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Bhaskar Pharmacy College RESULTS

RESULTS
In our current prospective study, a total number of 70 patients admitted in the ward in Apollo
hospital of Gastroenterology were assessed. Their nutritional status were assessed and managed.

 GENDER-WISE DISTRIBUTION OF PATIENTS:

All the patients are divided based on their sex.

Gender Number of patients Percentage%


Male 57 81.43
Female 13 18.57
Total 70 100
Table 7.1: Distribution of subjects based on sex.

The female to male ratio was found to be 1: 4 with 13 females patients and 57 male patients.

Gender-Wise Distribution

Males Females

19%

81%

Fig 7.1: Distribution of subjects based on Sex.

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Bhaskar Pharmacy College RESULTS

 AGE-WISE DISTRIBUTION OF PATIENTS :

The patients were divided into four groups based on their age.

Age group Number of patients Percentage %


Early adulthood (18-35) 3 4.28
Adulthood (36-50) 17 24.29
Late adulthood (51-65) 33 47.14
Old (65-80) 17 24.29
Total 70 100
Table 7.2: Distribution of subjects based on age group.

Age-Wise Distribution

4%

24%
25%

47%

Early Adulthood (18-35) Adulthood (36-50) Late Adulthood (51-65) Old (65-80)

Fig. 7.2: Distribution of Subjects based on age group.

Out of all the patients admitted in the hospital, most of the patients affected with Chronic Liver
Disease were in late adulthood with an age group of 51-65 (47.14%) of patients followed by
adulthood with an age group of 36-50 (24.29%) of patients.

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Bhaskar Pharmacy College RESULTS

 DISTRIBUTION OF PATIENTS BASED ON ETIOLOGY:


All patients are divided into five groups based on the etiology:

Etiology Number of patients Percentage %


Males Females Males Females
Alcohol 21 02 36.84 15.38
Hepatitis 10 03 17.54 23.08
Jaundice 15 05 26.32 38.46
Cryptogenic 07 01 12.28 7.7
Obesity 04 02 7.02 15.38
Total 57 13 100 100
Table 7.3: Distribution of subjects based on Etiology.

ETIOLOGICAL STATUS
45

40 38.46%
36.84%
P
E 35
R
30
C 26.32%
E 25 23.08%
N MALES
T 20 17.54%
15.38% 15.38% FEMALES
A 15 12.28%
G
E 10 7.7% 7.02%
%
5

0
ALCOHOL HEPATITIS JAUNDICE CRYPTOGENIC OBESITY

Fig 7.3: Distribution of subjects based on Etiology.

When the patients were divided according to the Etiology of Chronic Liver Disease, most of the
female patients were having a known etiology of Jaundice i.e., 38.46% but most of the male
patients were Alcoholics i.e., 36.84%.

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Bhaskar Pharmacy College RESULTS

 DISTRIBUTION OF PATIENTS BASED ON BODY MASS INDEX (BMI):

The patients were divided into four groups based on their weights:

BMI Category Males


Approach Percentage% Follow up Percentage% P-value
Underweight 01 1.75 01 1.75
(<18.5)
Normal weight 30 52.63 38 66.67
(18.5-24.9) 0.0165
Overweight 15 26.31 12 21.05
(25-29.9)
Obese (> 30) 11 19.29 06 10.52
TOTAL 57 100 57 100
Table 7.4 a: Comparison of BMI of approach and follow up of male subjects.

BMI OF MALE PATIENTS


P 66.67%
70
E
R 60 52.63%
PERCENTAGE OF
C 50 APPROACH
E MALE
N 40
T 26.31% PERCENTAGE OF
30 21.05% 19.29% FOLLOW UP
A 10.52%
20 MALE
G
E 10 1.75% 1.75%
%
0
UNDER WT. NORMAL WT. OVER WT. OBESE

Fig 7.4 a: Comparison of BMI of approach and follow up of male subjects.

