Obstruction in patients with colorectal cancer increases morbidity and mortality in association with altered nutritional status

Intestinal obstruction aggravates the prognosis of colorectal cancer (CRC) patients. The aim of this study was to carry out a comparative analysis of nutritional status and inflammatory response in CRC patients with or without intestinal obstruction. The study was carried out on 43 patients with CRC. Twenty-three of these patients had intestinal obstruction. Anthropometric measurements, serum protein content, acute phase reactants, and diagnostic and risk nutritional indices were analyzed. The presence of intestinal obstruction reduced albumin (31 +/- 5.2 vs. 36 +/- 4.2 g/l; P = 0.0025) and prealbumin (0.13 +/- 0.047 vs. 0.21 +/- 0.042 g/l; P = 0.0001) and increased C-reactive protein (49 +/- 43.8 vs. 14 +/- 16.7 mg/l; P = 0.006) and alpha1-antitrypsin (189 +/- 34.7 vs. 148 +/- 35.4 mg/dl; P = 0.0011). Intestinal obstruction was related to malnutrition (86% vs. 33%; P = 0.019) and Mullen's prognostic nutritional index (48 +/- 21.7 vs. 31 +/- 17.9; P = 0.038) in CRC patients. Mullen's nutritional risk index was inversely correlated to total cholesterol (r = -0.51; P = 0.0002) and albumin (r = -0.81; P = 0.0001). No correlation was found between Duke's tumor stages and acute phase response, inflammatory parameters, and malnutrition. In conclusion, intestinal obstruction occurred more frequently in CRC patients with malnutrition. The increased morbidity and mortality of CRC patients was also associated with acute phase response, inflammation, and low serum cholesterol and triglyceride concentration.

Nutritional status of outpatients with systemic immunoglobulin light-chain amyloidosis 1

BACKGROUND

Maintenance of a good nutritional status is associated with prolonged survival in many chronic diseases. To date, the nutritional status of outpatients with immunoglobulin light-chain (AL) amyloidosis has not been evaluated.

OBJECTIVE

The aims of this study were to obtain information regarding the nutritional status of AL amyloidosis outpatients and to investigate its prognostic role.

DESIGN

One hundred six consecutive patients with histologically confirmed AL amyloidosis were enrolled. Anthropometric, biochemical, and clinical variables were measured. The Kaplan-Meier method was used to calculate survival. A Cox proportional hazard model was constructed to evaluate the prognostic effect of the nutritional variables.

RESULTS

Unintentional weight loss (median: 11.3%; range: 2.6-34% of usual nonedematous body weight) was documented in 58 subjects (54.7%). Body mass index (BMI; in kg/m2) was <22 in 25 subjects (23.6%). Serum prealbumin was <200 mg/L (lower reference limit) in 26 patients (24.5%). A multivariate analysis showed that the percentage weight loss was significantly greater in patients with than in those without cardiac involvement (P = 0.03), and it also differed significantly by New York Heart Association class (P = 0.02) and Eastern Cooperative Oncology Group performance status (P = 0.001). Cardiac involvement (P = 0.008), hematologic response to therapy (P = 0.013), BMI (P = 0.001) and serum prealbumin (P = 0.001) were independent predictors of survival.

CONCLUSIONS

Malnutrition is a prominent clinical feature of patients with AL amyloidosis. Appropriate nutritional evaluation that comprises the easily measurable nutritional variables associated with survival should be an integral part of the clinical assessment of AL amyloidosis outpatients.

