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Iversen MKF, Buhl A, Schnieber A. Nutritional risk predicts readmission within 30 and 180 days after discharge among older adult patients across a broad spectrum of diagnoses. Clin Nutr ESPEN 2024; 61:288-294. [PMID: 38777446 DOI: 10.1016/j.clnesp.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND AIMS Hospital readmissions can have negative consequences for older adult patients, their relatives, the hospital, and society. Previous studies indicate that older adult patients who are at nutritional risk during hospital admission are at higher risk of readmission. There is a lack of studies investigating this relationship across different older adult patient groups while using recommended instruments and adjusting for relevant confounders. Thus, the aim of the present study was to investigate whether nutritional status according to the Nutrition Risk Screening 2002 during hospitalization predicted readmission among older adult patients within 30 and 180 days across a broad spectrum of wards and diagnoses when adjusting for age, sex, length-of-stay, diagnosis, and discharge destination. MATERIALS AND METHODS The present study is a retrospective cohort study based on registry data and included 21,807 older adult patients (≥65 years) hospitalized during a 5-year period. In order to investigate the relationship between nutritional risk and readmission, hierarchical logistic regression analyses with readmission within 30 days (n = 8371) and 180 days (n = 7981) as the dependent variable were performed. RESULTS Older adult patients at nutritional risk during the index admission were 1.44 times more likely to be readmitted within 30 days after discharge (P < 0.001), and 1.47 times more likely to be readmitted within 180 days after discharge (P < 0.001), compared to older adult patients who were not at nutritional risk during index admission when adjusting for age, sex, discharge destination, diagnosis group, and length-of-stay. CONCLUSIONS Our results highlight the importance of focusing on nutritional status in older adults as a factor in the prevention of readmissions, including ensuring that practices, resources, and guidelines support appropriate screening procedures. Because nutritional risk predicts readmission both in a 30-days and 180-days perspective, the results point to the importance of ensuring follow-up on the screening result, both in the hospital context and after discharge.
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Affiliation(s)
- Mette Kathrine Friis Iversen
- VIA University College, Department of Nutrition and Health, Hedeager 2, Aarhus N 8200, Denmark; VIA University College, Research Centre for Health and Welfare Technology, Hedeager 2, Aarhus N 8200, Denmark.
| | - Annette Buhl
- VIA University College, Department of Nutrition and Health, Hedeager 2, Aarhus N 8200, Denmark; VIA University College, Research Centre for Health and Welfare Technology, Hedeager 2, Aarhus N 8200, Denmark.
| | - Anette Schnieber
- VIA University College, Department of Nutrition and Health, Hedeager 2, Aarhus N 8200, Denmark; VIA University College, Research Centre for Health and Welfare Technology, Hedeager 2, Aarhus N 8200, Denmark.
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Alvarez-Altamirano K, Bejarano-Rosales MP, González-Rodríguez BK, Mondragón-Nieto G, Alatriste-Ortiz G, Noguez LJJ, Gutiérrez-Salmeán G, Fuchs-Tarlovsky V. Prevalence of nutritional risk and malnutrition in hospitalized patients: a retrospective, cross-sectional study of single-day screening. Appl Physiol Nutr Metab 2024. [PMID: 38700079 DOI: 10.1139/apnm-2023-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Hospital malnutrition remains a significant public health issue, particularly in developing countries. The Global Leadership Initiative on Malnutrition (GLIM) proposed homogenizing criteria to standardize malnutrition diagnosis. This study aimed to retrospectively determine the prevalence of nutritional risk and malnutrition diagnoses among hospitalized patients using the Nutritional Risk Screening (NRS)-2002 screening instrument and the GLIM criteria, respectively. We conducted a retrospective, cross-sectional study from nutritional records of patients hospitalized in a single centre 2021. Nutrition data from records included medical diagnosis, gender, length of stay, age, weight, height, body mass index, weight loss, calf circumference, and middle upper arm circumference. Nutritional risk and malnutrition were evaluated using NRS-2002 and GLIM criteria. Its concordance was further evaluated by using a Kappa test. The study included 616 records of patients; 52.3% (n = 322) of the population were male. The prevalence of nutritional risk, according to NRS-2002, was 69.5% (n = 428). Nutritional risk as well as malnutrition diagnosis according to GLIM criteria was observed in 87.8% (n = 374) of patienttritional risk and malnutrition were evaluated using NRS-2002 and GLIM criteria. Its concordance was further evaluated by using a Kappa test. Ws. Tools showed a strong concordance (κ= 0.732). All anthropometric data, except for height, were found to be significantly different between patients with moderate and severe malnutrition (p < 0.05). Our findings highlight a high prevalence of malnutrition in this group of hospitalized patients in Mexico. NRS-2002 demonstrated good agreement with the diagnosis of malnutrition according to GLIM criteria and could be considered part of the straightforward two-step approach for malnutrition; however, further studies are needed.
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Affiliation(s)
| | | | | | | | | | - Liz J Jiménez Noguez
- Clinical Nutrition, Hospital General de México, Dr. Eduardo Liceaga. Mexico City, México
| | - Gabriela Gutiérrez-Salmeán
- Health Sciences Research Center (CICSA), Faculty of Health Sciences, Universidad Anáhuac México, Mexico City, Mexico
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Dos Santos JG, Saueressig C, Wolf R, Dos Santos JC, Silva FM, Franzosi OS, Alba VD. Identifying nutrition risk in emergency patients: What is the most appropriate screening tool? Nutr Clin Pract 2024. [PMID: 38575550 DOI: 10.1002/ncp.11147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The emergency department (ED) is the most frequent access route to the hospital. Nutrition risk (NR) screening allows the early identification of patients at risk of malnutrition. This study aimed to evaluate the feasibility and predictive validity of five different tools in EDs: Nutritional Risk Screening 2002 (NRS-2002), Nutritional Risk Emergency 2017 (NRE-2017), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), Malnutrition Universal Screening (MUST), and Malnutrition Screening Tool (MST). METHODS Patients with scores ≥3 according to the NRS-2002, ≥1.5 according to the NRE-2017, and ≥2 according to the MUST, RFH-NPT, or MST were classified with NR. Prolonged length of stay (LOS) and 1-year mortality were evaluated. RESULTS 431 patients were evaluated (57.31 ± 15.6 years of age; 54.4% women) in a public hospital in southern Brazil. The prevalence of NR was: 35% according to the NRS-2002, 43% according to the MST, 45% according to the NRE-2017 and MUST, and 49% according to the RFH-NPT. Patients with NR, had a greater risk of prolonged LOS (P < 0.001). The presence of NR was associated with an increased risk of 1-year mortality according to the NRS-2002 (hazard ratio [HR]: 4.04; 95% CI, 2.513-6.503), MST (HR: 2.60; 95% CI, 1.701-3.996), NRE-2017 (HR: 4.82; 95% CI, 2.753-8.443), MUST (HR: 4.00; 95% CI, 2.385-6.710), and RFH-NPT (HR: 5.43; 95% CI, 2.984-9.907). CONCLUSIONS NRE-2017 does not require objective data and presented predictive validity for all outcomes assessed, regardless of the severity of the disease, and thus appears to be the most appropriate tool for carrying out NR screening in the ED.
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Affiliation(s)
- Johnny Galhano Dos Santos
- Graduate Program in Food, Nutrition, and Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Saueressig
- Graduate Program Sciences in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata Wolf
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jéssica Correa Dos Santos
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Graduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Oellen Stuani Franzosi
- Nutrition and Dietetics Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Valesca Dall' Alba
- Graduate Program in Food, Nutrition, and Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program Sciences in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition and Dietetics Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Blanar V, Pospichal J, Eglseer D, Grofová ZK, Bauer S. Evaluation of Malnutrition Knowledge among Nursing Staff in the Czech Republic: A Cross-Sectional Psychometric Study. TEACHING AND LEARNING IN MEDICINE 2024:1-10. [PMID: 38515254 DOI: 10.1080/10401334.2024.2331234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
Construct: The Knowledge of Malnutrition - Geriatric 2.0' (KoM-G 2.0) instrument was designed to quantify nursing staff malnutrition knowledge in inpatient medical and rehabilitation care facilities, as well as home health care. It has been used to assess grasp of current clinical practice guidelines and proficiency in addressing issues related to malnutrition. It provides insight into familiarity with and capacity to tackle issues pertaining to malnutrition in clinical practice. Furthermore, it has been used assess the effectiveness of educational interventions aimed at improving nursing professionals knowledge and awareness of malnutrition. Background: The quality of nursing education affects malnutrition risk assessment, monitoring of food intake, and effectiveness of nutrition care. Improvements in malnutrition education require determining the current level of knowledge and benchmarking with other countries. In the Czech Republic, no nationwide assessment of nursing staff malnutrition knowledge has ever been conducted. Approach: The purpose of the study was to translate the KoM-G 2.0 instrument, gather initial validity evidence, and evaluate nursing staff knowledge of malnutrition in inpatient medical, rehabilitation care facilities, and home care in the Czech Republic. All inpatient healthcare facilities and home healthcare facilities in the Czech Republic were invited to participate. The Czech version of the internationally standardized KoM-G 2.0 (KoM-G 2.0 CZ) was used to assess nursing staff malnutrition knowledge between 3 February 2021 and 31 May 2021. A total of 728 nurses began the questionnaire, and 465 (63.9%) of respondents completed it and were included in the study. Data analyses examined instrument difficulty, discriminability, and reliability, as well as sources of variation in knowledge scores. Findings: The psychometric characteristics of the KoM-G 2.0 CZ instrument included the difficulty index Q (0.61), the discriminant index (ULI 0.29, RIT 0.38, upper-lower 30% 0.67), and Cronbach alpha (0.619). The overall mean of correct answers was 6.24 (SD 2.8). There was a significant impact of educational attainment and nutrition training on KoM-G 2.0 CZ scores. Conclusions: Our findings provide initial validity evidence that KoM-G 2.0 CZ is useful and appropriate for assessing malnutrition knowledge among Czech nursing staff. Our research identified gaps in knowledge and examples of good practice in understanding malnutrition that can be applied internationally. The knowledge of academic nurses was greater; therefore, we suggest they play a key role in nutritional care. We recommend continuous education to improve understanding of malnutrition in this setting.