Most of the male patients enrolled in the study were monitored adequately and were with normal
BMI (i.e.,66.67% of patients) and others were less likely overweight and obese.

 From the P- value (i.e.,0.0165) it was found that results were significantly effective.

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Bhaskar Pharmacy College RESULTS

Females
BMI Category Approach Percentage% Follow up Percentage% P-value
Underweight 3 23.07 2 15.38
(<18.5)
Normal weight 4 30.79 6 46.14
(18.5-24.9)
Overweight 3 23.07 3 23.09 0.0158
(25-29.9)
Obese (> 30) 3 23.07 2 15.38
TOTAL 13 100 13 100
Table 7.4 b: Comparison of BMI of approach and follow up of female subjects.

BMI OF FEMALE PATIENTS

P 50 46.14%
E
R 40 PERCENTAGE OF
C 30.79% APPROACH
E FEMALE
30
N 23.07% 23.07% 23.09% 23.07%
PERCENTAGE OF
T 20 15.38% 15.38% FOLLOW UP
A FEMALE
G
10
E
%
0
UNDER WT NORMAL WT OVER WT OBESE

Fig 7.4 b: Comparison of BMI of approach and follow up of female subjects

Most of the female patients enrolled in the study were monitored adequately and were with
normal BMI (i.e., 46.14% of patients) and other patients were less likely overweight and
Obese.

 From the P-value (i.e., 0.0158) it was found that results were significantly effective.

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Bhaskar Pharmacy College RESULTS

 DISTRIBUTION OF PATIENTS BASED ON MID-UPPER ARM CIRCUMFERENCE


(MUAC):

The patients were divided into three groups based on their nutritional status:

MUAC Category Males


Approach Percentage% Follow-up Percentage% P-value
Well Nourished 29 50.87 33 57.89
(28-32)
Moderately 19 33.33 20 35.09
Nourished (24-27) 0.0189
Severely Malnou- 09 15.78 04 7.02
rished (21-23)
TOTAL 57 100 57 100

Table 7.5 a: Comparison of MUAC of approach and follow up of male subjects.

MUAC STATUS OF MALE PATIENTS


70
P 57.89%
60
E 50.87%
R 50
C PERCENTAGE

E 40 OF APPROACH
33.33%35.09% MALE
N
T 30 PERCENTAGE
A OF FOLLOW UP
G 20 15.78% MALE

E 7.02%
10
%
0
WELL NOURISHED MODERATELY NOURISHED SEVERELY MALNOURISHED

Fig 7.5 a: Comparison of MUAC of approach and follow up of male subjects.

Of the 57 male patients, most of the patients were well nourished (i.e., 57.89%) and moderately
nourished (i.e., 35.09%) and only 7.02% of patients were severely malnourished.

 From the P-value (i.e., 0.0189) it was found that results were significantly effective.

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Bhaskar Pharmacy College RESULTS

MUAC Category Females


Approach Percentage% Follow-up Percentage% P-value
Well Nourished 6 46.15 7 53.8
(28-32)
Moderately 3 23.07 2 15.4
Nourished (24-27) 0.0244
Severely Malnou- 4 30.76 4 30.8
rished (21-23)
TOTAL 13 100 13 100
Table 7.5 b: Comparison of MUAC of approach and follow up of female subjects.

MUAC STATUS OF FEMALES PATIENTS


60
53.8%
P
E 50 46.15%
R
C 40 PERCENTAGE OF
APPROACH
E 30.76%
FEMALES
N 30
23.07% PERCENTAGE OF
T FOLLOW UP
A 20 15.4% 30.8% FEMALES
G
E 10
%
0
WELL NOURISHED MODERATELY NOURISHED SEVERELY MALNOURISHED

Fig 7.5 b: Comparison of MUAC of approach and follow up of female subjects.

Of the 13 female patients, most of the patients were well nourished (i.e.,53.8%) and others
were moderately nourished (i.e.,15.4 %) and only 30.8% of patients were severely malnourished.

 From the P-value (i.e., 0.0244) it was found that the results were significantly effective.

