respectivamente. O %GC revelou sobrepeso e obesidade em 50,7% (PRÉ), 66,7% (PERI) e 57,4% (PÓS); 67,7% (S/TRH) e 54,8% (C/TRH) – essas diferenças não foram estatisticamente significativas. O risco de DCV foi considerado alto e muito alto para a maioria das mulheres: 90,7% (PRÉ), 95,8% (PERI) e 84,1% (PÓS); 90,3% (S/TRH) e 76,2% (C/TRH) e não houve diferença estatística entre os grupos. Conclusão: Grande parte das mulheres apresentou alto risco de afecções relacionadas à obesidade, como a DCV, justificando a atenção à mulher no climatério para a prevenção das principais causas de mortalidade nesse grupo. / Purpose: To evaluate the nutritional status and cardiovascular disease (CVD) risk of climacteric women. Methodology: Transversal study, composed by 200 women aged 35-65 years, grouped according to the climacteric stage: premenopause (PRE), perimenopause (PERI) and postmenopause (POS). The PÓS group was divided in two groups: with no hormonal replacement therapy (N/HRT) and with oral HRT for at least 12 months (W/HRT). The nutritional status was assessed by body mass index (BMI) and body fat percentage (BF%); the CVD risk was assessed by waist hip ratio (WHR). The significance level used for the analyses was alpha=5%. Results: According to BMI, the pre-obesity + obesity prevalences were 65,4% (PRÉ), 70,9% (PERI) e 67,4% (POS) and there was no significant difference among these groups. Compared with the group W/HRT, there was a higher rate (p=0,04) of obesity among women in the N/HRT group: 21,4% and 48,4%, respectively. The BF% showed overweight and obesity in 50,7% (PRE), 66,7% (PERI) and 57,4% (POS); 67,7% (N/TRH) and 54,8% (W/TRH), differences that were not statisticaly significant. In all groups there was a greater proportion of women considered with high and very high risk of CVD: 90,7% (PRE), 95,8% (PERI) and 84,1% (POS); 90,3% (N/TRH) and 76,2% (W/TRH) and the risk did not differ statisticaly among the groups. Conclusion: The majority of women had increased obesity-related and cardiovascular disease risk, emphasizing women´s health attention programms to the prevention of the leading mortality causes in this group.

A autora estudou a situação nutricional de crianças de 1 a 4 anos de idade, residentes no município de Carapicuiba - São Paulo, no início da atividade de suplementação alimentar. Estudou-também a relação existente entre o estado nutricional do referido grupo etário com a suplementação alimentar, nível sócio-econômico e escolaridade das mães. Avaliou num período de 5 meses, as variáveis em estudo, principalmente as referentes ao nível sócio-econômico, educação alimentar e estado nutricional, bem como as suas modificações e interrelações. Encontrou que a frequência de crianças de l a 4 anos de idade, com algum grau de desnutrição segundo a classificação de GOMEZ, foi de 37,1 por cento na primeira fase do estudo, na segunda fase constatou-se uma diminuição nas proporções correspondentes às crianças desnutridas, desaparecendo desnutridas do grau dois (D2) e permanecendo os dois casos de desnutridos do grau três (D3). Encontrou também que 90,4 por cento das mães de 217 pré-escolares estudados, não tinham escolaridade ou apresentavam primeiro grau incompleto e que neste nível se encontravam 47,2 por cento de crianças desnutridas. A proporção de crianças desnutridas cujas mães tinham segundo grau incompleto foi de 35,4 por cento . No entanto após cinco meses de atividade da suplementação alimentar quando foi realizado paralelamente o programa de educação nutricional, a redução de crianças desnutridas para o grupo de mães sem escolaridade foi acentuada e altamente significante. Quanto a renda constatou que 53,8 por cento da população estudada tinha renda per-capita inferior a dois salários mínimos. A autora relacionando estado nutricional com renda per capita, observou que quanto menor a renda maior a proporção de desnutrido. / Nutritional status of children 1 to 4 years of age resident in the town of Carapicuíba, São Paulo, Brazil was studied at the begining of supplementation activities and 5 months later. Data were related to age, socio-economic level and scholastic status of mothers. Results show that 37,1 per cent children were malnurished at the begining of the study and that there was a reduction of the rate five months later. There was a reduction of II degree malnutntion. However III degree malnurished children did not show any improvement. Considering scholastic status of mothers, it was found that 90.4 per cent were either illiterate or had not completed primary school; 42,2 per cent of the children were malnurished whereas those whose mothers had completed high school and had started college, presented a rate of 35.4 per cent of malnutrition. Five months later a higly significant differente of rates was observed in the group whose mothers were illiterate. Regarding socio-economic status, the \"per capita\" income of 53.8 per cent of families was below two \"minimum salaries\" (salário mínimo). Results showed that the lower the \"per capita\" income the higher the malnutrition rates.