Nutrient analysis of the Guamanian diet: acceptable energy distribution with inadequate nutrient quality

Nutrition-related diseases are now a major health problem and cause of mortality on Guam. The purpose of this study is to document the nutrient content of the diet of adults on Guam with ethnic and sex differences. The subjects were 400 adults residing on Guam selected to reflect the population distribution of the island for ethnicity and gender. A 24-hour dietary recall was administered via telephone using two-dimensional food models. The diets were analyzed for nutrient content using the Food Intake Analysis System. T-tests were used to compare the mean nutrients and a Kruskal-Wallis test was used to compare the median for the two genders. Analysis of variance was used to compare mean nutrient intakes among the ethnic groups. Results show a generally appropriate intake of energy with energy distribution of carbohydrate, protein and fat within guidelines established by the National Academy of Sciences (U. S.). Nutrients that likely exceed recommendations for good health include saturated fat, cholesterol, and sodium with mean (+/- SD) intake at 10.5 +/- 4.1 of kcals, 352 +/- 256 mg/d, and 3226 +/- 1901 mg/d, respectively. Fiber, vitamin A, C, and E, folate, and magnesium are at levels that suggest inadequacy because large proportions of the sample, 96%, 48%, 56%, 83%, 85%, and 74%, respectively, were below the Estimated Adequate Intake (EAR) for these nutrients. Median intake is exceptionally low for calcium, 360 mg/d, and potassium, 2169 mg/d, and large proportions of the sample, 92% and 96%, are below the Adequate Intake (AI) level for calcium and potassium, respectively. This nutrient profile is associated with increased risk for chronic disease.

The disease profile of poverty: morbidity and mortality in northern Uganda in the context of war, population displacement and HIV/AIDS

The population of Gulu District (northern Uganda) has been severely incapacitated by war, epidemics and social disruption. This study is aimed at describing disease patterns and trends in this area through a retrospective analysis of discharge records for 155205 in-patients of Lacor Hospital in the period 1992-2002. The burden of infectious diseases in childhood is overwhelming, with malaria accounting for the steepest increase in admissions. Admissions for war-related injuries and malnutrition fluctuated with the intensity of the war and the severity of famine. Emerging and re-emerging infections, such as HIV/AIDS, tuberculosis and Ebola, accounted for a heavy disease burden; however, there has been a trend for admissions related to HIV/AIDS and tuberculosis to decrease since the implementation of community-based services. Vulnerable groups (infants, children and women) accounted for 79.8% of admissions. Long-term war, population displacement, the collapse of social structures and the breakdown of the health system place people at a much greater risk of persistent, emerging and re-emerging infectious diseases, malnutrition and war-related injuries, shaping the 'disease profile of poverty'. Most of the disease burden results from infectious diseases of childhood, whose occurrence could be dramatically reduced by low-cost and effective preventive and curative interventions.

Protein and energy supplementation in elderly people at risk from malnutrition

BACKGROUND

Evidence for the effectiveness of nutritional supplements containing protein and energy, which are often prescribed for older people, is limited. Furthermore malnutrition is more common in this age group and deterioration of nutritional status can occur during illness. It is important to establish whether supplementing the diet is an effective way of improving outcomes for older people at risk from malnutrition.

OBJECTIVES

This review examined the evidence from trials for improvement in nutritional status and clinical outcomes when extra protein and energy were provided, usually in the form of commercial 'sip-feeds'.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Healthstar, CINAHL, BIOSIS, CAB abstracts. We also hand searched nutrition journals and reference lists and contacted 'sip-feed' manufacturers. Date of most recent search: March 2004.

SELECTION CRITERIA

Randomised controlled trials and quasi-randomised controlled trials of oral protein and energy supplementation in older people with the exception of groups recovering from cancer treatment or in critical care.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trials prior to inclusion and independently extracted data and assessed trial quality. Authors of trials were contacted for further information as necessary.

MAIN RESULTS

Forty-nine trials with 4790 randomised participants have been included in the review. Most included trials had poor study quality. The pooled weighted mean difference [WMD] for percentage weight change showed a benefit of supplementation of 2.3% (95% confidence interval (CI) 1.9 to 2.7) from 34 trials. There was a reduced mortality in the supplemented compared with control groups (relative risk (RR) 0.74, CI 0.59 to 0.92) from 32 trials. The risk of complications from 14 trials showed no significant difference (RR 0.95, 95% CI 0.81 to 1.11). Few trials were able to suggest any functional benefit from supplementation. The pooled weighted mean difference (WMD) for length of stay from 10 trials also showed no statistically significant effect (WMD -1.98 days, 95% CI -5.20 to 1.24).