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Bhaskar Pharmacy College RESULTS

 NUTRITIONAL STATUS OF PATIENTS BASED ON CALF-CIRCUMFERENCE:


The patients were divided into three groups based on their nutritional status:

Calf circumference Males


Category Approach Percentage% Follow up Percentage% P-value
Well nourished 28 49.12 32 56.1
(31-48)
Moderately nourished 25 43.86 24 42.1
(28-30) 0.0433
Severely malnourished 04 7.02 01 1.8
(<28)
TOTAL 57 100 57 100
Table 7.6 a: Comparison of Calf-circumference of approach and follow up of male subjects.

NUTRITIONAL STATUS OF MALE PATIENTS

60 56.1%
P 49.12%
E 50
43.86%42.1%
R PERCENTAGE OF
C 40 APPROACH
E MALES
N 30 PERCENTAGE OF
FOLLOW UP
T
MALES
A 20
G
E 10 7.02%
% 1.8%
0
WELL NOURISHED MODERATELY NOURISHED SEVERELY MALNOURISHED

Fig 7.6 a: Comparison of Calf-circumference of approach and follow up of male subjects.

Depending on the nutritional status 57 male patients were divided into 3 groups of which 56.1%
patients were well nourished and others were moderately nourished (i.e.,42.1%) and severely
malnourished (i.e., 1.8%) of patients.

 From the P-value (i.e., 0.0433) it was found that the results were significantly effective.

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Bhaskar Pharmacy College RESULTS

Calf circumference Females


Category Approach Percentage% Follow-up Percentage% P-value
Well nourished 06 46.15 07 53.8
(31-48)
Moderately 06 46.15 06 46.2
nourished (28-30) 0.0417
Severely 01 7.69 0 0
malnourished (<28)
TOTAL 13 100 13 100
Table 7.6 b: Comparison of calf-circumference of approach and follow up of females subjects.

NUTRITIONAL STATUS OF FEMALE PATIENTS

60
53.8%
P
E 50 46.15% 46.15% 46.2%
PERCENTAGE OF
R
APPROACH
C 40
FEMALES
E
PERCENTAGE OF
N 30
FOLLOWUP
T FEMALES
A 20
G
E 10 7.69%
% 0%
0
WELL NOURISHED MODERATELY NOURISHED SEVERELY MALNOURISHED

Fig 7.6 b : Comparison of calf circumference of approach and follow up of female subjects.

Depending on the nutritional status 13 female patients were divided into 3 groups of which
53.8% patients showed a good improvement in their nutritional status and 46.2% were
moderately nourished.

 From the P-value (0.0417) it was found that the results were significantly effective.

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Bhaskar Pharmacy College RESULTS

 DISTRIBUTION OF PATIENTS BASED ON CLINICAL DATA:

The patients were divided into two groups based on the presence and absence of Anemia:

Anemia Number of Patients Percentage %


Approach Follow-up Approach Follow-up
Present 49 13 70 18.5
Absent 21 57 30 81.5
Total 70 70 100 100
Table 7.7: Distribution of subjects based on presence or absence of Anemia.

PERCENTAGE OF ANEMIC PATIENTS

90
81.5%
80
P 70%
E 70
R
60
C
E 50 APPROACH
N
T 40 FOLLOWUP
30%
A 30
G 18.5%
E 20
% 10
0
ANEMIA PRESENT ANEMIA ABSENT

Fig 7.7: Distribution of subjects based on presence or absence of Anemia.

Among 70 patients, 70% of Patients were anemic at the time of approach but after the initiation
of proper dietary intake only 18.5% of patients were anemic.

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Bhaskar Pharmacy College RESULTS

 The patients were divided into four groups based on the grades of edema:

Category Number of Patients Percentage %


Approach Follow-up Approach Follow-up
Edema No edema 33 53 47.1 75.8
(0 grade)
Below the ankle 14 09 20 12.8
(+ grade)
Pitting edema 20 08 28.6 11.4
below the knee
(++ grade)
Generalized edema 03 0 4.3 0
(+++ grade)
Total 70 70 100 100
Table 7.8 : Distribution of subjects based on grades of Edema.