by Sophie S.F. Leung. / Thesis (M.D.)--Chinese University of Hong Kong, 1990. / Bibliography: leaves [194]-[203] / Chapter PART I --- INTRODUCTION / Chapter CHAPTER ONE --- GENERAL INTRODUCTION AND AIMS --- p.2 / Chapter CHAPTER TWO --- NUTRITIONAL STATUS OF HONG KONG INFANTS - A LITERATURE REVIEW --- p.4 / Chapter CHAPTER THREE --- ASSESSMENT OF NUTRITIONAL STATUS / Chapter 3.1 --- Methods of Assessment --- p.12 / Chapter 3.2 --- Physical Growth : Auxology --- p.15 / Chapter 3.2.1 --- Growth parameters --- p.16 / Chapter 3.2.2 --- In an individual --- p.17 / Chapter "3,2.3" --- In a population --- p.19 / Chapter 3.2.4 --- Reference standards --- p.19 / Chapter 3.2.5 --- Classification of malnutrition --- p.23 / Chapter 3.3 --- Dietary Surveys --- p.26 / Chapter 3.3.1 --- Methods of data collection --- p.26 / Chapter 3.3.2 --- Recommended dietary allowance / recommended nutrient requirement --- p.30 / Chapter 3.3.3 --- Use of RDA in interpretation of food consumption surveys --- p.32 / Chapter 3.3.4 --- Nutritional allowances for infant --- p.33 / Chapter PART II --- STUDY DESIGN AND RESULTS / Chapter CHAPTER FOUR --- MATERIALS AND METHODS / Chapter 4.1 --- The Research Team --- p.39 / Chapter 4.2 --- The Study Population --- p.39 / Chapter 4.3 --- Follow up --- p.41 / Chapter 4.4 --- Data on Morbidity and Infant Care Practice --- p.41 / Chapter 4.5 --- "Anthropometry (I) : Weight, Length, Head Circumference, Weight and Length Velcoity" --- p.42 / Chapter 4.5.1 --- Data collection --- p.42 / Chapter 4.5.2 --- Data analysis --- p.45 / Chapter 4.6 --- Anthropometry (II) : Mid-arm circumference --- p.46 / Chapter 4.7 --- "Anthropometry (III) : Triceps, Subscapular Skinfold Thickness" --- p.47 / Chapter 4.8 --- Dietary Data Collection and Analysis --- p.48 / Chapter 4.9 --- Number of Observations --- p.50 / Chapter 4.10 --- Haematological and Biochemical Study --- p.51 / Chapter CHAPTER FIVE --- "RESULTS (I) : DEMOGRAPHY, INFANT CARE PRACTICES AND MORBIDITY" / Chapter 5.1 --- Family Demographic Data --- p.58 / Chapter 5.1.1 --- "Ethnicity, age, weight and height" --- p.58 / Chapter 5.1.2 --- Occupation and family income --- p.59 / Chapter 5.1.3 --- Education --- p.59 / Chapter 5.1.4 --- Accommodation --- p.59 / Chapter 5.2 --- Study Infants --- p.60 / Chapter 5.2.1 --- "Sex, birth size and birth order" --- p.60 / Chapter 5.2.2 --- Mode of delivery --- p.61 / Chapter 5.3 --- Infant Care Arrangements and practices --- p.61 / Chapter 5.4 --- Morbidity --- p.62 / Chapter 5.5 --- Physical Examination --- p.63 / Chapter CHAPTER SIX --- RESULTS (II) : AUXOLOGY / Chapter 6.1 --- Physical Size --- p.73 / Chapter 6.1.1 --- "Weight, length and head circumference" --- p.73 / Chapter 6.1.2 --- Triceps and subscapular skinfold thickness --- p.74 / Chapter 6.1.3 --- Midarm circumference --- p.75 / Chapter 6.1.4 --- Midarm circumference/occipito frontal circumference --- p.75 / Chapter 6.2 --- Growth Velocity --- p.75 / Chapter 6.3 --- Difference between sex --- p.76 / Chapter CHAPTER SEVEN --- RESULTS (III) : NUTRIENT INTAKE / Chapter 7.1 --- Dietary Practice --- p.99 / Chapter 7.1.1 --- Early (preweaning period): birth to 6 months --- p.99 / Chapter 7.1.2 --- Late (weaning period): 6 to 24 months --- p.100 / Chapter 7.2 --- Specific Nutrient Intakes --- p.102 / Chapter 7.2.1 --- Energy --- p.102 / Chapter 7.2.2 --- Protein --- p.103 / Chapter 7.2.3 --- Fat --- p.103 / Chapter 7.2.4 --- "Iron, calcium, vitamin D and vitamin C" --- p.103 / Chapter 7.2.5 --- Sex differences in nutrient intake --- p.104 / Chapter CHAPTER EIGHT --- HAEMATOLOGICAL AND BIOCHEMICAL STUDY OF IRON AND VITAMIN D STATUS AT 18 MONTHS / Chapter 8.1 --- Iron --- p.122 / Chapter 8.2 --- Vitamin D --- p.123 / Chapter PART III --- DISCUSSION / Chapter CHAPTER NINE --- EVIDENCE FOR ADEQUATE NUTRITION IN THE STUDY INFANTS / Chapter 9.1 --- Use of Infant