AUTHORS' CONCLUSIONS

Supplementation produces a small but consistent weight gain in older people. There may also be a beneficial effect on mortality. However, there was no evidence of improvement in clinical outcome, functional benefit or reduction in length of hospital stay with supplements. Additional data from large-scale multi-centre trials are still required.

[Survival and habitual nutrient intake among elderly men]

The aim of this paper was to determinate whether the intake of energy and nutrients was associated with all-cause mortality in the elderly men of the Warsaw region. Data on the intake of energy and nutrients were collected using a 3-day record method, in spring 1999. The mortality follow-up period lasted until December 31, 2003. During this period 43 men (29.5 % subjects) died. The all-cause mortality was higher among subgroup of elderly men with lower intake of carbohydrates, dietary fiber, vitamin B1, vitamin B6, vitamin PP, potassium, phosphorus, magnesium, zinc, copper and among subgroup of men with lower intake of total fat, saturated and monounsaturated fatty acids.

Dietary advice and nutritional supplements in the management of illness-related malnutrition: systematic review

BACKGROUND AND AIMS

This review investigated whether dietary advice to improve nutritional intake in adults with illness-related malnutrition improved mortality, morbidity, weight and energy intake, and whether oral nutritional supplements gave additional benefit, when given in combination with dietary advice.

METHODS

Systematic review of randomised controlled trials comparing dietary advice with either (i) no advice, (ii) nutritional supplements or (iii) dietary advice plus nutritional supplements, in people with illness-related malnutrition.

RESULTS

Twenty-four trials (25 comparisons) met the inclusion criteria, including 2135 randomised participants. Duration of follow-up ranged from 16 days to 24 months. There was no significant difference in mortality or morbidity for each comparison. Groups receiving supplements gained significantly more weight (or lost significantly less weight) than those who received dietary advice, weighted mean difference 1.09 kg (0.29-1.90) (4 studies). There were no significant differences in weight and energy intake between groups for the other comparisons. Few data were available for other outcomes.

CONCLUSIONS

Nutritional supplements may have a greater role than dietary advice in the short-term improvement of body weight in illness-related malnutrition. There is a lack of evidence to support dietary advice in the management of illness-related malnutrition, but this is based on few, often poor quality, studies.

Receiver operating characteristic analysis of body mass index to detect increased risk of functional morbidity in Vietnamese rural adults

OBJECTIVE

To assess the performance of low BMI, and define optimal BMI cut-off values in order to detect fever-associated adult morbidity.

DESIGN

A cohort study of adults between 18 and 60 y in rural Vietnam, whose BMI and health status were assessed at baseline, and who were then monitored for illness events for 4 months. Nonparametric receiver operating characteristic (ROC) analysis was used to evaluate the performance of low BMI to detect the average number of restricted-days due to illness and to determine optimal cut-off values.

SETTING

A rural commune in the Red River Delta, northern Vietnam.

SUBJECTS

The study included 693 men and 739 women aged 18-60-y.

RESULTS

At baseline, 21% of the study participants had a BMI<18.5 kg/m(2). As BMI progressively decreased, the percentage of participants experiencing morbidity with fever increased. The areas under the ROC curves for BMI were significantly greater than 0.5 for all levels of monthly average restricted-days of illness (MARDI) with fever, with best performance for >5 days/month. Excluding participants with acute or chronic disease at baseline improved the performance of BMI to detect MARDI with fever of >5 days (area under ROC curve 0.95; 95% CI 0.92, 0.99). With increasing levels of MARDI with fever, BMI cut-offs fell to 17.9 kg/m(2) when MARDI with fever was >5 days.

CONCLUSIONS

The ROC analysis demonstrates that low BMI performs well as a risk indicator of MARDI with fever of >5 days with an optimal BMI cut-off value of 17.9 kg/m(2).