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Affiliation(s)
- Vit Blanar
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Jan Pospichal
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Zuzana Kala Grofová
- Department of Nutrition and Dietology, Pardubice Hospital, Pardubice, Czech Republic
| | - Silva Bauer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Zhou B, Zhang Y, Hiesmayr M, Gao X, Huang Y, Liu S, Shen R, Zhao Y, Cui Y, Zhang L, Wang X. Dietary Provision, GLIM-Defined Malnutrition and Their Association with Clinical Outcome: Results from the First Decade of nutritionDay in China. Nutrients 2024; 16:569. [PMID: 38398893 PMCID: PMC10893253 DOI: 10.3390/nu16040569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/04/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Malnutrition is a common and serious issue that worsens patient outcomes. The effects of dietary provision on the clinical outcomes of patients of different nutritional status needs to be verified. This study aimed to identify dietary provision in patients with eaten quantities of meal consumption and investigate the effects of dietary provision and different nutritional statuses defined by the GLIM criteria on clinical outcomes based on data from the nutritionDay surveys in China. A total of 5821 adult in-patients from 2010 to 2020 were included in this study's descriptive and Cox regression analyses. Rehabilitation and home discharge of 30-day outcomes were considered a good outcome. The prevalence of malnutrition defined by the GLIM criteria was 22.8%. On nutritionDay, 51.8% of all patients received dietary provisions, including hospital food and a special diet. In multivariable models adjusting for other variables, the patients receiving dietary provision had a nearly 1.5 higher chance of a good 30-day outcome than those who did not. Malnourished patients receiving dietary provision had a 1.58 (95% CI [1.36-1.83], p < 0.001) higher chance of having a good 30-day outcome and had a shortened length of hospital stay after nutritionDay (median: 7 days, 95% CI [6-8]) compared to those not receiving dietary provision (median: 11 days, 95% CI [10-13]). These results highlight the potential impacts of the dietary provision and nutritional status of in-patients on follow-up outcomes and provide knowledge on implementing targeted nutrition care.
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Affiliation(s)
- Bei Zhou
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
- Department of Nutrition, Acupuncture, Moxibustion and Massage College, Health Preservation and Rehabilitation College, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing 210023, China
| | - Yupeng Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Michael Hiesmayr
- Center for Medical Data Science, Section for Medical Statistics, Medical University Vienna, Spitalgasse 23, A-1090 Vienna, Austria;
| | - Xuejin Gao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Yingchun Huang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Sitong Liu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Ruting Shen
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China;
| | - Yao Cui
- Department of Nutrition, Pizhou Hospital, Xuzhou Medical University, Xuzhou 221004, China;
| | - Li Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Xinying Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
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Anari R, Nikooyeh B, Ghodsi D, Amini M, Neyestani TR. An in-depth analysis of hospital food waste in terms of magnitude, nutritional value, and environmental and financial perspectives: A cross-sectional study. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2024; 42:167-177. [PMID: 37300389 DOI: 10.1177/0734242x231176733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hospital food waste has nutritional, economic and environmental impacts, and halving food waste is a sustainable development goal. This study aimed to quantify hospital food waste and its nutritional, environmental and financial values in medical and surgical wards. In a cross-sectional study in three educational hospitals, nutritional and demographic data of adult inpatients were collected. The food waste was measured at breakfast, lunch and snack times, and a 24-hour food recall was fulfilled for each patient. Also, the nutritional, environmental and financial values of discarded food were calculated. Food waste contributors were determined using linear regression. Totally, 398 meals were evaluated. The average served food was about 1 kg patient-1 day-1, while 539.5 g patient-1 day-1(50.1% of the served food) was discarded. Mean food wastes were 148.9 g (standard deviation (SD): 130.1), 364.3 g (SD: 257.2) and 80.2 g (SD: 101.5) in breakfast, lunch and snacks, equal to 45.7% (SD: 36.9), 51.4% (SD: 36.1) and 62.4% (SD: 53.2) of the served food, respectively. Rice, soup, milk and fruits were mostly discarded. Severely malnourished patients had higher daily food waste. Food preparation and waste were estimated to cost on average US$1.8 and US$0.8 patient-1 day-1, respectively. Each kilogram of food waste resulted in 8.1 m2 of land use, 1.4 kg of CO2-equivalent gas emission, and about 1003 L of water wastage. Half of the hospital food was discarded which means waste of nutrients, environmental resources and money. Current data can help authorities to plan for reducing hospital food waste.
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Affiliation(s)
- Razieh Anari
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Nikooyeh
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Delaram Ghodsi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Amini
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tirang R Neyestani
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mikkelsen S, Tobberup R, Skadhauge LB, Rasmussen HH, Holst M. "More2Eat" in patients at nutritional risk during hospital stay lowers the risk of three-month mortality. Clin Nutr ESPEN 2023; 57:29-38. [PMID: 37739671 DOI: 10.1016/j.clnesp.2023.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Malnutrition is a common problem among hospitalized patients due to increased nutrient requirements and reduced food intake or uptake of nutrients. The aim of this prospective cohort study was to investigate the association of nutritional risk status (at or not at risk by NRS-2002) as well as energy and protein intake, use of oral nutritional supplements (ONS) and snack meals in at risk patients during hospitalization and adverse outcomes (length of stay (LOS), readmissions and mortality) at three-months follow-up. METHODS Data were collected at baseline and at three-months follow-up in patients hospitalized at 31 units at a Danish University Hospital. Diet records were performed at baseline by using the nurses' quartile nutrition recording methods. Data about disease and clinical outcomes were collected from electronic medical records at baseline and three-months follow-up. RESULTS A total of 318 patients were included. Patients at nutritional risk (n = 149, 47%) had higher risk of longer LOS (≥20 days (OR = 4.24 [1.81;9.95] and ≥30 days OR = 2.50 [1.22;5.14])), having one readmission (OR = 1.86 [1.15;3.01]) and death (OR = 2.56 [1.27;5.20]) compared to patients not at nutritional risk (n = 169, 53%). A longer LOS was associated with patients who achieved ≥75% of energy and protein requirements, consumed snack meals incl. and excl. oral nutritional supplements. Readmissions in patients at nutritional risk during the three-months were not associated with food intake during the index hospitalization. Mortality was observed in 43 of the 318 (13.5%) hospitalized patients. A lower mortality was associated with increased energy and protein intake in patients at nutritional risk. CONCLUSIONS The results of this study indicate a longer LOS, higher readmission rate and increased mortality in patients at nutritional risk compared to patients not at risk. Patients at nutritional risk had lower risk of three-month mortality and longer LOS during index hospitalization with increased energy and protein intake. Readmissions in patients at nutritional risk were not affected by food intake. The association of nutritional risk with poorer outcomes indicates that good nutritional care including constant attention to food-intake during hospitalization can be beneficial regarding mortality.
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Affiliation(s)
- Sabina Mikkelsen
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Randi Tobberup
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Lotte Boa Skadhauge
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Henrik Højgaard Rasmussen
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre skovvej 5, 9000 Aalborg, Denmark.
| | - Mette Holst
- Danish Nutrition Science Centre and Department of Gastroenterology, Aalborg University Hospital, Søndre skovvej 5, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre skovvej 5, 9000 Aalborg, Denmark.
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Young A, Kozica-Olenski S, Mallan K, McRae P, Treleaven E, Walsh Z, Mudge A. Developing and validating a novel staff questionnaire to identify barriers and enablers to nutrition and mealtime care on hospital wards. Nutr Diet 2023; 80:389-398. [PMID: 37169361 DOI: 10.1111/1747-0080.12815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
AIMS Improving hospital nutrition and mealtime care is complex and often requires multifaceted interventions and implementation strategies to change how staff, wards and systems operate. This study aimed to develop and validate a staff questionnaire to identify multilevel barriers and enablers to optimal nutrition and mealtime care on hospital wards, to inform and evaluate local quality improvement. METHODS Literature review, multidisciplinary focus groups and end-user testing informed questionnaire development and establishment of content and face validity. To determine the construct validity, the questionnaire was administered to ward staff working in five wards across two facilities (acute hospital, rehabilitation unit). Exploratory factor analysis was used to estimate the number of factors and to guide decisions about whether to retain or reject individual items. Scale reliability was assessed using Cronbach's alpha. RESULTS The questionnaire was completed by 138 staff, with most respondents being nurses (57%) and working in the acute care facility (76%). Exploratory factor analysis supported construct validity of four of the original seven subscales. The final questionnaire consisted of 17 items and 4 sub sub-scales related to (1) Personal Staff Role; (2) Food Service; (3) Organisational Support, and (4) Family Involvement; each sub-scale demonstrated good reliability with Cronbach's alpha values all >0.70. CONCLUSION This novel and brief questionnaire shows good reliability and preliminary evidence of construct validity in this small sample. It provides a potentially useful instrument to identify barriers and enablers to nutrition and mealtime care from the staff perspective and inform where improvement efforts should be focused.
