Nutritional Status and Oxidative Stress on Admission and Discharge of Myocardial Infarction Patients

Document Type : Research Paper


1 Department of Nutrition, School of Medicine, Biochemistry and Nutrition, Endoscopic & Minimally Invasive Surgery, and Cancer Research Centers, Mashhad University of Medical Sciences (MUMS), Paradise Daneshgah, Azadi Square, Mashad, Iran

2 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences (MUMS), Paradise Daneshgah, Azadi Square, Mashad, Iran

4 From the Department of Medical Biochemistry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran.

5 Biochemistry of Nutrition Research Center , School of Medicine, Mashhad University of Medical Science, Mashhad, Iran.

6 Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK


Introduction: The present study aimed to evaluate the effects of hospitalization on the nutritional status and prooxidant-antioxidant balance (PAB) of the patients with myocardial infarction (MI).Methods: This study was conducted on 57 patients diagnosed with MI with the mean age of 58.44±12.80 years. The patients were admitted to the cardiac care unit (CCU) of Ghaem Hospital in Mashhad, Iran. Nutritional status of the patients was assessed using the nutritional risk screening (NRS-2002) questionnaire. In addition, anthropometric and biochemical parameters and their changes were evaluated. PAB was also assessed as an oxidative stress marker. In total, 15 patients stayed in the hospital for more than one week. The measurements were performed upon admission and discharge.Results: Upon admission, 49.1% of the patients were well-nourished, and 50.9% were at nutritional risk. As expected, the patients were overweight (36.8%) or obese (19.2%), and all the measures of adiposity were high. Well-nourished patients had lower serum PAB comparatively, while the difference was not statistically significant. The prevalence of the suboptimal nutrition index increased from 46.7% upon admission to 53.3% upon discharge. However, the increase was not considered significant due to the small sample size. Serum PAB increased within one week after admission, while the change was not significant (P=0.249).Conclusion: According to the results, the prevalence of suboptimal nutrition was high in the MI patients in Iran and increases during hospitalization.