Factores pronósticos de mortalidad relacionados con el estado nutricional en ancianos hospitalizados

BACKGROUND AND OBJECTIVE

The proportion of elderly patients hospitalized in acute care wards has progressively increased. Patients with a decreased functional status are prone to have malnutrition which negatively affects their prognosis and increases mortality. However, it is unclear whether functional and nutritional status are independent risk factors of mortality.

PATIENTS AND METHOD

We investigated the relation between functional status (Katz index) and nutritional parameters and the incidence of mortality in a prospective, observational study of a cohort of elderly patients who were admitted to an internal medicine ward. Prevalence of malnutrition upon admission and cumulative incidence rate of in-hospital mortality were computed. Also, potential nutritional and functional prognostic factors for in-hospital mortality were identified by multiple logistic regression.

RESULTS

The prevalence of malnutrition in 105 patients included in the cohort was 57.1% (95 percent confidence interval, 47.1% to 66.8%). The incidence of in-hospital mortality was 14.3% (95 percent confidence interval, 8.2% to 22.5%). After adjustment, independent prognostic factors for in-hospital mortality were: a high level of functional dependence (F and G categories of Katz index, OR 6.1; 95 percent confidence interval, 1.4 to 26.3), diminished levels of serum transferrin (each decrement of 1g/L, OR 8.3; 95 percent confidence interval, 3.4 to 20.0) and lymphocyte cell counts (each decrement of 0.5 x 10(9) cells/L, OR 2.3; 95 percent confidence interval, 1.5 to 3.5).

CONCLUSIONS

The prevalence of malnutrition and the incidence of mortality are very high in the hospitalized elderly. In our cohort, decreased serum transferrin and lymphocyte cell count, and an increased level of functional status were associated with an increased risk of in-hospital mortality. Given the high prevalence of geriatric patients in acute care hospitals, strategies to promote an adequate nutrition may reduce the risk of death.

A clinical review of micronutrients in HIV infection

This article reviews current literature on the role of micronutrients in human immunodeficiency virus (HIV) infection. Deficiencies of micronutrients are common in HIV-infected persons. They occur due to malabsorption, altered metabolism, gut infection, and altered gut barrier function. There is a compelling association of deficiencies of micronutrients in HIV-infection with immune deficiency, rapid disease progression, and mortality. Also, there is increased risk of vertical HIV transmission from mother to child with deficiency of vitamin A, and of neurological impairment with vitamin B12. The last five years have been exciting in micronutrient research, and there is promise that some micronutrients may be key factors in maintaining health in HIV immunodeficiency, and in reducing mortality. Selenium appears important in reducing virulence of HIV and slowing disease progression. Vitamin A supplementation in pregnant women with HIV may reduce maternal mortality and improve birth outcomes. Supplementation in children with HIV may accelerate growth. Carotenoid supplementation is being evaluated. Vitamin B12 may slow HIV immune deficiency disease progression, and reverse neurological compromise. Clinical benefit of supplementation with some micronutrients may be measurable in the presence of pre-existing deficiency. Apart from improved general nutrition, the impact of micronutrient supplements on health and their optimal use in HIV infection is controversial because there are so few controlled clinical trials. Further research is needed to elucidate the role of micronutrient deficiencies on the course of HIV infection, and the preventive and therapeutic role of supplementation in its clinical management. Nevertheless, current knowledge supports the use of routine multivitamin and trace element supplementation as adjuvant to conventional antiretroviral drug treatment as a relatively low-cost intervention.