EDEMA-GRADES WISE DISTRIBUTION


80 75.8%

P 70
E
60
R
C 47.1% PERCENTAGE
50
E OF APPROACH

N 40
PERCENTAGE
T 28.6% OF FOLLOWUP
30
A
20%
G 20
E 12.8% 11.4%
% 10 4.3%
0%
0
NO EDEMA BELOW THE PITTING EDEMA GENERALIZED
ANKLE BELOW THE KNEE EDEMA

Fig 7.8: Distribution of subjects based on grades of Edema.

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Bhaskar Pharmacy College RESULTS

Maximum number of the patients were with no edema (i.e., 75.8%) and few patients were
with edema below the ankle and pitting edema below the knee (i.e., 12.8% and 11.4%
respectively).

 The patients were identified with muscle wasting:

Co-morbididty Number of patients Percentage %


Approach Follow-up Approach Follow-up
Muscle Present 21 06 30 8.6
wasting Absent 49 64 70 91.4
Total 70 70 100 100
Goitre 0 0 0 0
Bitots spot 0 0 0 0

Table 7.9 : Distribution of subjects based on presence or absence of Muscle wasting.

COMORBIDITY STATUS
100
91.4%
90
P
80
E 70%
R 70 PERCENTAGE
C 60 OF APPROACH
E
50 PERCENTAGE
N
OF FOLLOWUP
T 40
30%
A 30
G
E 20
8.6%
% 10
0
MUSCLE WASTING PRESENT MUSCLE WASTING ABSENT

Fig 7.9: Distribution of subjects based on presence or absence of Muscle wasting.

The co-morbidity status of the patients was improved as there were 30% of patients with
presence of muscle wasting were reduced to 8.6%.

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Bhaskar Pharmacy College RESULTS

 DISTRIBUTION OF PATIENTS BASED ON SCREENING SCORE:

The subjects were divided into 3 categories based on their screening scores:

Category Number of Patients Percentage %


Approach Follow-up Approach Follow-up
Normal (12-14 points) 18 42 25.7 60
At risk (8-11 points) 38 26 54.3 37.1
Malnourished (0-7 points) 14 02 20 2.9
Total 70 70 100 100

Table 7.10: Distribution of subjects based on MNA screening score.

MNA SREENING SCORE


70
60%
P 60
54.3%
PERCENTAGE
E
OF APPROACH
R 50
C PERCENTAGE
E 40 37.1% OF FOLLOWUP
N
T 30 25.7%
A 20%
G 20
E
% 10
2.9%
0
NORMAL AT RISK MALNOURISHED

Fig 7.10: Distribution of subjects based on MNA screening score.

According to MNA screening score, patients when assessed were mostly at risk of
malnourishment but after the implementation of appropriate dietary plan, 60% of patients were
well nourished and fewer patients were at risk of malnutrition and malnourished.

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Bhaskar Pharmacy College RESULTS

 DISTRIBUTION OF PATIENTS BASED ON MALNUTRITION INDICATOR


SCORE:

Category Number of Patients Percentage %


Approach Follow-up Approach Follow-up
Normal 15 43 21.4 61.4
At risk 38 27 54.3 38.6
Malnourished 17 0 24.3 0
Total 70 70 100 100
Table 7.11: Distribution of subjects based on Malnutrition Indicator Score.

MALNUTRITION INDICATOR SCORE STATUS


70
61.4%
P 60 54.3%
E
R 50
PERCENTAGE
C OF APPROACH
38.6%
E 40
N PERCENTAGE
T 30 24.3% OF FOLLOWUP
A 21.4%
G 20
E
% 10
0%
0
NORMAL AT RISK MALNOURISHED

Fig 7.11: Distribution of subjects based on Malnutrition Indicator Score.