  1. Kinosian B, Jeejeebhoy KN. What is malnutrition? Does it matter? Nutrition (Burbank, Los Angeles County, Calif). 1995;11(2 Suppl):196-7.
  2. Lochs H, Allison S, Meier R, Pirlich M, Kondrup J, van den Berghe G, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clinical nutrition. 2006;25(2):180-6.
  3. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clinical nutrition. 2008;27(1):5-15.
  4. Lucchin L, D'Amicis A, Gentile MG, Battistini NC, Fusco MA, Palmo A, et al. An Italian investigation on nutritional risk at hospital admission: The PIMAI (Project: Iatrogenic MAlnutrition in Italy) study. European e-Journal of Clinical Nutrition and Metabolism. 2009;4(4):e199-e202.
  5. Rinninella E, Cintoni M, De Lorenzo A, Addolorato G, Vassallo G, Moroni R, et al. Risk, prevalence, and impact of hospital malnutrition in a Tertiary Care Referral University Hospital: a cross-sectional study. Internal and emergency medicine. 2018:1-9.
  6. Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MA. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients–. The American journal of clinical nutrition. 2005;82(5):1082-9.
  7. Correia MIT, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical nutrition. 2003;22(3):235-9.
  8. Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Malnutrition at hospital admission-contributors and effect on length of stay. Journal of Parenteral and Enteral Nutrition. 2016;40(4):487-97.
  9. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. Bmj. 1994;308(6934):945-8.
  10. Correia MIT, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: A systematic review. Clinical Nutrition. 2017;36(4):958-67.
  11. Soeters P, Reijven P, Allison S, Konig W, Sobotka
    L. Diagnosis of malnutrition-Screening and assessment. Basics in clinical nutrition. 2011:21-32.
  12. Ruiz ÁJ, Buitrago G, Rodríguez N, Gómez G, Sulo S, Gómez C, et al. Clinical and economic outcomes associated with malnutrition in hospitalized patients. Clinical Nutrition. 2018.
  13. Parizadeh SM, Ferns GA, Ghandehari M, Hassanian SM, Ghayour‐Mobarhan M, Parizadeh SMR, et al. The diagnostic and prognostic value of circulating microRNAs in coronary artery disease: A novel approach to disease diagnosis of stable CAD and acute coronary syndrome. Journal of cellular physiology. 2018;233(9):6418-24.
  14. Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, et al. Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. European heart journal. 2007;28(20):2525-38.
  15. Eglseer D, Halfens RJG, Lohrmann C. Use of an electronic malnutrition screening tool in a hospital setting: effects on knowledge, attitudes and perceived practices of healthcare staff. Br J Nutr. 2018;120(2):150-7.
  16. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clinical nutrition. 2003;22(4):415-21.
  17. Bassey EJ. Demi-span as a measure of skeletal size. Annals of human biology. 1986;13(5):
  18. Komlos J. Anthropometric history: an overview of a quarter century of research. Anthropologischer Anzeiger. 2009:341-56.
  19. Tzotzas T, Krassas GE, Doumas A. Body composition analysis in obesity: radionuclide and non radionuclide methods. Hellenic journal of nuclear medicine. 2008;11(1):63-71.
  20. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. Journal of Clinical Epidemiology. 1972;25(6):329-43.
  21. Gudivaka R, Schoeller D, Kushner RF. Effect of skin temperature on multifrequency bioelectrical impedance analysis. Journal of Applied Physiology. 1996;81(2):838-45.
  22. Kyle UG, Genton L, Karsegard L, Slosman DO, Pichard C. Single prediction equation for bioelectrical impedance analysis in adults aged 20–94 years. Nutrition. 2001;17(3):248-53.
  23. Alamdari DH, Ghayour-Mobarhan M, Tavallaie S, Parizadeh MR, Moohebati M, Ghafoori F, et al. Prooxidant–antioxidant balance as a new risk factor in patients with angiographically defined coronary artery disease. Clinical biochemistry. 2008;41(6):375-80.
  24. Alamdari DH, Paletas K, Pegiou T, Sarigianni M, Befani C, Koliakos G. A novel assay for the evaluation of the prooxidant–antioxidant balance, before and after antioxidant vitamin admini-stration in type II diabetes patients. Clinical biochemistry. 2007;40(3-4):248-54.
  25. Kondrup J, Johansen N, Plum L, Bak L, Larsen IH, Martinsen A, et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clinical nutrition. 2002;21(6):461-8.
  26. Rasmussen HH, Kondrup J, Staun M, Ladefoged K, Kristensen H, Wengler A. Prevalence of patients at nutritional risk in Danish hospitals. Clinical nutrition. 2004;23(5):1009-15.
  27. Liang X, Jiang Z-M, Nolan MT, Efron DT, Kondrup J. Comparative survey on nutritional risk and nutritional support between Beijing and Baltimore teaching hospitals. Nutrition. 2008;
  28. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clinical nutrition. 2008;27(3):340-9.
  29. Campbell I. Limitations of nutrient intake. The effect of stressors: trauma, sepsis and multiple organ failure. European journal of clinical nutrition. 1999;53(s1):s143.
  30. Pirlich M, Schütz T, Kemps M, Luhman N, Minko N, Lübke HJ, et al. Social risk factors for hospital malnutrition. Nutrition. 2005;21(3):295-300.
  31. Dupertuis Y, Kossovsky M, Kyle U, Raguso C, Genton L, Pichard C. Food intake in 1707 hospitalised patients: a prospective comprehensive hospital survey. Clinical Nutrition. 2003;22(2):
  32. Incalzi RA, Gemma A, Capparella O, Cipriani L, Landi F, Carbonin P. Energy intake and in-hospital starvation: a clinically relevant relationship. Archives of internal medicine. 1996;156(4):425-9.
  33. Sullivan DH, Sun S, Walls RC. Protein-energy undernutrition among elderly hospitalized patients: a prospective study. Jama. 1999;
  34. Pirlich M, Schütz T, Norman K, Gastell S, Lübke HJ, Bischoff SC, et al. The German hospital malnutrition study. Clinical nutrition. 2006;25(4):563-72.