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15 September 1996 | Volume 125 Issue 6 | Page 520
Berlowitz and colleagues [1] used a large Veterans Administration database to identify clinical and functional status variables that predict pressure ulcer development. Although they refer to poor nutrition as a known risk factor, their multivariable analysis identifies no variable that is closely related to nutritional status. At least three possible explanations exist.
One explanation is simply that the database did not contain information on nutrient intake or "nutritional status." The second is that some nutritional variables were included, but no association was found. The associations among nutrient intake, nutritional status, and the presence or development of pressure ulcers are in fact surprisingly loose [2]. Malnutrition is generally automatically acknowledged as a risk factor, although many studies (perhaps this one) found no association between nutrition and pressure ulcers.
The third possibility is complex. The term "malnourished" can refer to an otherwise healthy, starving child, a case in which providing food would clearly help. The term can also describe a cachectic patient with metastatic lung cancer: All measures of nutritional status are abnormal, but dietary intervention to aid survival is useless. Some nursing home residents may more closely resemble the latter than the former. Nutrient intake and nutritional variables might both be affected (although differently) by chronic, wasting illness or by extreme, fragile debility, but aggressive provision of nutrients would be fruitless.
If analysis of this large database shows no relation between nutrition and development of pressure ulcers, I believe the authors should emphasize this fact. Currently, many persons are attached to feeding tubes or receive dietary supplements on the basis of a belief that such a relation exists.
1. Berlowitz DR, Ash AS, Brandeis GH, Brand HK, Halpern JL, Moskowitz MA. Rating long-term care facilities on pressure ulcer development: importance of case-mix adjustment. Ann Intern Med. 1996; 124:557-63.
2. Finucane TE. Malnutrition, tube feeding and pressure sores: data are incomplete. J Am Geriatr Soc. 1995; 43:447-51. About Letters
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Rating Long-Term Care Facilities on Pressure Ulcers
TO THE EDITOR:
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