Preoperative Nutritional Assessment And Its Prognostic Effect On Patients With Rheumatic Heart Disease

In order to investigate dietary and nutritional status of patients suffered from rheumatic heart disease (RHD), provide clinic with sufficient nutrition therapy, nutrition nursing and health instruction on theory basis, 108 patients with rheumatic heart disease scheduled for valve replacement surgery were randomly selected in this study. Investigation of diets and diet habits were performed on 74 of them. At the same time, assessment of nutritional status was completely carried out by physical biochemical and laboratory examination. Relationship between preoperative nutritional assessment and prognosis was also carried out by the survey.Materials and methods:1. Investigation of diet and diet habit of RHD patients 74 cases were randomly selected and each was given a specially designed questionnaire. All food taken by patients everyday was collected exactly by 24-hours recall, and compared with Chinese People Dietary Reference Intakes (DRIs) and the Food Tower after being classified and calculated. Compared with those taken by light physical force stated in RNI, nutriments taken by the patients were calculated and assessed by the Quality Control System of Clinical Nutrition. 2. Nutritional assessment of preoperative RHD patients Patient's nutritional status was evaluated with physical examination, biochemical examination and laboratory examination by using molecular experiments and et al. Nutritional assessment indexes include anthropometry index, serum protein index, serum fat index, immunity index and biochemical index.3. Relationship between nutritional assessment and prognosis of RHD patientsPatients with RHD were divided into 3 groups by BMI: (1) malnutrition group,BMI≤18.5; (2) well-fed group, 18.5﹤BMI≤25; (3) over nutrition group, BMI>25. Relationship between BMI and prognosis was observed.Patients were divided into 2 groups by serum albumin: (1) hypoalbuminemia group, ALB≤35g/L; (2) hyperalbuminemia group, ALB>35g/L. Relationship between serum albumin and prognosis was also observedResults1. Investigation of diet and diet habit on RHD patientsTotal amount of food intake is insufficient, which results in an insufficient energy intake of only 1759.2±311.3kcal/d. The proportion of energy-containing nutriments is not proper. Protein, fat and carbohydrate provide 14.80%, 31.28% and 54.02% of total energy intake respectively. It can be seen that fat provides higher ratio of energy while carbohydrate provides lower. The structure and proportion of protein is proper, but amino acid is in poor composing proportion. Methionine is the limited amino acid. Total fat intake is in the RNI standard scale, among which RNImal fat and plant fat are 44% and 56%. Total cholesterol intake is higher than normal. It is universal that vitamine intakes are not enough. All kinds of vitamins are lower than normal except vitamine E and vitamine PP overstock and vitamine B12 and vitamine C are normal. Folic acid intake is so low that it reaches only 19.57% of WHO RDA lower limit. Minerals and trace elements intakes are also widely low, the lowest of which is fluorin, reaching only 2% of WHO RDA lower limit. Iron, iodine, sodium, chromium and cobalt are superfluous, among which iodine intake is far more than WHO RDA 150μg/d. In addition, a few patients didn't form good diet habit. Some used to smoke and drink and exercise too much or too little.2 Nutritional assessment of preoperative RHD patients The incidence of malnutrition in preoperative RHD patients can reach 35.14% according to BMI nutritional assessment. There is no significant difference between single valve replacement (SVR) and double valve replacement (DVR) patients. Female is higher than male in the incidence of malnutrition. The higher the heart NYHA functional class is, the worse the nutritional status of the patients is. Incidenceof malnutrition in patients of NYHA functional class Ⅳ is as high as 62.5%. Concentration of serum protein decreases widely and DVR patients decrease more than SVR patients...