Characteristics and Outcomes of Adult Inpatients With Malnutrition

Nutrition intervention goals from the perspectives of patients at risk of malnutrition: A qualitative study

BACKGROUND

Nutrition counselling is characterised by a collaborative approach where the patient and the dietitian establish goals that promote health and self-management. Little is known about goal-setting in nutrition interventions of patients at risk of malnutrition. The present study aims to describe the perspectives and needs of patients at risk of malnutrition regarding goals of nutrition interventions.

METHODS

Semi-structured interviews were conducted with 15 patients from three primary care centres and one hospital in mid-Sweden selected through purposive sampling. Interview transcripts were analysed using reflexive thematic analysis following the six-phase guidelines of Braun and Clarke to identify patterns of shared meaning and themes in the data.

RESULTS

The findings highlight that the participants rarely reflected on their personal goals of the nutrition intervention. Instead, they strived to maintain strength and energy, with the nutrition counselling being seen as supportive in managing nutrition impact symptoms. They described discrepancies between their perspectives and the dietitian's regarding weight goals and the diet prescribed to gain weight.

CONCLUSIONS

The study findings suggest that elucidating patients' goals is key to counteracting the discrepancies between the dietitians' clinically oriented goals and patients' perspectives. Goal-setting is part of the dietitian's structured working process, whereas the patient's lifeworld is complex and unstructured. To provide person-centred nutrition care, new strategies and tools are needed to facilitate collaborative goal-setting. These approaches will bridge the gap between clinical goals and patients' individual needs, promoting better alignment and improved outcomes.

Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care-A Feasibility Study

BACKGROUND

The refeeding syndrome (RFS) is an oftentimes-unrecognized complication of reintroducing nutrition in malnourished patients that can lead to fatal cardiovascular failure. We hypothesized that a clinical decision support system (CDSS) can improve RFS recognition and management.

METHODS

We developed an algorithm from current diagnostic criteria for RFS detection, tested the algorithm on a retrospective dataset and combined the final algorithm with therapy and referral recommendations in a knowledge-based CDSS. The CDSS integration into clinical practice was prospectively investigated for six months.

RESULTS

The utilization of the RFS-CDSS lead to RFS diagnosis in 13 out of 21 detected cases (62%). It improved patient-related care and documentation, e.g., RFS-specific coding (E87.7), increased from once coded in 30 month in the retrospective cohort to four times in six months in the prospective cohort and doubled the rate of nutrition referrals in true positive patients (retrospective referrals in true positive patients 33% vs. prospective referrals in true positive patients 71%).

CONCLUSION

CDSS-facilitated RFS diagnosis is possible and improves RFS recognition. This effect and its impact on patient-related outcomes needs to be further investigated in a large randomized-controlled trial.

Setting goals with patients at risk of malnutrition: A focus group study with clinical dietitians

OBJECTIVE

Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition.

METHODS

Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes.

RESULTS

Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal-setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically-oriented goals and patients' personal goals.

CONCLUSION

Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness.

PRACTICE IMPLICATIONS

Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.

Social Determinants of Health (Social Risk) and Nutritional Status Among Community-Dwelling Older Adults Living in a Rural Setting: The Atahualpa Project

Background:

Several studies have attempted to clarify the role of social determinants of health (SDH) on nutritional status of older adults, but results are inconsistent due to differences in SDH assessments at different levels of population development. In this study, we assessed this association in community-dwelling older adults living in rural Ecuador. Methods: SDH were measured by the Gijon’s Social-Familial Evaluation Scale (SFES) and nutritional status by the Mini Nutritional Assessment (MNA^®). Multivariate logistic regression models were fitted to assess the association between SDH components and nutritional status. Locally weighted scatterplot smoothing (LOWESS) and a generalized linear model were used to evaluate the potential non-linearity of the association between the Gijon’s SFES and MNA^® scores.

Results:

A total of 295 individuals (mean age: 72.1 ± 7.6 years; 58% women) were enrolled. There was an inverse association between the total Gijon’s SFES and nutritional status (OR: 0.75; 95% C.I.: 0.65-0.86; P < .001). Three of five components of the Gijon’s SFES (family situation, social relationships, and support networks) were inversely associated with nutritional status in multivariate logistic regression models. A LOWESS plot, together with a generalized linear model, showed an inverse linear relationship between the continuous Gijon’s SFES and MNA^® scores. One standard deviation of increase in the continuous Gijon’s SFES score (2.39 points) decreased the MNA^® score by 0.78 points.

