title: [Validation of a method of dispensing nutritional supplements in a tertiary hospital].
abstract: BACKGROUND
  Nutritional supplements are an essential component of the management of hospital hyponutrition, although their costs are high. There exists the need for methods allowing a rational prescription of them.
  
  
  OBJECTIVE
  To analyze the validity of the criteria for dispensing the nutritional supplements (NS) used at our center (by using as a reference the CONUT system).
  
  
  METHODS
  We retrospectively reviewed the petition formularies of NS sent from the different departments for 15 months (April/2010-June/2011). We analyzed the following variables: petitionary department; pathology; BMI; recent weight loss; decreased intake > 50%; total proteins; albumin; lymphocytes; total cholesterol; and assessment of the hyponutrition level according to the CONUT system. We compared the validity of our dispensing criteria of NS to those of the CONUT system by means of the Kappa coefficient.
  
  
  RESULTS
  We received 524 petitions (34.9/month). Pathologies: infectious (31.1%), tumor (26.1%), postsurgical (19%), others (23.8%). 88.9% of the patients had recent weight loss and 83.4% decreased intake > 50%. BMI: 24.8 ± 7.5 kg/m². Laboratory parameters: albumin 2.6 ± 0.7 g/dL, total proteins 5.7 ± 2.4 g/dL, total cholesterol 152 ± 172 mg/dL, lymphocytes 1,561 ± 1,842/ mm3. Assessment of the hyponutrition level according to the CONUT system: normal (12%), mild hyponutrition (23.1%), moderate (41.6%), severe (23.3%). Adherence to our hospital requisites for the dispensation of NS: none (6.3%), one (33.6%), two (43.1%), all three (17%). We compared the number of requisites to the degree of hyponutrition (CONUT system), yielding a weak agreement index (Kappa = 0.207; p < 0.001). 156 patients (29.8% of all the petitions) received a NS in spite of having a normal nutrition level or mild hyponutrition according to the CONUT system. Most of these commands (116; 74.4%) met just one criterion for dispensing a NS, and in 93.9% of them the reason alleged by the physician was a decreased intake > 50%.
  
  
  CONCLUSIONS
  our dispensation method of NS detects a greater percentage of patients susceptible of nutritional supplementation than the CONUT system. The main advantage of our system is the assessment of a decreased intake, which is the main indication for a NS at the hospital setting.
authors.affiliation: Unidad de de Nutrición y Dietética, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, España. olivajg@gmail.com
authors.forename: José Gregorio
authors.initials: JG
authors.lastname: Oliva García
authors.forename: Francisca
authors.initials: F
authors.lastname: Pereyra-García Castro
authors.forename: Néstor
authors.initials: N
authors.lastname: Benítez Brito
authors.forename: Eva María
authors.initials: EM
authors.lastname: Herrera Rodríguez
authors.forename: José Pablo
authors.initials: JP
authors.lastname: Suárez Llanos
authors.forename: Bruno Francisco
authors.initials: BF
authors.lastname: García Bray
authors.forename: José Enrique
authors.initials: JE
authors.lastname: Palacio Abizanda
mesh_terms: D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005568:Forms and Records Control; D006801:Humans; D044342:Malnutrition / Q000628:therapy; D009749:Nutrition Surveys; D015203:Reproducibility of Results; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*