Formula Throughout Infancy --- p.130 / Chapter 9.2 --- High Protein Intake in Weaning Period --- p.131 / Chapter 9.3 --- No Iron Deficiency Anaemia and Rickets --- p.132 / Chapter 9.4 --- Normal Health and Activity --- p.132 / Chapter 9.5 --- Secular Change in Infant Growth Observed Over the Last Twenty Years --- p.133 / Chapter 9.6 --- No Correlation between Energy/Protein Intake and Weight/Length --- p.134 / Chapter 9.7 --- No Social Deprivation --- p.134 / Chapter CHAPTER TEN --- LIMITATIONS OF RDA AS A STANDARD TO INTERPRET DIETARY INTAKE DATA / Chapter 10.1 --- Iron --- p.142 / Chapter 10.2 --- Vitamin D --- p.143 / Chapter 10.3 --- Energy --- p.143 / Chapter CHAPTER ELEVEN --- RELEVANCE OF INTERNATIONAL REFERENCES AS STANDARDS TO INTERPRET ADEQUATE GROWTH IN CHINESE INFANTS / Chapter 11.1 --- Misinterpretation of Undernutrition in the Study Infants --- p.150 / Chapter 11.1.1 --- NCHS reference --- p.150 / Chapter 11.1.2 --- Midarm circumference --- p.151 / Chapter 11.1.3 --- Skinfold thickness --- p.152 / Chapter 11.2 --- Shape of Growth Curve --- p.153 / Chapter CHAPTER TWELVE --- FURTHER EVIDENCE FOR A GENETIC ROLE IN CAUSING SMALLNESS IN THE STUDY INFANTS / Chapter 12.1 --- Weight at Birth --- p.165 / Chapter 12.2 --- Weight at 2 Years --- p.166 / Chapter 12.3 --- Correlation with Parental Size --- p.166 / Chapter 12.4 --- Comparison with Canadian and Australian infants --- p.168 / Chapter 12.5 --- Comparison with NCHS --- p.169 / Chapter CHAPTER THIRTEEN --- PRACTICAL IMPLICATIONS OF THE STUDY / Chapter 13.1 --- Present Infant Feeding Practices --- p.185 / Chapter 13.2 --- Contribution to Current Knowledge on Infant Feeding --- p.187 / Chapter 13.3 --- "Updated Growth Standards of Hong Kong Chinese Infants, Birth to 2 Years" --- p.189 / Chapter 13.4 --- Implication for Further Research --- p.192

Background and aims: Southern European countries have been showing high overweight and obesity (OW/OB) rates especially among the younger generations (Cattaneo et al. 2010). Portugal is one of those countries with 37.9% overweight and 15.3% obesity in 6 to 8 year olds (Rito et al. 2012). However little is known about the health of ethnic minorities living in its capital city, Lisbon. The Cape Verdean community in Lisbon, the second largest group in Portugal, would be expected to be more affected by this epidemic due to social inequalities. This community also tend to have low educational levels, material deprivation and struggle with discrimination and racism, factors that would likely be associated with a higher prevalence of OW/OB. The aim of this study was to assess the nutritional status of Cape Verdean ancestry children aged 6 to 12 years old living in Lisbon according to their socioeconomic status, general living conditions, family composition, diet and physical activity levels. To compare the findings with previous projects conducted in 1993 and 2009 in the same location with Cape Verdean ancestry children and with Portuguese ancestry children (national study conducted in 2009). To determine what early life factors have significant effect on these children's nutritional health. Methods : Physical measures and household information were collected from November 2013 to February 2014 in Cova da Moura Neighbourhood in Lisbon. Physical measures included height, weight, skinfolds, arm and waist circumferences. From these survey data body mass index (BMI) and the prevalence of stunting (chronic malnutrition - low height-for- age) and underweight (low-weight-for-age) were calculated according to reference values proposed by Frisancho (2008). Overweight and obesity values were defined based on the references established by the International Obesity Task Force (IOTF), CDC, and WHO depending on the specific aim or research question. Results: Results show this is a very deprived community with low