Nutritional indicators, peripheral blood lymphocyte subsets and survival in an institutionalised elderly population

The objectives of this study were to determine the percentage and absolute counts of the peripheral blood lymphocyte subsets, and to examine the relationship between lymphocyte subsets and nutritional status, and total mortality in an institutionalised elderly population. Design The study had a cross-sectional and observational design. The sample of 115 permanent elderly residents was drawn from large geriatric institution in Melbourne, Australia. The main outcome measures were as follows: (i) percentages and absolute counts of lymphocyte subsets, (ii) association between biochemical indices of nutritional status (ferritin, iron and zinc) and peripheral blood lymphocyte subsets, (iii) total mortality during a 22-month period in relation to baseline lymphocyte subset counts. Women had higher absolute counts of various lymphocyte subsets than men. Positive correlations of serum ferritin with the number of CD8 (T-suppressor cell) and of serum iron with CD56 (natural killer, NK cells) were observed in men. In women, serum zinc was positively correlated with the absolute counts of CD3 (total T-cells), CD4 (T-helper cell) and CD19 (total B-cell). The analysis of survival data after 22 months showed that the mean number of CD4 cells of non-survivors (524 +/-292 x10(6)cells/L) was significantly lower than that of survivors (759+/-292 x 10(6) cells/L). The biochemical indicators of iron and zinc status partly account for variations in lymphocyte subset counts, consistent with known effects of iron overload and of zinc deficiency on immunocompetence. The number of CD4 T-cells may be useful in the prediction of total mortality in an institutionalised elderly population.

The global problems of child malnutrition and mortality in different world regions

The study of child mortality occupies a special place in the field of demographic research, since it represents the negative component of population growth. Also, the world food problem has become a familiar topic since the end of the World War II. The idea that population growth will sometime in the future outrun food supplies and universal starvation occurs. This study deals with what happened in global and regional variations regarding the child malnutrition and mortality rates. The main objective of the study is to explain and to explore the effect of the social, demographic, economic and health factors on child malnutrition and mortality rates among different regions in the globe. The study includes ten regions of the whole world compared to other studies that covered only one or two regions. Data were collected from various sources. The sample involved 191 countries. These countries divided by regions of world as following. East Southern Africa, West Africa, East Asia and Pacific, South Asia, Eastern Europe and Central Asia, Europe, Middle East, North Africa, North America, and South America. The results of descriptive analysis show that the highest mean rate of child malnutrition was found in South Asia region (57 children per 100), while the smallest mean rate was found in Europe region (just 1 child per 100). In West Africa region, the average of child mortality rate per 1000, 172 children, was the highest among all regions in the world, while in Europe was found to be 14 children per 1000. The results of correlation coefficients reveal that there were positive associations between illiteracy rate, unemployment, poverty, fertility rate, family size, food consumption, maternal mortality rate, population per physician, and child malnutrition and mortality in the whole world regions. Some regions have strong significant associations, such as Sub-Saharan Africa, Asia, and Americas, and other were non-significant association, such as Europe, Middle East, and North Africa. The results suggest that there were negative associations between GNP, household income, protein consumption, and child malnutrition and mortality in all world regions except Europe and Central Asia regions.

Mortality among displaced former UNITA members and their families in Angola: a retrospective cluster survey

OBJECTIVE

To measure retrospectively mortality among a previously inaccessible population of former UNITA members and their families displaced within Angola, before and after their arrival in resettlement camps after ceasefire of 4 April 2002.

DESIGN

Three stage cluster sampling for interviews. Recall period for mortality assessment was from 21 June 2001 to 15-31 August 2002.

SETTING

Eleven resettlement camps over four provinces of Angola (Bié, Cuando Cubango, Huila, and Malange) housing 149 000 former UNITA members and their families.

PARTICIPANTS

900 consenting family heads of households, or most senior household members, corresponding to an intended sample size of 4500 individuals.

MAIN OUTCOME MEASURES

Crude mortality and proportional mortality, overall and by period (monthly, and before and after arrival in camps).

RESULTS

Final sample included 6599 people. The 390 deaths reported during the recall period corresponded to an average crude mortality of 1.5/10 000/day (95% confidence interval 1.3 to 1.8), and, among children under 5 years old, to 4.1/10 000/day (3.3 to 5.2). Monthly crude mortality rose gradually to a peak in March 2002 and remained above emergency thresholds thereafter. Malnutrition was the leading cause of death (34%), followed by fever or malaria (24%) and war or violence (18%). Most war victims and people who had disappeared were women and children.