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Affiliation(s)
- Adrienne Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Kozica-Olenski
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Kimberley Mallan
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elise Treleaven
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zoe Walsh
- Nutrition and Dietetics, Community and Oral Health Metro North Health, Melbourne, Victoria, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Greater Brisbane Medical School, University of Queensland, Brisbane, Queensland, Australia
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Möcking K, Hosters B. [Development of an advanced practice nurse (APN) role for nutrition management: A needs assessment using a mixed methods approach]. Pflege 2023. [PMID: 37184638 DOI: 10.1024/1012-5302/a000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Development of an advanced practice nurse (APN) role for nutrition management: A needs assessment using a mixed methods approach Abstract. Background: Nurses are attributed to play a key role in nutrition management. This field has emerged to be a subject of advanced nursing practice. Aim: Conducting a needs assessment on the role profile of an advanced practice nurse (APN) in nutrition management according to the PEPPA framework. Methods: Mixed methods design. In a cross-sectional study on the current practice, the diagnostic accuracy of nurses' nutrition screening using Nutritional Risk Screening (NRS 2002) compared with independent assessment by a nutrition expert using NRS 2022 was examined. In case of a positive screening result, reasons were determined using an in-depth assessment. In addition, semi-structured, guideline-based interviews were conducted and content-analysed. Results: The identification of patients at risk by nurses' nutrition screening showed a need for improvement (sensitivity: 56%, specificity: 96%; n = 195). Commonly identified reasons for (risk of) malnutrition (n = 51) were lack of desire to eat/lack of appetite or increased caloric needs due to illness. Development opportunities and expectations for an APN were specified based on the interviews (n = 20). They refer to skill enhancement, support within the interprofessional team in complex treatment cases and a stronger nursing role in nutrition management. Conclusions: Based on the needs assessment, the APN's areas of responsibility were identified and assigned to the Hamric model, and implementation strategies could be derived.
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Talebi S, Zeraattalab-Motlagh S, Vajdi M, Nielsen SM, Talebi A, Ghavami A, Moradi S, Sadeghi E, Ranjbar M, Habibi S, Sadeghi S, Mohammadi H. Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: An umbrella review of systematic reviews and meta-analyses of randomized trials. Nutr Clin Pract 2023; 38:564-579. [PMID: 36906848 DOI: 10.1002/ncp.10976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/02/2023] [Accepted: 02/05/2023] [Indexed: 03/13/2023] Open
Abstract
We conducted an umbrella review to summarize the existing evidence on the effect of early enteral nutrition (EEN) compared with other approaches, including delayed enteral nutrition (DEN), parenteral nutrition (PN), and oral feeding (OF) on clinical outcomes in hospitalized patients. We performed a systematic search up to December 2021, in MEDLINE (via PubMed), Scopus, and Institute for Scientific Information Web of Science. We included systematic reviews with meta-analyses (SRMAs) of randomized trials investigating EEN compared with DEN, PN, or OF for any clinical outcomes in hospitalized patients. We used "A Measurement Tool to Assess Systematic Reviews" (AMSTAR2) and the Cochrane risk-of-bias tool for assessing the methodological quality of the systematic reviews and their included trial, respectively. The certainty of the evidence was rated using the "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) approach. We included 45 eligible SRMAs contributing with a total of 103 randomized controlled trials. The overall meta-analyses showed that patients who received EEN had statistically significant beneficial effects on most outcomes compared with any control (ie, DEN, PN, or OF), including mortality, sepsis, overall complications, infection complications, multiorgan failure, anastomotic leakage, length of hospital stay, time to flatus, and serum albumin levels. No statistically significant beneficial effects were found for risk of pneumonia, noninfectious complications, vomiting, wound infection, as well as number of days of ventilation, intensive care unit days, serum protein, and pre-serum albumin levels. Our results indicate that EEN may be preferred over DEN, PN, and OF because of the beneficial effects on many clinical outcomes.
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Affiliation(s)
- Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Vajdi
- Student Research Committee, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan, Iran
| | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Ali Talebi
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abed Ghavami
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajjad Moradi
- Halal Research Center of IRI, FDA, Tehran, Iran.,Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Erfan Sadeghi
- Research Consultation Center (RCC), Shiraz University Of Medical Sciences, Shiraz, Iran
| | - Mahsa Ranjbar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajedeh Habibi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Sadeghi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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11
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Saueressig C, Ferreira PK, Glasenapp JH, Dall'Alba V. Food Intake Visual Scale-A practical tool for assessing the dietary intake of hospitalized patients with decompensated cirrhosis. Nutr Clin Pract 2023; 38:187-198. [PMID: 35118703 DOI: 10.1002/ncp.10840] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/02/2021] [Accepted: 12/26/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The aim of this study was whether the Food Intake Visual Scale (FIVS) can be used in clinical practice to measure food intake in patients with decompensated cirrhosis. METHODS A cross-sectional study was performed with patients with cirrhosis between April 2017 and July 2019. The food intake was assessed through the 1-day diet record (DR) and according to FIVS, which consists of pictures of four plates of food at different levels of consumption: "about all," "half," "a quarter," or "nothing." The analysis of variance test with Bonferroni multiple comparison analysis was used to compare the mean energy intake through the DR according to the FIVS categories. RESULTS This study included 94 patients with a mean age of 60.29 ± 9.33 years. Patients with lower food intake according to the FIVS categories also had lower mean energy and macronutrient intake according to the DR: patients eating "about all" (n = 49, 52.1%) consumed a mean of 1526.58 ± 428.27 kcal/day, patients eating "half" (n = 16, 17%) consumed a mean of 1282.08 ± 302.83 kcal/day, patients eating "a quarter" (n = 25, 26.6%) consumed a mean of 978.96 ± 468.81 kcal/day, and patients eating "nothing" (n = 4, 4.3%) consumed a mean of 353.59 ± 113.16 kcal/day (P < .001). CONCLUSION The results of this study demonstrate that FIVS can be implemented in clinical practice to measure food intake in patients with decompensated cirrhosis as a substitute for the DR because it is a noninvasive, low-cost, quick, reliable, and easy bedside method for obtaining data.
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Affiliation(s)
- Camila Saueressig
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pâmela Kremer Ferreira
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joana Hoch Glasenapp
- Department of Food, Nutrition, and Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Valesca Dall'Alba
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Food, Nutrition, and Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Nutrition, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Nutrition Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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12
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García-Almeida JM, García-García C, Ballesteros-Pomar MD, Olveira G, Lopez-Gomez JJ, Bellido V, Bretón Lesmes I, Burgos R, Sanz-Paris A, Matia-Martin P, Botella Romero F, Ocon Breton J, Zugasti Murillo A, Bellido D. Expert Consensus on Morphofunctional Assessment in Disease-Related Malnutrition. Grade Review and Delphi Study. Nutrients 2023; 15:nu15030612. [PMID: 36771319 PMCID: PMC9920608 DOI: 10.3390/nu15030612] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions.
