Nutritional status of patients in a long-stay hospital for people with mental handicap

Abstract

Objective: To investigate the general nutritional status of patients in Alexandra Hospital, Cape Town, and to determine whether dietary copper deficiency was causing anaemia in hospital patients. Design: Descriptive and cross-sectional analytical studies. Setting: A long-stay hospital for people with mental handicap. Subjects: Information was obtained from the total hospital population. In addition, groups of 15 patients were selected from each of two specific wards, one with active and the other inactive patients. To determine whether copper deficiency was causing anaemia, sample of 30 patients, -f divided into three groups (a hypochromic microcytic, a normochromic anaemic and a non-anaemic group) was studied. Main outcome measures: Body mass indices (BMI) and daily dietary intakes were compared with Recommended Daily Allowance (RDA) values. Serum copper and serum caeruloplasmin levels were used to detect possible copper deficiency. Results: A considerable number of patients were found to be underweight (32% of males and 26% of females had BMIs < 20). A smaller number were obese (6% of males and 17% of females had BMIs > 30). Poor nutrition was more common in severely handicapped patients and those with acquired causes of their mental handicap. Subjects with Down syndrome were generally well nourished and occasionally obese. Poor dietary intakes of biotin, pantothenic acid, vitamin D and copper were encountered. The serum copper and caeruloplasmin values were found to be within normal limits. Patients with hypochromic, microcytic anaemia had higher serum copper and caeruloplasmin levels than those with normochromic anaemia and the control group. Conclusions: A number of nutritional problems among the inpatient population were found. Many were undernourished, while a smaller number of patients were overweight. In both the active and inactive wards macronutrient intakes were generally within normal limits. However, some micronutrient nutritional deficiencies were encountered. We were unable to establish that dietary copper deficiency was the cause of anaemia in our patients. Elevated serum copper and caeruloplasmin levels found in hypochromic, microcytic patients were thought to result from the existence of low-grade infection, associated with elevation of the acute-phase protein, caeruloplasmin.

S Afr Med J 2000; 90: 1135-1140