According to malnutrition indicator score , patients when assessed were mostly at risk of
malnourishment but after the implementation of appropriate dietary plan, a change in 44% of
patients was observed.

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Bhaskar Pharmacy College RESULTS

 BIOCHEMICAL DATA OF THE PATIENTS:

Parameters Number of Patients Percentage %


Approach Follow-up Approach Follow-up
N Ab N Ab N Ab N Ab
Hemoglobin 21 49 57 13 30 70 81.43 18.57
Pre-albumin 25 45 38 32 35.7 64.3 54.2 45.8
Bilirubin 24 46 39 31 34.3 65.7 55.7 44.3
Albumin 24 46 49 21 34.3 65.7 70 30
Creatinine 53 17 63 07 75.7 24.3 90 10
Total Protein 58 12 67 03 82.8 17.2 95.7 4.3
ALT (SGPT) 54 16 59 11 77.2 22.8 84.3 15.7
AST (SGOT) 27 43 34 36 38.5 61.5 48.5 51.5
ALP 36 34 43 27 51.5 48.5 61.4 38.6
Urea 39 31 54 16 55.7 44.3 77.2 22.8
Sodium 60 20 69 01 71.5 28.5 98.6 1.4
Potassium 57 13 70 0 81.4 18.6 100 0
Glucose (sugars) 55 15 59 11 78.6 21.4 84.3 15.7
Prothrombin time 27 43 43 27 38.6 61.4 61.4 38.6
INR 19 51 42 28 27.2 72.8 60 40
Table 7.12: Distribution of subjects based on different biochemical parameters.

BIOCHEMICAL STATUS
120
N 100 APPROACH
P
U
M
A NORMAL
T 80
B APPROACH
I
E
E
60 ABNORMAL
R
N 40 FOLLOWUP
T NORMAL
O S
20 FOLLOWUP
F
0 ABNORMAL

Fig 7.12: Distribution of subjects based on different Biochemical Parameters.

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Bhaskar Pharmacy College RESULTS

Among 70 patients, most of the patients showed a very good improvement in biochemical data.

 DIETARY DATA OF THE SUBJECTS:

Comparison of dietary habits of patients with standard diet (i.e., high calorie, high protein,

low salt and low fat).

Eating pattern Number of patients


Approach (diet habit) Follow up (standard diet)
Poor (<1500) 37 26
Adequate (1500-2000) 18 33
Excess (>2000) 15 11
Total 70 70
Table 7.13 : Comparison of food habits with standard diet.

DIETARY HABITS
40

N 35
O
30
Approach diet
O Habit
F 25

20 Follow-up std
P diet
A 15
T
I 10
E
N 5
T
S 0
Poor(<1500) Adequate(1500-2000) Excess(>2000)

Fig 7.13: Comparison of food habits with standard diet .

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Bhaskar Pharmacy College RESULTS

After the comparison of food habits with the standard diet that was given to the patients, among
70 patients most of the patients i.e., 33 of the patients were with normal food habits, 26 of the
patients were with poor food habits and 11 of the patients were with excess food habits.

 DIETARY DIVERSITY SCORE (Standard diet/ food guide pyramid):

Number of patients, consuming different categories of high-protein calorie foods:

Cat-1
Fish, oils
and sweets

( 67 )
Cat-2 Cat-3
Milk, Yogurt, Meat, Poultry,
Cheese Fish, dry beans,
( 49 ) Eggs and nut group

( 25 )

Cat-4 Cat-5
Vegetables Fruits

( 63 ) ( 63 )

Cat-6

Bread, cereal, rice and pasta

( 48 )

Fig 7.14: Dietary method of assessing nutritional status by using dietary diversity score.

According to dietary method of assessing nutritional status the diversity score for each of the
patient was ≤ 6 as each category of food was not consumed by few number of patients. So, this
indicates that most of the patients were consuming a balanced nutrient diet.

Nutritional Assessment and Management in Chronic Liver Disease 73

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