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Affiliation(s)
- José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain
- IBIMA, Instituto de Investigación Biomédica y Plataforma en Nanomedicina, BIONAND, 29590 Málaga, Spain
- CIBEROBN, Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición, 28029 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Quirónsalud, 29004 Málaga, Spain
- Facultad de Medicina, University of Málaga, 29010 Málaga, Spain
| | - Cristina García-García
- PhD Program in Biomedicine, Translational Research and New Health Technologies, Faculty of Medicine, University of Málaga, 29071 Málaga, Spain
- Medical Director, Persan Farma, 35007 Las Palmas de Gran Canaria, Spain
- Correspondence: ; Tel.: +34-670326887
| | - María D. Ballesteros-Pomar
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, 24071 León, Spain
| | - Gabriel Olveira
- IBIMA, Instituto de Investigación Biomédica y Plataforma en Nanomedicina, BIONAND, 29590 Málaga, Spain
- Facultad de Medicina, University of Málaga, 29010 Málaga, Spain
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 29010 Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, 29016 Málaga, Spain
| | - Juan J. Lopez-Gomez
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Irene Bretón Lesmes
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Rosa Burgos
- Nutritional Support Unit, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, University Hospital Miguel Servet, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Pilar Matia-Martin
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Medicine Department, Universidad Complutense, 28040 Madrid, Spain
| | - Francisco Botella Romero
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Albacete, 02006 Albacete, Spain
| | - Julia Ocon Breton
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Ana Zugasti Murillo
- Nutrition Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Diego Bellido
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, 15405 Ferrol, Spain
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13
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Mesbah S, Mesbah H, Haumont LA, Thibault R. The evaluation of consumed food portions as a screening test for malnutrition in the older people living in a nursing home: A cross-sectional pilot study. NUTR CLIN METAB 2023. [DOI: 10.1016/j.nupar.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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14
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McClave SA. 2022 Peggi Guenter Excellence in Clinical Practice Lectureship: Expanding the clinical practice of nutrition—Challenging the known, exposing inconvenient truths, and engaging the young. Nutr Clin Pract 2022; 37:1257-1271. [DOI: 10.1002/ncp.10918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/10/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stephen A. McClave
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine University of Louisville Louisville Kentucky USA
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15
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Shang J, Zhao G, Gong J, Su D, Wang Y, Wang L. Nutritional Risk Screening 2002 predicts surgical outcomes in 1532 patients undergoing total joint arthroplasty: A retrospective cohort study. Nutr Clin Pract 2022; 38:636-647. [PMID: 36446553 DOI: 10.1002/ncp.10934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/30/2022] [Accepted: 10/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Limited information exists about the predictive effect of Nutritional Risk Screening (NRS) 2002 on orthopedic surgery. The aim of the present study is to explore the role of NRS 2002 in postoperative complications and resource utilization in patients with total joint arthroplasty (TJA). METHODS We retrospectively collected the demographics and surgical results of nearly 2000 TJA patients admitted from 2016 to 2020 and assessed the differences in short- and long-term complications and resource utilization parameters. Multivariate linear, logistic regression, and subgroup analysis were subsequently used to control for potential confounders. Survival analysis was performed to further verify the cumulative incidence of postoperative complications. RESULTS We identified 1532 patients receiving TJA, 8.7% of which were at nutrition risk (NRS 2002 score ≥3 out of 7). Preoperative nutrition risk was associated with an increased risk of systemic complications, incisional complications, surgical site infection (SSI), incisional SSI, periprosthetic joint infection, dislocation, and periprosthetic fracture after TJA (odds ratio [OR], 3.62-31.99; all P < 0.05). Preoperative nutrition risk was further associated with an increased risk of cardiac complications, respiratory complications, urinary complications, and arthroplasty-related reoperation (OR, 3.16-12.29; all P < 0.01). Moreover, preoperative nutrition risk was associated with increased costs and length of stay, and increased risk of unplanned intensive care unit admission, arthroplasty-related readmission, infection-related readmission, and SSI-related readmission. CONCLUSIONS NRS 2002 is associated with an elevated risk of postoperative complications and increased resource utilization, following TJA. Thus, routine screening is recommended to identify nutrition risk statuses of patients undergoing elective TJA.
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Affiliation(s)
- Jingjing Shang
- Department of Pharmacy The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University Changzhou China
| | - Gongyin Zhao
- Department of Orthopedics The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University Changzhou China
| | - Jinhong Gong
- Department of Pharmacy The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University Changzhou China
| | - Dan Su
- Department of Pharmacy The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University Changzhou China
| | - Yuji Wang
- Department of Orthopedics The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University Changzhou China
| | - Liangliang Wang
- Department of Orthopedics The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University Changzhou China
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16
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Malnutrition via GLIM Criteria in General Surgery Patients. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1175851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose: The purposes are to determine malnutrition in elective general surgery patients via GLIM criteria, compare GLIM criteria with NRS2002 and to determine the effect of malnutrition on Length of Stay (LoS).
Materials and Methods: Malnutrition was detected with NRS2002 and GLIM. GLIM was evaluated in two different ways as 1-NRS2002 (first four questions) was used as a preliminary malnutrition screening tool for GLIM and 2-All patients were evaluated with GLIM without a preliminary assessment. Reduced muscle mass in GLIM, was assessed using different anthropometric measurements and cut-off points. In total, 10 different GLIM models were constituted. Data were collected within 48 hours of admission. Agreement between malnutrition tools was determined via Kappa. Logistic regression models were established to present the effect of malnutrition on long LoS. p
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17
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Zhang B, Li Y, Chen Y. Prognosis-Related Nutritional Score for Cancer Patients (PRNS): a clinical nutritional score derived from a retrospective cohort study. Lab Invest 2022; 20:477. [PMID: 36266719 PMCID: PMC9583551 DOI: 10.1186/s12967-022-03696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022]
Abstract
Background Nutritional assessment and quality of life (QOL) have become important indices for therapeutic efficacy in patients with malignancies. We aim to develop and validate an easy-to-use questionnaire with prognostic value to assess nutritional status in hospitalized cancer patients. Methods A comprehensive survey focused on patient-generated subjective global assessment (PG-SGA) and 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30 Chinese version) was performed in a cohort of 22,776 patients derived from the INSCOC study. Among them, 1948 patients were followed for 3 years after admission. An observational, retrospective, cross-sectional cohort study was conducted in accordance with TRIPOD statement. Breiman's random forest model was applied to calculate variable importance (VIMP) for items in PG-SGA and EORTC QLQ-C30 (Chinese version) for nutritional recommendation. Cox regression model was employed to construct Prognosis-Related Nutritional Score for Cancer Patients (PRNS). Kaplan–Meier Survival curve, ROC and DCA were calculated to evaluate prognostic value of nutritional status categorized by PRNS, and compared with PG-SGA. Results Nutritional status was classified into 4 levels by PRNS scores: well nourished (≤ 4.5 points), mild malnourished (5–7.5 points), moderate malnourished (8–14.5 points), and severe malnourished (≥ 15 points). Significant median overall survival differences were found among nutritional status groups stratified by the PRNS (all Ps < 0.05). Compared with PG-SGA, PRNS had better prognostic value for survival stratified by nutritional status. The external, internal validity, test–retest reliability and rater reliability were satisfactory. Conclusions We systematically developed and validated PRNS as a nutrition screening tool for cancer patients. Compared with PG-SGA, PRNS has better prognostic value and simpler operation. Trial registration Investigation on Nutrition Status and its Clinical Outcome of Common Cancers, ChiCTR1800020329. Registered 24 December 2018—Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=31813 Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03696-x.
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Affiliation(s)
- Bingdong Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China.,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Yuerui Li
- Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.,Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Yongbing Chen
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China. .,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China. .,Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China.
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18
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Munoz N, Litchford M, Cereda E. Nutrition and Wound Care. Phys Med Rehabil Clin N Am 2022; 33:811-822. [DOI: 10.1016/j.pmr.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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19
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Prospective observational cohort study of reached protein and energy targets in general wards during the post-intensive care period: The PROSPECT-I study. Clin Nutr 2022; 41:2124-2134. [DOI: 10.1016/j.clnu.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/21/2022]
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20
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Dubé MD, Rothfusz CA, Emara AK, Hadad M, Surace P, Krebs VE, Molloy RM, Piuzzi NS. Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management. Curr Rev Musculoskelet Med 2022; 15:311-322. [PMID: 35501548 DOI: 10.1007/s12178-022-09762-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW 8.5 to 50% of total joint arthroplasty (TJA) patients are reported to have preoperative malnutrition. The narrative review identifies the relationship between preoperative malnutrition for TJA patients and postoperative outcomes as well as the use of perioperative nutritional intervention to improve postoperative complications. RECENT FINDINGS Biochemical/laboratory, anthropometric, and clinical measures have been widely used to identify preoperative nutritional deficiency. Specifically, serum albumin is the most prevalent used marker in TJA because it has been proven to be correlated with protein-energy malnutrition due to the surgical stress response. However, there remains a sustained incidence of preoperative malnutrition in total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients due to a lack of agreement among the available nutritional screening tools and utilization of isolated laboratory, anthropometric, and clinical variables. Previous investigations have also suggested preoperative malnutrition to be a prognostic indicator of complications in general, cardiac, vascular, and orthopaedic surgery specialties. Serum albumin, prealbumin, transferrin, and total lymphocyte count (TLC) can be used to identify at-risk patients. It is important to employ these markers in the preoperative setting because malnourished TKA and THA patients have shown to have worse postoperative outcomes including prolonged length, increased reoperation rates, increased infection rates, and increased mortality rates. Although benefits from high-protein and high-anti-inflammatory diets have been exhibited, additional research is needed to confirm the use of perioperative nutritional intervention as an appropriate treatment for preoperative TJA patients.
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Affiliation(s)
- Michael D Dubé
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | | | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Matthew Hadad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Peter Surace
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Phase Angle Is a Stronger Predictor of Hospital Outcome than Subjective Global Assessment-Results from the Prospective Dessau Hospital Malnutrition Study. Nutrients 2022; 14:nu14091780. [PMID: 35565747 PMCID: PMC9100773 DOI: 10.3390/nu14091780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
This prospective cohort study of 16,943 consecutive patients compared phase angle (PhA, foot-to-hand at 50 kHz) and subjective global assessment (SGA) to predict outcomes length of hospital stay (LOS) and in-hospital mortality in patients at risk of malnutrition (NRS-2002 ≥ 3). In 1505 patients, the independent effects on LOS were determined by competing risk analysis and on mortality by logistic regression. In model I, including influence factors age, sex, BMI, and diagnoses, malnourished (SGA B and C) patients had a lower chance for a regular discharge (HR 0.74; 95%CI 0.69−0.79) and an increased risk of mortality (OR 2.87; 95%CI 1.38−5.94). The association of SGA and outcomes regular discharge and mortality was completely abrogated when PhA was added (model II). Low PhA reduced the chance of a regular discharge by 53% in patients with a PhA ≤ 3° (HR 0.47; 95%CI 0.39−0.56) as compared to PhA > 5°. Mortality was reduced by 56% for each 1° of PhA (OR 0.44; 95%CI 0.32−0.61). Even when CRP was added in model III, PhA ≤ 3° was associated with a 41% lower chance for a regular discharge (HR 0.59; 95%CI 0.48−0.72). In patients at risk of malnutrition, the objective measure PhA was a stronger predictor of LOS and mortality than SGA.
