Pilot study on the effects of dietary supplementation on recovery and nutrition outcomes of inpatients in selected public health facilities

Abstract

Nutritional status and .food intake are critical factors III disease process. Therefore nutrition care and support are key factors in patients' management during active phase of acute infection, disease and convalescence. A cross sectional study was carried 0 ut in three health facilities to assess the nutritional status of inpatients. This study investigated nutritional status of patients on admission, and identified factors that influence acceptability of hospital diets. A pilot study on multiple micronutrient supplementations was carried out in Mbagathi district hospital which had a relatively higher proportion of malnourishe~atients and longer .average length of hospital stay. Subjects were enrolled from among inpatients being admitted for treatment of pulmonary tuberculosis, pneumonia, malaria, control gastroenteritis/diarrhea, dehydration disorders, undernutrition and anemia. Patients willing to participate and who satisfied the inclusion criteria; adults aged 18-50 years, admitted for control of pulmonary TB, gastro enteritis were included in the study. Data from the trial facility was pooled by treatment group and analyzed for changes in the end points. The effect of food supplements were based on serum albumin ~ I \ ,/ . concentrations, total lymphocyte counts, hemoglobin and hematocrit changes at the primary level. Other variables included dietary intake, changes in erythrocyte sedimentation rates (ESR), and signs and symptoms in clinical presentation. Analysis consisting of summary descriptive statistics, analysis of variance (ANOV A) paired and . independent t test for intra and inter group comparisons were undertaken. xiv The finding indicate that the chronically ill patients were on average undernourished with a mean body mass index 17.8 ± 3.2kg/m2 at the time of admission. History of frequent hospitalization (43.7%), and poor nutritional status admission are likely, were likely to be the main reasons these patients had a longer mean average length of stay (ALOS) 10.8 ± 6.9 days, low serum albumin, 34.3 ± 8.5 g/dl, low mean hemoglobin 8.9 ± 1.8 and high infection level as indicated by high mean erythrocyte sedimentation rate (ESR) 98.9 ± 46.2 mm/hr. The study showed that appearance, smell, and taste of hospital diets and food supplements are key factors that contribute to food intake and adheherence to supplementation for hospitalized patients. The mean calorie, protein and fat intake of 1080 ± 457.7 kcals, 28 ± 15.6 gms, and 17.6 ± 1.9 gms respectively were below recommended dietary allowance (RDA) for healthy individuals. In conclusion, the study identified that intake of hospital food could not adequately meet the nutrient needs of most of the study subjects. It was however not conclusive on multiple micronutrient supplementation in relation to recovery due to early discharge and failure for patients to return for post discharge evaluation. In order to meet the nutrient needs of patients, improvement on nutrient density, palatability and presentation are required. Supplementation with multiple micronutrients may also be required to shorten the recovery period to the deficient patient. Follow up controlled studies based on these are required to enable estimation of efficacy of such interventions in inpatients.