educational levels and mostly employed in the service sector. Maternal height and child birth order showed a significant association with child's height. Moreover maternal height and age are associated with child leg length. Living in a single parent family is associated with an increase in child BMI of 1.412 units when accounting for maternal waist circumference. Also significant differences in height for boys and girls were observed between Cape Verdean and Portuguese children. Generally, Cape Verdeans growth falls within the healthy range of International growth references across all of the survey data collected. Cape Verdean rates for combined over nutrition (overweight and obesity) in 2013 (9.8% for boys and 16.7% for girls) are lower than the Portuguese (33% for boys and 31.7% for girls). Logistic regression models showed that Cape Verdean children have a lower risk of being OW/OB compared to Portuguese children when accounting for breastfeeding,birth weight,maternal education and occupation. Conclusions : Despite living in a deprived neighbourhood these Cape Verdean children seem to have grown healthier than Portuguese ancestry children. The challenge for policy makers will be to support improvement of the poverty related living conditions of this community without creating a risky environment for increasing prevalence of overweight and obesity.

Com a finalidade de avaliar um conjunto de curvas de ganho de peso de gestantes, foram tomadas, em dois grupos de mulheres, medidas antropométricas maternas como peso, estatura, peso habitual, peso no final da gravidez, perímetro cefálico, perímetro braquial, prega cutânea tricipital, bem como medidas antropométricas do recém-nascido ao nascer (peso, comprimento, perímetro cefálico), além de ter sido realizado estudo da dieta das gestantes. A comparação entre as curvas e as demais variáveis antropométricas, maternas ou fetais, mostrou que os resultados são semelhantes, mesmo em grupos diferentes entre si como os aqui estudados. As gestantes classificadas como desnutridas através das curvas de ganho de peso também o são quando outras técnicas são aplicadas. Os filhos de gestantes desnutridas têm peso, comprimento e perímetro cefálico significantemente menores que os filhos de gestantes normais ou obesas. Verificou-se ainda que não há relação entre a ingestão de calorias, proteínas e ferro e o estado nutricional materno. A estatura e a idade-gestacional maternas não interferiram nesse processo diagnóstico. Os resultados permitiram considerar as curvas estudadas como bons indicadores de desnutrição materna e fetal. / This study has been carried out with the purpose of evaluating curves of weight gain during pregnancy. Two gruups of women were selected and the following values were obtained for each them: maternal prepregnancy weight, weight at the end of pregnancy, height, cephalic circumference, arm circumference and triceps skinfold. Also some anthropometric measurements of tne newborn children were taken, such as weight, lenght and cephalic circumference. A dietary survey was aLso carried out. When the cuRves and the other measurements were compared, it was seen that the results were similar in both of the groups of mothers studied. Pregnant women classified as undernourished in terms of the weight gain curves are also classified in the same way when other tecniques are used. Babies born-to undernourished mothers have an impairment in intra-uterine growth, as compared to babies born to normal or obese mothers. There is no relation between caloric, protein and iron intake and maternal nutrition status. Maternal height and gestational age do not play any part in this diagnostic process. The results permit to consider the curves here studied as good indicators of maternal and fetal malnutrition.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 69-79).