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22
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Recent and current low food intake – prevalence and associated factors in hospital patients from different medical specialities. Eur J Clin Nutr 2022; 76:1440-1448. [PMID: 35411028 PMCID: PMC9550619 DOI: 10.1038/s41430-022-01129-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Background/Objectives Poor food intake is a major etiological factor of malnutrition. This research aims to describe the prevalence of recent and current low food intake (LIRC) and to identify factors associated with LIRC in adult hospital patients from different medical specialities. Subject/Methods 1865 patients participating in the nutritionDay survey 2016–2020 in Germany were included. LIRC was defined by decreased eating both on nutritionDay and in the week before hospitalisation. Multivariate binary logistic regression was used to identify factors associated with LIRC overall and in different specialities. Results LIRC was observed in 21.1% of all patients, with the highest prevalence in Gastroenterology (26.6%) and the lowest in Neurology (11.2%). Weight loss within three months before nutritionDay (OR 2.62 [95% CI 1.93–3.56]), (very) poor self-rated health (2.17 [1.62–2.91]), female sex (1.98 [1.50–2.61]), uncertain weight loss (1.90 [1.03–3.51]), digestive disease (1.90 [1.40–2.56]), inability to walk without assistance (1.55 [1.14–2.12]) and emergency admission (1.38 [1.02–1.86]) were associated with increased risk, cardiac insufficiency (0.55 [0.37–0.83]) and being in a neurological ward (0.51 [0.28–0.92]) with decreased risk in the total sample. In Gastroenterology and Oncology, estimates were higher than in the entire sample; no significant associations were found in Neurology and Geriatrics, presumably due to the low prevalence of LIRC in Neurology and limited data quality in Geriatrics. Conclusion LIRC is common in German hospital patients and associated with female sex, poor health and decreased functional status. Interdisciplinary differences suggest a discipline-specific approach to dealing with malnutrition.
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Malnutrition Increases Hospital Length of Stay and Mortality among Adult Inpatients with COVID-19. Nutrients 2022; 14:nu14061310. [PMID: 35334967 PMCID: PMC8949069 DOI: 10.3390/nu14061310] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 12/18/2022] Open
Abstract
Background: Malnutrition has been linked to adverse health economic outcomes. There is a paucity of data on malnutrition in patients admitted with COVID-19. Methods: This is a retrospective cohort study consisting of 4311 COVID-19 adult (18 years and older) inpatients at 5 Johns Hopkins-affiliated hospitals between 1 March and 3 December 2020. Malnourishment was identified using the malnutrition universal screening tool (MUST), then confirmed by registered dietitians. Statistics were conducted with SAS v9.4 (Cary, NC, USA) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters, while accounting for possible covariates in regression analysis predicting mortality or the log-transformed length of stay. Results: COVID-19 patients who were older, male, or had lower BMIs had a higher likelihood of mortality. Patients with malnutrition were 76% more likely to have mortality (p < 0.001) and to have a 105% longer hospital length of stay (p < 0.001). Overall, 12.9% (555/4311) of adult COVID-19 patients were diagnosed with malnutrition and were associated with an 87.9% increase in hospital length of stay (p < 0.001). Conclusions: In a cohort of COVID-19 adult inpatients, malnutrition was associated with a higher likelihood of mortality and increased hospital length of stay.
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Emara AK, Hadad MJ, Dube M, Klika AK, Burguera B, Piuzzi NS. Team Approach: Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty. JBJS Rev 2022; 10:01874474-202203000-00001. [PMID: 35230998 DOI: 10.2106/jbjs.rvw.21.00138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Nutritional assessment is a critical element of routine preoperative assessment and should be approached by an interdisciplinary team that involves the primary care physician, dietitian, and orthopaedist. » Patients should be stratified on the basis of their nutritional risk, which influences downstream optimization and deficiency reversal. » The scientific literature indicates that nutritional supplementation affords protection against adverse outcomes and helps functional recovery, even among patients who are not at nutritional risk. » Published investigations recommend a sufficient preoperative interval (at least 4 weeks) to ensure an adequate nutritional intervention in malnourished patients as opposed to regarding them as nonsurgical candidates.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew J Hadad
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael Dube
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Northeast Ohio Medical University, Rootstown, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bartolome Burguera
- Department of Endocrinology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Tobberup R, Jager-Wittenaar H, Sørensen J, Kopp LHP, Svarstad P, Sætre P, Ottery FD. Translation and cultural adaptation of the scored Patient-Generated Subjective Global Assessment (PG-SGA©). Clin Nutr ESPEN 2022; 47:215-220. [PMID: 35063204 DOI: 10.1016/j.clnesp.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIM The Patient-Generated Subjective Global Assessment (PG-SGA©) is a globally used malnutrition screening, assessment, triage and monitoring tool. The aim of this study was to perform a linguistic and content validation of the translated and culturally adapted version of the PG-SGA for the Danish setting. METHOD The study was conducted according to the International Society of Pharmaeconomics and Outcomes Research (ISPOR) Principles of Good Practice for the Translational and Cultural Adaptation Process for Patient-Reported Outcomes Measures. Cancer patients (n = 121) and healthcare professionals (HCPs, n = 80) participated in the cognitive debriefing. A questionnaire was used in the cognitive debriefing in which comprehensibility, difficulty, and content validity (relevance) were quantified by a 4-point scale. Item and scale indices were calculated using the average item ratings divided by the number of respondents for content validity (Item-CVI, Scale-CVI), comprehensibility (Item-CI, Scale-CI) and difficulty (Item-DI, Scale-DI). As pre-defined, item indices <0.78 required further analysis of the item, and scale indices ≥0.90 were defined as excellent and 0.80-0.89 as acceptable. RESULTS The patient component of the PG-SGA was rated as excellent content validity (Scale-CVI = 0.95) by HCPs and easy to comprehend (Scale-CI = 0.97) and use (Scale-DI = 0.92) by patients. The professional component of the PG-SGA was rated as acceptable content validity (Scale-CVI = 0.80), but below acceptable for comprehension (Scale-CI = 0.71) and difficulty (Scale-DI = 0.69). The physical exam was rated the least comprehensible Item-CI = 0.51-0.70) and most difficult (Item-DI = 0.33-0.063). CONCLUSION The PG-SGA was successfully translated and culturally adapted to the Danish setting. Patients found it easy to understand and to complete. Except for the physical exam, HCPs rated the PG-SGA as relevant, comprehensive, and easy to use. Training of HCPs is recommended before implementing the tool into clinical practise.
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Affiliation(s)
- Randi Tobberup
- Center for Nutrition and Bowel Failure, Aalborg University Hospital, Aalborg, Denmark.
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands; Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jonas Sørensen
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Luise H P Kopp
- Department of Quality and Development, Division of Adult and Health, Haderslev Municipality, Haderslev, Denmark
| | - Pernille Svarstad
- Center for Nutrition and Bowel Failure, Aalborg University Hospital, Aalborg, Denmark
| | - Pia Sætre
- Center for Nutrition and Bowel Failure, Aalborg University Hospital, Aalborg, Denmark
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de Cáceres C, Rico T, Abreu C, Velasco AI, Lozano R, Lozano MC. Caloric adequacy of parenteral nutrition and its influence on the clinical outcome of hospitalised patients. Nutr Health 2022; 29:277-285. [PMID: 35023408 DOI: 10.1177/02601060211070108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background: The adaptation of Parenteral Nutrition (PN) to actual energy requirements of hospitalised patients is essential, since excessive and insufficient nutritional intake have been associated with poor clinical outcomes. Aim: To evaluate the adaptation of prescribed PN to the estimated nutritional requirements using three predictive equations and the influence of excessive/insufficient nutrient intake on patient clinical outcomes (nutritional parameters, metabolic and infectious complications). Methods: Prospective, observational study in hospitalised patients nutritionally assessed. Data was collected the first and fifth/sixth day of PN with clinical (infection, length of hospital stay), biochemical (visceral proteins, cholesterol, glucose, triglycerides, lymphocytes, CRP) and anthropometric parameters (skin folds, height, weight). Theoretical requirements were calculated using Harris-Benedict (HB), Mifflin-St Jeor (MF) and 25 Kcal/Kg/day formulas. The HB formula was used to compare estimated and provided requirements. Results: A total of 94 patients (mean: 72 ± 13.7 years old) were included with initial mean weight and height of 69.2 Kg and 162.8 cm, respectively (mean BMI: 26.1 Kg/m2). No statistically significant differences were found between the actual (1620 Kcal/day) and estimated caloric mean calculated with HB (1643 Kcal/day) and MF (1628 Kcal/day). When comparing with the caloric estimation, 31.9% of patients were underfed, while 14.9% were overfed. Intergroup analysis demonstrated significant variations in albumin, prealbumin, glucose, cholesterol, triglycerides and MUAC, with a significant increase of hyperglycaemia (+37.86; p < 0.05) and hypertriglyceridemia (+63.10; p < 0.05), being higher in overfed patients. Conclusion: In our study, inadequate nutrient intake was associated with a higher degree of hyperglycaemia and hypertriglyceridemia, without positive impact on anthropometric parameters.