CONCLUSIONS

This population of displaced Angolans experienced global and child mortality greatly in excess of normal levels, both before and after the 2002 ceasefire. Malnutrition deaths reflect the extent of the food crisis affecting this population. Timely humanitarian assistance must be made available to all populations in such conflicts.

Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial

BACKGROUND AND PURPOSE

Previous studies suggest that undernourished patients with acute stroke do badly. The data, however, are not robust. We aimed to reliably assess the importance of baseline nutritional status as an independent predictor of long-term outcome after stroke in a large prospective cohort enrolled in the Feed Or Ordinary Diet (FOOD) trial, a multicenter randomized trial evaluating various feeding policies.

METHODS

Patients admitted to hospital with a recent stroke were enrolled in the FOOD trial. Data on nutritional status and other clinical predictors of outcome were collected at trial entry. At 6 months, the coordinating center collected data on survival and functional status (modified Rankin Scale). Outcome assessment was done by researchers blinded to baseline assessments and treatment allocation.

RESULTS

Between November 1996 and November 2001, 3012 patients were enrolled, and 2955 (98%) were followed up. Of the 275 undernourished patients, 102 (37%) were dead by final follow-up compared with only 445 (20%) of 2194 patients of normal nutritional status (odds ratio [OR], 2.32; 95% CI, 1.78 to 3.02). After adjustment for age, prestroke functional state, and stroke severity, this relationship, although weakened, still held (OR, 1.82; 95% CI, 1.34 to 2.47). Undernourished patients were more likely to develop pneumonia, other infections, and gastrointestinal bleeding during their hospital admission than other patients.

CONCLUSIONS

These data provide reliable evidence that nutritional status early after stroke is independently associated with long-term outcome. It supports the rationale for the FOOD trial, which continues to recruit and aims to estimate the effect of different feeding regimes on outcome after stroke and thus determine whether the association observed in this study is likely to be causal.

Body mass index, height, weight, arm circumference, and mortality in rural Bangladeshi women: a 19-y longitudinal study

BACKGROUND

Studies in Western populations report a J- or U-shaped relation between body mass index (BMI; in kg/m(2)) and mortality, in which persons with extremes of BMI experience increased mortality. In contrast, little is known about populations in developing countries, where nutritional status is lower.

OBJECTIVE

The objective was to examine the association between BMI and mortality in Bangladeshi women.

DESIGN

A cohort of 1888 rural Bangladeshi women (mean age: 27.9 y) was followed over 19 y. Height, weight, arm circumference, fertility, and socioeconomic data were obtained between 1975 and 1979. Mortality, loss-to-follow-up, and additional socioeconomic data were identified by the demographic surveillance system of the International Centre for Health and Population Research, Bangladesh. Proportional hazards regression was used to examine the relation between BMI and all-cause mortality.

RESULTS

The association between BMI and mortality was reverse J-shaped. After adjustment for socioeconomic indicators, the risk of dying was highest in women with BMIs in the lowest 10% of the decile distribution (< 16.39) and lowest in women with intermediate (11-89% range of the decile distribution) BMIs (16.39-20.71). Women with BMIs in the highest 10% of the distribution (> 20.71) had slightly elevated mortality (NS) compared with those with intermediate BMIs. Age and education were strongly associated with mortality. Women without schooling had a risk of mortality 4 times that of women with > or = 1 y of schooling.

CONCLUSIONS

A woman's BMI relative to the BMI distribution in the local population may be a better predictor of mortality than is absolute BMI. The contribution of education in reducing mortality supports development programs aimed at increasing women's education.