Emerging favourable as well as unfavourable nutrition patterns are observed in societies undergoing rapid social and economic change. The aim of this thesis is to analyse the associations between household and maternal resources and infant and young child feeding habits and nutritional status in rural Nicaragua, a low-income transitional society. All households (n=1,500) in Los Cuatro Santos with at least one child (0-3 y) were visited to collect information on feeding of the youngest child. Children´s anthropometry was also measured using standardised World Health Organisation (WHO) techniques. Validated instruments were used to assess household and maternal resources. All instruments had been adapted to the local context and piloted in a nearby community.  The education of the mother showed more independent variation in the studied outcomes. The odds for exclusive breastfeeding were highest in infants aged 0 to 5 months of mothers with the lowest education. Further, children aged 6 to 35 months with lowest educated mothers were less likely to consume highly processed snacks (HP snacks) and sugar-sweetened beverages (SSBs). They were also less likely to be exposed to a double burden of suboptimal feeding (concurrent unmet WHO recommended feeding practices and consumption of HP snacks or SSBs). However, children aged 6 to 35 months were more prone to infrequently meet dietary diversity and to more shortness. Children in the same age group with lower educated mothers were also shorter in households with the lowest housing quality. Higher level of maternal education contributed both favourably and unfavourably to child feeding and nutrition. This was reflected in more and less frequent practice of the WHO feeding indicators, but also in more frequent children´s consumption of HP snacks and SSBs. Higher maternal education was associated with taller children, even in households with the lowest housing quality.

Malnutrition is reported to be common in hospitals (10-60%), residential aged care facilities (up to 50% or more) and in free living individuals with severe or multiple disease (>10%) (Stratton et al., 2003). Published Australian studies indicate similar results (Beck et al., 2001, Ferguson et al., 1997, Lazarus and Hamlyn, 2005, Middleton et al., 2001, Visvanathan et al., 2003), but are generally limited in number, with none conducted across multiple centres or in residential aged care facilities. In Australia, there is a general lack of awareness and recognition of the problem of malnutrition, with currently no policy, standards or guidelines related to the identification, prevention and treatment of malnutrition. Malnutrition has been found to be associated with the development of pressure ulcers, but studies are limited. The consequences of the development of pressure ulcers include pain and discomfort for the patient, and considerable costs associated with treatment and increased length of stay. Pressure ulcers are considered largely preventable, and the demand for the establishment of appropriate policy, standards and guidelines regarding pressure ulcers has recently become important because the incidence and prevalence of pressure ulcers is increasingly being considered a parameter of quality of care. The aims of this study program were to firstly determine the prevalence of malnutrition and its association with pressure ulcers in Queensland Health hospitals and residential aged care facilities; and secondly to estimate the potential economic consequences of malnutrition by determining the costs arising from pressure ulcer attributable to malnutrition; and the economic outcomes of an intervention to address malnutrition in the prevention of pressure ulcers. The study program was conducted in two phases: an epidemiological study phase and an economic modelling study phase. In phase one, a multi centre, cross sectional audit of a convenience sample of subjects was carried out as part of a larger audit of pressure ulcers in Queensland public acute and residential aged care facilities in 2002 and again in 2003. Dietitians in 20 hospitals and six aged care facilities conducted single day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment, in either or both audits. Subjects excluded were obstetric, same day, paediatric and mental health patients. Weighted average proportions of nutritional status categories for acute and residential aged care facilities across the two audits were determined and compared. The effects of gender, age, facility location and medical specialty on malnutrition were determined via logistic regression. The effect of nutritional status on the presence of pressure ulcer was also determined via logistic regression. Logistic regression analyses were carried out using an analysis of correlated data approach with SUDAAN statistical package (Research Triangle Institute, USA) to account for the potential clustering effect of different facilities in the model. In phase two, an exploratory economic modelling framework was used to estimate the number of cases of pressure ulcer, total bed days lost to pressure ulcer and the economic cost of these lost bed days which could be attributed to malnutrition in Queensland public hospitals in 2002/2003. Data was obtained on the number of relevant separations, the