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Affiliation(s)
- Carmen de Cáceres
- Pharmacy Department, 222051Hospital General de Segovia, Segovia, Spain
| | - Teresa Rico
- Pharmacy Department, 222051Hospital General de Segovia, Segovia, Spain
| | - Cristina Abreu
- Endocrinology and Nutrition Service, 222051Hospital General de Segovia, Segovia, Spain
| | | | - Rafael Lozano
- 73076Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
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Guenter P, Blackmer A, Malone A, Mirtallo JM, Phillips W, Tyler R, Barrocas A, Resnick HE, Anthony P, Abdelhadi R. Update on use of enteral and parenteral nutrition in hospitalized patients with a diagnosis of malnutrition in the United States. Nutr Clin Pract 2022; 37:94-101. [PMID: 35025121 DOI: 10.1002/ncp.10827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Malnutrition continues to be associated with outcomes in hospitalized patients. METHODS An updated review of national data in patients with a coded diagnosis of malnutrition (CDM) and the use of nutrition support (enteral nutrition [EN] and parenteral nutrition [PN]) was conducted using the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project and Medicare Claims data. RESULTS Results demonstrated a growing trend in CDM accompanied by continued low utilization of PN and EN. CONCLUSION Underutilization of nutrition support may be due to product shortages, reluctance of clinicians to use these therapies, undercoding of nutrition support, strict adherence to published guidelines, and other factors.
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Affiliation(s)
- Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | - Allison Blackmer
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | - Jay M Mirtallo
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | | | - Renay Tyler
- University of Maryland Medical Center, Baltimore, MD, USA
| | | | | | - Pat Anthony
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | - Ruba Abdelhadi
- University of Kansas School of Medicine, Kansas City, MO, USA
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Process of medical nutrition therapy. NUTR HOSP 2022; 39:1166-1189. [DOI: 10.20960/nh.04265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Thibault R, Abbasoglu O, Ioannou E, Meija L, Ottens-Oussoren K, Pichard C, Rothenberg E, Rubin D, Siljamäki-Ojansuu U, Vaillant MF, Bischoff SC. ESPEN guideline on hospital nutrition. Clin Nutr 2021; 40:5684-5709. [PMID: 34742138 DOI: 10.1016/j.clnu.2021.09.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 12/16/2022]
Abstract
In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.
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Affiliation(s)
- Ronan Thibault
- Unité de Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer Institute, NuMeCan, Rennes, France.
| | - Osman Abbasoglu
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elina Ioannou
- Department of Nutrition, Limassol General Hospital, Cyprus
| | - Laila Meija
- Riga Stradins University, Pauls Stradins Clinical University Hospital, Latvia
| | - Karen Ottens-Oussoren
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
| | - Claude Pichard
- Unité de Nutrition, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Elisabet Rothenberg
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden, Sweden
| | - Diana Rubin
- Vivantes Netzwerk für Gesundheit GmbH, Humboldt Klinikum und Klinikum Spandau, Berlin, Germany
| | | | | | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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Poudineh S, Shayesteh F, Kermanchi J, Haghdoost AA, Torabi P, Pasdar Y, Azimi-Nezhad M, Safarian M, Hajifaraji M, Eslami-Hasan-Abadi S, Pournik O, Barkhidarian B, Norouzy A. A multi-centre survey on hospital malnutrition: result of PNSI study. Nutr J 2021; 20:87. [PMID: 34706721 PMCID: PMC8555146 DOI: 10.1186/s12937-021-00741-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Disease-related malnutrition is associated with adverse outcomes such as increased rates of morbidity and mortality, prolonged hospital stay, and extra costs of health care. This study was conducted to assess nutritional status among patients and to determine the risk factors for malnutrition in Iran university f. Methods Persian Nutritional Survey In Hospitals (PNSI) was a cross-sectional study that conducted in 20 university hospitals across Iran. All the patients with age range of 18 to 65 years, who were admitted or discharged, were assessed by subjective global assessment (SGA). Results In total, 2109 patients were evaluated for malnutrition. Mean values of age and body mass index were 44.68 ± 14.65 years and 25.44 ± 6.25 kg/m2, respectively. Malnutrition (SGA-B & C) was identified in 23.92% of the patients, 26.23 and 21% of whom were among the admitted and discharged patients, respectively. The highest prevalence of malnutrition was in burns (77.70%) and heart surgery (57.84%) patients. Multivariate analysis presented male gender (OR = 1.02, P < 0.00), malignant disease (OR = 1.40, P < 0.00), length of hospital stay (OR = 1.20, P < 0.00), and polypharmacy (OR = 1.06, P < 0.00) as independent risk factors for malnutrition. Malnutrition was not associated with age (P = 0.10). Conclusion This study provides an overall and comprehensive illustration of hospital malnutrition in Iran university hospitals, finding that one out of four patients were malnourished; thus, appropriate consideration and measures should be taken to this issue. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00741-1.
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Affiliation(s)
- Somayeh Poudineh
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, P.O. Box: 91779-48464, Pardise Daneshghah, Azadi Square, Mashhad, Iran
| | - Forough Shayesteh
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, P.O. Box: 91779-48464, Pardise Daneshghah, Azadi Square, Mashhad, Iran
| | | | - Ali-Akbar Haghdoost
- Department of Biostatics and Epidemiology, Public Health School, Kerman University of Medical Sciences, Kerman, Iran
| | - Parisa Torabi
- Ministry of Medical and Health Education, Tehran, Iran
| | - Yahya Pasdar
- Department of Nutritional Sciences, Health Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Azimi-Nezhad
- Department of Basic Medical Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohammad Safarian
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, P.O. Box: 91779-48464, Pardise Daneshghah, Azadi Square, Mashhad, Iran
| | - Majid Hajifaraji
- National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Omid Pournik
- Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Barkhidarian
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, P.O. Box: 91779-48464, Pardise Daneshghah, Azadi Square, Mashhad, Iran
| | - Abdolreza Norouzy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, P.O. Box: 91779-48464, Pardise Daneshghah, Azadi Square, Mashhad, Iran.
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Bernstein A, Moore R, Rhee L, Aronson D, Katz D. A digital dietary assessment tool may help identify malnutrition and nutritional deficiencies in hospitalized patients. RESEARCH IDEAS AND OUTCOMES 2021. [DOI: 10.3897/rio.7.e70642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Malnutrition is common among hospitalized patients and associated with longer hospital stays, higher rates of rehospitalization, and increased mortality. Validated questionnaires of varying sensitivity and specificity to help identify patients at risk of malnutrition have been developed, but none has been broadly adopted. Tools to identify patients at risk for malnutrition should be quick, inexpensive, easy to administer and use, not require specialized nutrition knowledge, and provide results which can be entered into an electronic medical record; ideally, the tool should be deployed within 24 hours of admission and repeated if warranted. We hypothesize that a novel digital nutrition assessment tool which uses the Diet Quality Photo Navigation (DQPN) method, can help triage hospitalized patients toward further evaluation of nutritional status. We further propose that micronutrient deficiencies may be identified at the same time as malnutrition and that the reimbursement and cost savings from DQPN will prove substantially greater than the combined costs of its use and triggered dietitian consult. Deploying DQPN upon admission will represent an addition to standard hospital intake procedure that is frictionless for patients and health professionals, and one which may be overseen by clerical rather than clinical staff. The digital format of DQPN, which can be integrated into electronic medical records, will facilitate easier tracking and management of nutritional status over the course of hospitalization and post-discharge. To evaluate the hypotheses, DQPN will be deployed in a hospital setting to a group of patients who will also be seen by a registered dietitian to assess the nutritional status of each patient. Receiver operating characteristic curves will determine the point, or criterion, at which maximal true positivity rate and least false positivity rate for a diagnosis of malnutrition and specific nutrient deficiencies align. The study cohort will also be compared to a matched historical cohort to compare total medical spend and reimbursement between the intervention cohort and matched control. Testing of these hypotheses will thus allow for insight into whether DQPN may be used to identify malnutrition and nutrient deficiencies in hospitalized patients and, in so doing, improve patient outcomes, reduce healthcare utilization, and bring financial benefit to hospitals.
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Correia MITD, Sulo S, Brunton C, Sulz I, Rodriguez D, Gomez G, Tarantino S, Hiesmayr M. Prevalence of malnutrition risk and its association with mortality: nutritionDay Latin America survey results. Clin Nutr 2021; 40:5114-5121. [PMID: 34461585 DOI: 10.1016/j.clnu.2021.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes. METHODS On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay. RESULTS The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P < 0.001) for patients eating one-quarter of their meal (compared with those who ate the full meal), increasing to 6.6 (95% CI [5.02, 8.7]; P < 0.0001) for patients who ate none of the food offered. CONCLUSIONS Based on compilation of nDay surveys throughout Latin America, 2 of every 5 hospitalized patients were at risk for malnutrition. The associated risk for hospital mortality was up to 6-fold higher among patients who ate little or none of their meal on nDay. This high prevalence showed scant improvement over rates two decades ago-a compelling rationale for new focus on nutrition education and training of professionals in acute care settings.