Conclusion:

Study results show a significant inverse association between high social risk and a good nutritional status. Components of the Gijon’s SFES measuring social isolation are responsible for this association.

Prevalence and characteristics of starvation-related malnutrition in a mid-Atlantic healthcare system: A cohort study

BACKGROUND

Malnutrition in the hospital negatively impacts outcomes, including readmissions, mortality, and cost. Starvation-related malnutrition (SRM) is a state of chronic undernutrition with little to no inflammation. Research on SRM within the hospital setting is lacking. Our objective was to determine the prevalence and characteristics of malnutrition within the hospital, focusing on characteristics associated with readmissions in those with SRM.

METHODS

We conducted a retrospective cohort study analyzing characteristics of adult in patients with acute disease-related malnutrition (ADM) and chronic disease-related malnutrition (CDM) compared with patients with SRM. Prevalence of all malnutrition types was calculated as the total number of malnourished patients divided by the total number of hospital discharges. Analysis of variance with Tukey post hoc analysis was performed to determine differences between characteristics of patients with SRM and other forms of malnutrition.

RESULTS

Total prevalence of malnutrition was 2.8%. Of malnourished patients, 17.6%, 79.9%, and 2.5% had ADM, CDM, and SRM, respectively. Patients with SRM had lower body mass index (BMI) (P < .001) and higher rates of readmission (P = 0.046), infectious disease (P < .001), psychiatric disease (P < .001), and substance abuse (P < .001) than patients with ADM or CDM. Readmitted patients with SRM had lower BMI and higher rates of infection and drug abuse than those without readmission.

CONCLUSION

The high incidence of comorbid substance abuse and mental illness in patients with SRM provide important targets for treatment that might reduce readmission and improve outcomes.

Malnutrition prevalence and associated biochemical factors among drug-resistance tuberculosis (DR-TB) patients at key treatment sites in Conakry City, Republic of Guinea

Introduction

drug-resistant tuberculosis is a major global health problem and a threat to health security given the increase in the number of cases and the challenges associated with care. Besides, the relationship between poor nutritional status and tuberculosis is clearly established. For relevant and evidence-based public health decision-making regarding the management of malnutrition in patients with drug-resistant tuberculosis in the initial phase, it is essential to estimate the prevalence of malnutrition and understand the risk factors associated with it.

Methods

we performed a retrospective cohort study in drug-resistant tuberculosis patients aged 18 years and older, among which the nutritional status was assessed through BMI. All predictors were included in a prediction model using the multivariate logistic model according to the lowest Akaike criterion. Discrimination and model calibration was evaluated using receiver performance analysis, and the Hosmer and Lemeshow test.

Results

this study revealed a prevalence of malnutrition of 64.7% in drug-resistant tuberculosis patients in our 218-patient series. The factors associated with malnutrition were: unsuccessful treatment, the active presence of mycobacterium tuberculosis, increased bacteriological conversion time, increased serum creatinine, increased transaminase SGPT of the liver, and anaemia. Some of the factors not associated with malnutrition included the history of anti-tuberculosis treatment, vomiting, hepatic SGPT, initial AFB count, smear and culture conversion time, depression, and chest X-ray.

Conclusion

malnutrition remains a concern among drug-resistant tuberculosis patients in Guinea as it affects more than half of them with a negative impact on the outcome of treatment. Implementing specific interventions for these high-risk patients, including nutritional supplementation, psychosocial support, and treatment for tuberculosis, can improve management for better treatment outcomes.

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe undernourishment. RFS derives from an abnormal electrolyte and fluid shifts leading to many organ dysfunctions. Symptoms generally appear within 2-5 days of re-feeding and may be absent/mild or severe and life threating, depending on the pre-existing degree of malnutrition and comorbidities. The lack of a standard definition and the nonspecificity of the symptoms make both incidence estimate and diagnosis difficult. In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed a unifying definition for the RFS and its severity classification. The awareness of the condition is crucial for identifying patients at risk, preventing its occurrence, and improving the management. The objectives of this narrative review were to summarize the current knowledge and recommendations about the RFS and to provide useful tips to help physicians to recognize and prevent the syndrome.

A narrative review of healthcare financing and reimbursement of nutritional support for patients in Singapore

AIMS

Nutritional support is used frequently in Singapore's healthcare settings, but limited research has been published on how it is financed. This paper aims to provide a narrative review on the financing of nutritional support in Singapore for acute care, step-down care, intermediate and long-term care (ILTC), community and home settings.