incidence rate of pressure ulcer, the independent effect of pressure ulcers on length of stay, the cost of a bed day, and the attributable fraction of malnutrition in the development of pressure ulcers determined using the prevalence of malnutrition, the incidence rate of developing a pressure ulcer and the odds risk of developing a pressure ulcer when malnourished (as determined previously). A probabilistic sensitivity analysis approach was undertaken whereby probability distributions to the specified ranges for the key input parameters were assigned and 1000 Monte Carlo samples made from the input parameters. In an extension of the above model, an economic modelling framework was also used to predict the number of cases of pressure ulcer avoided, number of bed days not lost to pressure ulcer and economic costs if an intensive nutrition support intervention was provided to all nutritionally at risk patients in Queensland public hospitals in 2002/2003 compared to standard care. In addition to the above input parameters, data was obtained on the change in risk in developing a pressure ulcer associated with an intensive nutrition support intervention compared to standard care. The annual monetary cost of the provision of an intensive nutrition support intervention to at risk patients was modelled at a cost of AU$ 3.8-$5.4 million for additional food and nutritional supplements and staffing resources to assist patients with nutritional intake. A probabilistic sensitivity analysis approach was again taken. A mean of 34.7 + 4.0% and 31.4 + 9.5% of acute subjects and a median of 50.0% and 49.2% of residents of aged care facilities were found to be malnourished in Audits 1 and 2, respectively. Variables found to be significantly associated with an increased odds risk of malnutrition included: older age groups, metropolitan location of facility and medical specialty, in particular oncology and critical care. Malnutrition was found to be significantly associated with an increased odds risk of having a pressure ulcer, with the odds risk increasing with severity of malnutrition. In acute facilities moderate malnutrition had an odds risk of 2.2 (95% CI 1.6-3.0, p<0.001) and severe malnutrition had an odds risk of 4.8 (95% CI 3.2-7.2, p<0.001) of having a pressure ulcer. The overall adjusted odds risk of having a pressure ulcer when malnourished (total malnutrition) in an acute facility was 2.6 (95% CI 1.8-3.5, p<0.001). In residential facilities, where the audit results were presented separately, the same pattern applied with moderate malnutrition having an odds risk of 1.7 (95% CI 1.2-2.2, p<0.001) and 2.0 (95% CI 1.5-2.8, p<0.001); and severe malnutrition having an odds risk of 2.8 (95% CI1.2-6.6, p=0.02) and 2.2 (95% CI 1.5-3.1, p<0.001), for Audits 1 and 2 respectively. There was no statistical difference between these odds risk ratios between the audits. The overall adjusted odds risk of having a pressure ulcer when malnourished (total malnutrition) in a residential aged care facility was 1.9 (95% CI 1.3-2.7, p<0.001) and 2.0 (95% CI 1.5-2.7, p<0.001) for Audits 1 and 2 respectively. Being malnourished was also found to be significantly associated with an increased odds risk of having a higher stage and higher number of pressure ulcers, with the odds risk increasing with severity of malnutrition. The economic model predicted a mean of 3666 (Standard deviation 555) cases of pressure ulcer attributable to malnutrition out of a total mean of 11162 (Standard deviation 1210), or approximately 33%, in Queensland public acute hospitals in 2002/2003. The mean number of bed days lost to pressure ulcer that were attributable to malnutrition was predicted to be 16050, which represents approximately 0.67% of total patient bed days in Queensland public hospitals in 2002/2003. The corresponding mean economic costs of pressure ulcer attributable to malnutrition in Queensland public acute hospitals in 2002/2003 were estimated to be almost AU$13 million, out of a total mean estimated cost of pressure ulcer of AU$ 38 526 601. In the extension of the economic model, the mean economic cost of the implementation of an intensive nutrition support intervention was predicted to be a negative value ( -AU$ 5.4 million) with a standard deviation of $AU3.9 million, and interquartile range of –AU$ 7.7 million to –AU$ 2.5 million. Overall there were 951 of the 1000 re-samples where the economic cost is a negative value. This means there was a 95% chance that implementing an intensive nutrition support intervention was overall cost saving, due to reducing the cases of pressure ulcer and hospital bed days lost to pressure ulcer. This research program has demonstrated an independent association between malnutrition and pressure ulcers, on a background of a high prevalence of malnutrition, providing evidence to justify the elevation of malnutrition to a safety and quality issue for Australian healthcare organisations, similarly to pressure ulcers. In addition this research provides preliminary economic evidence to justify the requirement for consideration of healthcare policy, standards and guidelines regarding systems to identify, prevent and treat malnutrition, at least in the case of pressure ulcers in Australia.

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.