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Affiliation(s)
- M Isabel T D Correia
- Department of Surgery, Universidade Federal de Minas Gerais Medical School, Belo Horizonte, Brazil
| | | | | | - Isabella Sulz
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems Medical University Vienna, Vienna, Austria
| | - Dolores Rodriguez
- Clinical Nutrition Department, SOLCA Cancer Hospital, Guayaquil, Ecuador
| | | | - Silvia Tarantino
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems Medical University Vienna, Vienna, Austria
| | - Michael Hiesmayr
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems Medical University Vienna, Vienna, Austria
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Putting the 2019 Nutrition Recommendations for Pressure Injury Prevention and Treatment into Practice. Adv Skin Wound Care 2021; 33:462-468. [PMID: 32810059 DOI: 10.1097/01.asw.0000688412.05627.96] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
GENERAL PURPOSE To explore the changes in the National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Clinical Practice Guideline for Prevention and Treatment of Pressure Ulcers/Injuries (CPG) nutrition recommendations and strategies for implementation. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Synthesize the current evidence regarding nutrition approaches to medical conditions, including pressure injury prevention and treatment.2. Summarize the changes and recommendations in the 2019 edition of the CPG. ABSTRACT Healthy diets provide essential nutrients needed to maintain healthy skin and prevent or manage pressure injuries. The 2019 Clinical Practice Guideline for Prevention and Treatment of Pressure Ulcers/Injuries published by the National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance includes specific nutrition recommendations for patients with pressure injuries. The purpose of this CE/CME article is to explore the changes in the nutrition recommendations and strategies for implementation.
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Schuetz P, Sulo S, Walzer S, Vollmer L, Brunton C, Kaegi-Braun N, Stanga Z, Mueller B, Gomes F. Cost savings associated with nutritional support in medical inpatients: an economic model based on data from a systematic review of randomised trials. BMJ Open 2021; 11:e046402. [PMID: 34244264 PMCID: PMC8273448 DOI: 10.1136/bmjopen-2020-046402] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Nutritional support improves clinical outcomes during hospitalisation as well as after discharge. Recently, a systematic review of 27 randomised, controlled trials showed that nutritional support was associated with lower rates of hospital readmissions and improved survival. In the present economic modelling study, we sought to determine whether in-hospital nutritional support would also return economic benefits. METHODS The current economic model applied cost estimates to the outcome results from our recent systematic review of hospitalised patients. In the underlying meta-analysis, a total of 27 trials (n=6803 patients) were included. To calculate the economic impact of nutritional support, a Markov model was developed using transitions between relevant health states. Costs were estimated accounting for length of stay in a general hospital ward, hospital-acquired infections, readmissions and nutritional support. Six-month mortality was also considered. The estimated daily per-patient cost for in-hospital nutrition was US$6.23. RESULTS Overall costs of care within the model timeframe of 6 months averaged US$63 227 per patient in the intervention group versus US$66 045 in the control group, which corresponds to per patient cost savings of US$2818. These cost savings were mainly due to reduced infection rate and shorter lengths of stay. We also calculated the costs to prevent a hospital-acquired infection and a non-elective readmission, that is, US$820 and US$733, respectively. The incremental cost per life-day gained was -US$1149 with 2.53 additional days. The sensitivity analyses for cost per quality-adjusted life day provided support for the original findings. CONCLUSIONS For medical inpatients who are malnourished or at nutritional risk, our findings showed that in-hospital nutritional support is a cost-effective way to reduce risk for readmissions, lower the frequency of hospital-associated infections, and improve survival rates.
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Affiliation(s)
- Philipp Schuetz
- Internal Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- University of Basel, Basel, Swizerland
| | - Suela Sulo
- Abbott Nutrition, Abbott Park, Illinois, USA
| | - Stefan Walzer
- MArS Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany
- State University Baden-Weurttemberg, Lörrarch, germany
- Weingarten University of Applied Sciences, Weingarten, Germany
| | - Lutz Vollmer
- MArS Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany
| | | | | | - Zeno Stanga
- Inselspital Universitatsspital Bern, Bern, BE, Switzerland
| | - Beat Mueller
- Internal Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Filomena Gomes
- Internal Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- The New York Academy of Sciences, New York city, New York, USA
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
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Hong K, Sulo S, Wang W, Kim S, Huettner L, Taroyan R, Kerr KW, Kaloostian C. Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs. J Prim Care Community Health 2021; 12:21501327211017014. [PMID: 34009072 PMCID: PMC8138290 DOI: 10.1177/21501327211017014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background and Objectives: Over 25% of United States (US) community-dwelling, older adults are at
nutritional risk. Health and cost burdens of poor nutrition can be lowered
by nutrition programs for hospital inpatients, but few studies have looked
at the impact on outpatients. The objective of our study was to assess
outcomes of a nutrition focused quality improvement program (QIP) on
healthcare resource use and costs in poorly nourished outpatients. Methods: This pre-post QIP study was implemented at 3 US healthcare system clinics.
Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions,
and were enrolled over a 15-month interval. For comparison, historical
(n = 600) and concurrent control (n = 600) groups were used. Assessment of
poor nutritional status was performed during each patient’s baseline visit.
Healthcare resource use (hospitalizations, emergency department visits, and
outpatient clinic visits), medication use, and costs were determined for a
90-day interval. Results: QIP patients (mean age 61.6 years) were predominantly female (62.5%) and
overweight/obese (81.7%). The proportion of QIP outpatients presenting for
healthcare services was significantly reduced compared to both historical
and concurrent controls—relative risk reduction (RRR) versus historical
(11.6%, P < .001) and versus concurrent (8.9%,
P = .003). Of those who presented, RRR for healthcare
resource use by QIP was significant in comparison with historical (12.9%,
P = .022) but not concurrent controls. No significant
differences were observed for medication usage. Lower resource use among QIP
patients yielded total cost savings of $290 923 or per-patient savings of
$485. Conclusions: Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare
resource use and cut costs. Such findings underscore benefits of nutritional
interventions for community-dwelling outpatients with poor nutritional
status.
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Affiliation(s)
- Kurt Hong
- University of Southern California, Los Angeles, CA, USA
| | - Suela Sulo
- Abbott Laboratories, Abbott Park, IL, USA
| | - William Wang
- University of Southern California, Los Angeles, CA, USA
| | - Susan Kim
- University of Southern California, Los Angeles, CA, USA
| | | | - Rose Taroyan
- University of Southern California, Los Angeles, CA, USA
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36
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Anghel S, Kerr KW, Valladares AF, Kilgore KM, Sulo S. Identifying patients with malnutrition and improving use of nutrition interventions: A quality study in four US hospitals. Nutrition 2021; 91-92:111360. [PMID: 34274654 DOI: 10.1016/j.nut.2021.111360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated how specific nutrition interventions were implemented at four US hospitals, compared rates of malnutrition diagnosis and assessment between physicians and registered dietitian nutritionists (RDNs), and examined how these differences affected the nutrition intervention received during patients' hospital stay. METHODS Data on patients' nutrition status and nutrition interventions were collected from 16 669 hospital inpatient records. Data on intervention utilization for patients with differing nutrition assessments and diagnoses from different health care practitioners were compared using descriptive statistics and χ2 tests. RESULTS The study found high levels of agreement between physician diagnosis and RDN assessment of malnutrition (88%). Much of this agreement related to patients identified as not malnourished. Of patients identified as malnourished by either physician diagnosis or RDN assessment, agreement was reached in 55.5% of patients. Less than half (46.3%) of patients identified as malnourished had a documented nutrition intervention. Oral nutritional supplements (ONS) were the most commonly used intervention, with 5.1% of patients receiving them. Patients identified as malnourished by physician diagnosis, but not by RDN assessment, were more likely to receive enteral and parenteral nutrition. Patients identified as malnourished by RDN assessment, but not by physician diagnosis, were more likely to have received ONS, meals and snacks, counseling, and food/nutrition-related medication management. CONCLUSION The high level of agreement on assessment and malnutrition diagnosis suggests positive levels of malnutrition care coordination at the study hospitals. However, significant room for improvement exists in providing interventions to inpatients diagnosed with malnourishment. Differences in interventions may reflect dissimilar approaches commonly used by different practitioners and should be a topic of future study.
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Affiliation(s)
- Sharen Anghel
- Overlook Medical Center, Atlantic Health System, Summit, New Jersey, United States
| | - Kirk W Kerr
- Abbott Nutrition, Columbus, Ohio, United States.
| | | | | | - Suela Sulo
- Abbott Nutrition, Columbus, Ohio, United States
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37
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da Silva TA, Gomes MMA, Generoso SDV, Correia MITD. Critical analysis of factors affecting the efficiency of nutrition therapy teams. Clin Nutr ESPEN 2021; 44:397-401. [PMID: 34330496 DOI: 10.1016/j.clnesp.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/06/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nutrition therapy (NT), defined as the provision of oral, enteral, or parenteral nutrition, should be considered a part of the holistic approach to patient care, while quality assessment of its practices is crucial. The present study aimed to identify variables capable of explaining the reason behind compliance of NTTs with the regulatory requirements. METHODS A cross-sectional study focused on assessing the quality of nutritional therapy practices among NTTs who previously stated to be able to comply with requirements of the Brazilian law versus those who were not able to meet these demands. Hospitals were classified as A (teams that had previously reported to be able to meet the requirements) and B (those unable to comply with them). The study was approved by the ethics committees of all participant institutions. RESULTS Twenty six hospitals met the inclusion criteria. The main hospital features, such as size, classification, service type, and percentage of hospitals providing NT were similar. Hospitals differed on the median number of patients undergoing NT per week: in group B (41.0; IR = 28.0-58.0) and group A (11.0; IR = 5.0-48.0) (p < 0.05), but there were no differences regarding personnel expertise. Both hospital groups had low quality control of the NT processes. CONCLUSION Lack of quality assurance is responsible for the inadequate services in both type of institutions.