METHODS

A structured search strategy was applied to available electronic databases using selected search terms, with additional reports and grey literature identified using iterative searches.

RESULTS

A limited number of publications were found via electronic databases. The majority of publications were from governmental reports/ press releases, and healthcare organizations' websites. While funds are available via MediSave, MediShield Life, MediFund, and various other schemes, they may not be sufficient for individuals on long-term nutritional support.

CONCLUSIONS

More funding sources for nutritional support are urgently required for patients in ILTC. Means-testing mechanism and targeting may need to improve to ensure access to financial assistance for nutritional support and prevent poorer outcomes and higher medical costs. Medical providers, dietitians, pharmacists and social workers play a role in determining need, prescribing and accessing nutritional support for optimal care of individuals in hospitals and ILTC. Future policies will need to address the issues of access to nutritional support in the elderly and low-income populations.

Nutrition Status and Health-Related Quality of Life Among Outpatients With Advanced Head and Neck Cancer

This pilot study evaluated nutrition status and health-related quality of life (HRQOL) outcomes among outpatients with head and neck cancer (HNC). Data were collected from 19 patients (18 males, 1 female) during 3 time points: once before chemoradiotherapy (CRT) initiation and 1 and 3 months after CRT. Nutrition status was evaluated using the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Malnutrition was defined as PG-SGA stage B (moderate/suspected malnutrition) or stage C (severely malnourished). HRQOL was assessed through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its HNC-specific module (QLQ-H&N35). We found that well-nourished patients reported having fewer issues with pain, fatigue, appetite loss, chewing, sticky saliva, coughing, and social eating than those categorized as malnourished (P < .05). The association between the global quality-of-life score and PG-SGA score was statistically significant but weak in strength (r = -0.37, P = .012). Although PG-SGA identified 70% as either moderately or severely malnourished before treatment initiation, the mean body mass index was in the overweight category (29 ± 5 kg/m² ). Compared with pretreatment, patients reported more severe problems with chewing, swallowing, sticky saliva, dry mouth, speech, social eating, and taste and smell sensations at 1-month follow-up, although issues with dry mouth persisted 3 months post treatment (P = .003). In conclusion, malnourished patients reported having worse HRQOL symptoms compared with well-nourished patients. Routine nutrition and psychosocial assessment through PG-SGA and EORTC tools might help identify patients in need of nutrition and psychosocial care.

Risk for malnutrition in family practice non-attenders living in the community: A cross-sectional study from Slovenia

OBJECTIVES

The aim of this study was to determine the prevalence of malnutrition and the factors associated with malnutrition in a population of family practice non-attenders. This would enable us to recognize the extent of the problem and anticipate the measures needed to improve the current situation.

METHODS

This was a cross-sectional observational study in a family medicine setting. Participants were adults living in the community (≥18 y of age) who had not visited their chosen family physician in the previous 5 y (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2025 non-attenders. Data were collected by community nurses in the participants' homes. The main outcome measure was the Malnutrition Universal Screening Tool.

RESULTS

The sample consisted of 1641 participants (81% response rate). Increased risk for malnutrition was determined in 216 participants (13.2%; 95% confidence interval, 11.6-14.9). The multivariate model showed a significant association of increased risk for malnutrition with age and body mass index interaction (P = 0.022); number of chronic diseases (P = 0.001); poor assessment of current health (P = 0.001); a feelings of loneliness (P <0.001); and increased pain intensity (P = 0.003).

CONCLUSION

A screening program at the primary health care level could help identify patients at risk for malnutrition early. This could be followed by appropriate nutrition support, which may help to reverse or halt the malnutrition trajectory and the negative outcomes associated with poor nutritional status.

Malnutrition definitions in clinical practice: To be E43 or not to be?

Malnutrition is a disease that imposes a significant healthcare cost burden in the United States, especially when left undiagnosed and untreated for an extended period of time. This article discusses traditional malnutrition diagnostic criteria for adults and why registered dietitian nutritionists and physicians should no longer use these criteria to determine nutrition status. It concludes with the malnutrition clinical characteristics currently accepted in the United States and globally, with implications for practice. Clinical documentation specialists and medical coders can use this information to better interpret medical record documentation and assign the correct International Classification of Diseases, 10th Revision, Clinical Modification codes to the coding abstract.