Changes in child survival are strongly associated with changes in malnutrition in developing countries

Considerable evidence suggests that malnutrition affects human performance, health and survival, including physical growth, morbidity, mortality, cognitive development, reproduction, physical work capacity and risks for several adult-onset chronic diseases. In recent decades, development agencies and governments have emphasized selective interventions to improve health and nutritional status, such as immunizations, oral rehydration, antibiotics and micronutrients, with child survival as a major motivation and justification. Although the efficacy of these approaches for improving child survival has been amenable to study, providing some of the rationale for using these approaches, it has not been possible to test directly the effects of improvements in general malnutrition. The present study quantified the effects of changes in general malnutrition, as measured by child weight-for-age (WA), on changes in child survival in 59 developing countries, using aggregate, longitudinal data at national and subnational levels from 1966 to 1996. Mixed model analysis (in SAS) was used, to take advantage of the multilevel and longitudinal nature of these data sets. Changes in WA have a statistically significant effect on changes in child mortality, independent of socioeconomic and policy changes represented by the secular trend. The secular trend in mortality began earlier and leveled off at higher mortality rates in populations with a higher prevalence of malnutrition. Gaps in coverage of selective interventions are more likely and more serious in the more malnourished populations. Continued reduction in mortality will require improved targeting of selective interventions and general nutritional improvement to the most marginal populations.

Does inflammation or undernutrition explain the low cholesterol-mortality association in high-functioning older persons? MacArthur studies of successful aging

OBJECTIVES

To explore the effect of inflammation and undernutrition on the association between hypocholesterolemia and higher overall mortality in high-functioning older persons.

DESIGN

Prospective cohort study.

SETTING

Three U.S. communities.

PARTICIPANTS

A cohort of 870 participants from the MacArthur Studies of Successful Aging.

MEASUREMENTS

Baseline information was obtained for serum levels of cholesterol, C-reactive protein, interleukin-6, and albumin; body mass index; prevalent medical conditions; health behaviors; and medications. Crude and multivariate logistic regression analyses were used to examine the association between serum total cholesterol levels and 7-year all-cause mortality, while adjusting for potential confounders.

RESULTS

In univariate analysis, the risk ratio of low serum total cholesterol level (<169 mg/dL) for 7-year total mortality was 1.90 (95% confidence interval (CI) = 1.18-3.07). The multiple adjusted risk ratios were 1.82 (95% CI = 1.10-3.00) after controlling for markers of inflammation and nutrition and 1.39 (95% CI = 0.80-2.40) after adjustment for additional cardiovascular risk factors. Sex was an important confounding variable that contributed to the observed inverse association between low serum cholesterol and overall mortality in univariate analysis.

CONCLUSIONS

Hypocholesterolemia is not an independent risk factor for increased overall mortality in high-functioning community-dwelling older men and women. The association between low total cholesterol and high mortality observed in crude analysis is mainly confounded by common cardiovascular risk factors, rather than underlying inflammation or undernutrition.

[A sixteen-year epidemiological profile of a pediatric intensive care unit, Brazil]

OBJECTIVE

To review epidemiological data from patients admitted to a Pediatric Intensive Care Unit (PICU), Brazil, and to compare them to medical aspects associated to disease severity and mortality. Also, to profile these patients, including demographic data, disease prevalence, mortality rates and associated factors.

METHODS

Retrospective data were collected from all patients admitted in a PICU of a university hospital between 1978 and 1994. Data were presented as percentages and compared using Chi-square, and calculating the relative risk (RR) with a 95% confidence interval, p<0.05.

RESULTS

Of 13, 101 patients selected, most of them were boys (58.4%), younger than 12 months of age (40.4%), well-nourished (69.5%), and with clinical disease (73.1%). The general mortality rate was 7.4%. Patients aged less than 12 months showed a RR of 1.86 (CI 1.65 - 2.10; p<0.0001), while the RR of malnutrition was 2.98 (CI 2.64 - 3.36; p<0.0001).

CONCLUSIONS

The epidemiological survey showed that the mortality is higher in malnourished children younger than 12 months of age. Sepsis was the most main cause of death.