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Affiliation(s)
- Thales Antônio da Silva
- Pharmacy School, Food of Science Program, Universidade Federal de Minas Gerais, Antônio Carlos Avenue, 6627, Pampulha, 31270-901, Belo Horizonte, MG, Brazil
| | - Mel Mariá Assunção Gomes
- Nursing School, Department of Nutrition, Nutrition and Health Program, Universidade Federal de Minas Gerais, Professor Alfredo Balena Avenue, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Simone de Vasconcelos Generoso
- Nursing School, Department of Nutrition, Nutrition and Health Program, Universidade Federal de Minas Gerais, Professor Alfredo Balena Avenue, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Maria Isabel Toulson Davisson Correia
- Medical School, Department of Surgery, Universidade Federal de Minas Gerais, Professor Alfredo Balena Avenue, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.
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38
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical Nutrition and Human Rights. An International Position Paper. Nutr Clin Pract 2021; 36:534-544. [PMID: 34013590 DOI: 10.1002/ncp.10667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogota, Colombia
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, Tours, France
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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39
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical nutrition and human rights. An international position paper. Clin Nutr 2021; 40:4029-4036. [PMID: 34023070 DOI: 10.1016/j.clnu.2021.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, El Bosque University, Bogotá, Colombia.
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, LA, USA.
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand.
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica Del Country, Bogota, Colombia.
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de La Universidad de Chile, Santiago, Chile.
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, France.
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
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40
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Paulsen MM, Varsi C, Andersen LF. Process evaluation of the implementation of a decision support system to prevent and treat disease-related malnutrition in a hospital setting. BMC Health Serv Res 2021; 21:281. [PMID: 33766017 PMCID: PMC7995565 DOI: 10.1186/s12913-021-06236-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Malnutrition is present in 30% of hospitalized patients and has adverse outcomes for the patient and the healthcare system. The current practice for nutritional care is associated with many barriers. The MyFood decision support system was developed to prevent and treat malnutrition. Methods This paper reports on a process evaluation that was completed within an effectiveness trial. MyFood is a digital tool with an interface consisting of an app and a website. MyFood includes functions to record and evaluate dietary intake. It also provides reports to nurses, including tailored recommendations for nutritional treatment. We used an effectiveness-implementation hybrid design in a randomized controlled trial. The RE-AIM (Reach, Efficiency, Adoption, Implementation, Maintenance) framework was used to perform a process evaluation alongside the randomized controlled trial, using a combination of quantitative and qualitative methods. An implementation plan, including implementation strategies, was developed to plan and guide the study. Results Reach: In total, 88% of eligible patients consented to participate (n = 100). Adoption: Approximately 75% of the nurses signed up to use MyFood and 50% used the reports. Implementation: MyFood empowered the patients in their nutritional situation and acted as a motivation to eat to reach their nutritional target. The compliance of using MyFood was higher among the patients than the nurses. A barrier for use of MyFood among the nurses was different digital systems which were not integrated and the log-in procedure to the MyFood website. Despite limited use by some nurses, the majority of the nurses claimed that MyFood was useful, better than the current practice, and should be implemented in the healthcare system. Conclusions This study used a process evaluation to interpret the results of a randomized controlled trial more in-depth. The patients were highly compliant, however, the compliance was lower among the nurses. MyFood empowered the patients in their nutritional situation, the usability was considered as high, and the experiences and attitudes towards MyFood were primarily positive. Focus on strategies to improve the nurses’ compliance may in the future improve the MyFood system’s potential. Trial registration The trial was registered in ClinicalTrials.gov 26/01/2018 (NCT03412695). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06236-3.
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Affiliation(s)
- Mari Mohn Paulsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, box 1110 Blindern, 0317, Oslo, Norway. .,National Advisory Unit on Disease-related Undernutrition, Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - Cecilie Varsi
- Center for Digital Health Research, Oslo University Hospital, Division of Medicine, Aker hospital, box 4959 Nydalen, 0424, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, box 1110 Blindern, 0317, Oslo, Norway
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41
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Latif J, Dabbous M, Weekes CE, Baldwin C. The effectiveness of trained volunteer delivered interventions in adults at risk of malnutrition: A systematic review and meta-analysis. Clin Nutr 2021; 40:710-727. [DOI: 10.1016/j.clnu.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 01/07/2023]
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42
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Cardenas D, Bermúdez C, Pérez A, Diaz G, Cortés LY, Contreras CP, Pinzón-Espitia OL, Gómez G, González MC, Fantin R, Gutierrez J, Sulz I, Tarantino S, Hiesmayr M. Are traditional screening tools adequate for monitoring the nutrition risk of in-hospital patients? An analysis of the nutritionDay database. JPEN J Parenter Enteral Nutr 2021; 46:83-92. [PMID: 33554364 DOI: 10.1002/jpen.2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status. METHODS We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores. RESULTS A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87). CONCLUSIONS This is the first large-scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in-hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogota, Colombia
| | - Charles Bermúdez
- Surgery Department, Clínica La Colina and Clínica del Country, Bogota, Colombia
| | | | - Gustavo Diaz
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogota, Colombia
| | - Lilia Yadira Cortés
- Nutrition and Biochemistry Department, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Olga Lucía Pinzón-Espitia
- Facultad de Medicina, Departamento de Nutrición Humana, Universidad Nacional de Colombia, Hospital Universitario Mayor-Méderi, Universidad del Rosario, Bogota, Colombia
| | - Gabriel Gómez
- Surgery Department, Clínica del Country, Bogota, Colombia
| | - Maria Cristina González
- Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Romain Fantin
- School of Medicine and School of Public Health, Faculty of Medicine, Universidad de Costa Rica, San José, Costa Rica
| | - José Gutierrez
- Nutritional Support Unit, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Isabella Sulz
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Silvia Tarantino
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Hiesmayr
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
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43
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Celik ZM, Islamoglu AH, Sabuncular G, Toprak HS, Gunes FE. Evaluation of malnutrition risk of inpatients in a research and training hospital: A cross-sectional study. Clin Nutr ESPEN 2021; 41:261-267. [PMID: 33487274 DOI: 10.1016/j.clnesp.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS Malnutrition is one of the most important factors affecting the prognosis of inpatients. The aim of this study is to determine the malnutrition risk of hospitalized patients and to examine the relationship between the presence of malnutrition and other parameters. METHODS The study included 162 inpatients over the age of 25 who were staying in the hospital's internal medicine service for 7 days or more and who volunteered to participate in the study. A demographic-information questionnaire, consisting of 5 sections, a 24-h food recall record, NRS-2002, NRI and Beck Depression Inventory was given to patients during bedside interviews. After obtaining the necessary permission, the anthropometric measurements and biochemical parameter values of the patients were taken from their files. All statistical analyzes were performed by researchers with the SPSS package program. RESULTS Of 162 patients (48.8% female, 51.2% male), 24.7% were at risk for malnutrition according to NRS-2002 and 66.7% of the patients were not depressive, based on the Beck Depression Inventory scale. The malnutrition risk was higher (60.0%) in patients who had been hospitalized for more than 15 days (p = 0.010). The majority of those with malnutrition had no problems preventing them from eating (32.5%), were found to be not depressive (52.5%) and were in the normal range of body mass index (57.5%) (p = 0.002, p = 0.034, p = 0.001; respectively). Nutrient intake was lower in patients with a higher malnutrition risk, but the difference was insignificant (p > 0.05). Albumin levels (p = 0.028) and total protein levels (p = 0.015) were significantly lower in patients who were at risk of malnutrition. While overweight patients showed higher levels of serum albumin (p < 0.001), CRP levels were found to be lower in overweight patients (p < 0.001). CONCLUSIONS It was found that the majority of patients with malnutrition were in the normal range for BMI. Nutritional intake and biochemical parameters should be followed closely in patients who are at risk of malnutrition. Depression can be a cause for insufficient nutrition and should be evaluated, particularly in patients whose length of hospital stay is greater than 7 days.
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Affiliation(s)
- Zehra Margot Celik
- Marmara University, Faculty of Health Sciences, Department of Nutrition and Dietetics Istanbul, Turkey.
| | - Ayse Humeyra Islamoglu
- Marmara University, Faculty of Health Sciences, Department of Nutrition and Dietetics Istanbul, Turkey.
| | - Guleren Sabuncular
- Marmara University, Faculty of Health Sciences, Department of Nutrition and Dietetics Istanbul, Turkey.
| | - Hatice Selcen Toprak
- Ministry of Health, University of Health Sciences Sultan Abdulhamid Han Training and Research Hospital, 34718, Kadıköy, Istanbul, Turkey.
| | - Fatma Esra Gunes
- Marmara University, Faculty of Health Sciences, Department of Nutrition and Dietetics Istanbul, Turkey.
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44
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Jong J, Porter J, Palermo C, Ottrey E. Meals beyond the bedside: An ethnographic exploration of staffs' perspectives and experiences of communal dining in subacute care. Nurs Health Sci 2021; 23:372-380. [PMID: 33438822 DOI: 10.1111/nhs.12812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 12/25/2022]
Abstract
Communal dining offers multiple benefits for hospital patients, yet dining rooms may be underutilized in practice. This study aimed to understand and explore staffs' perspectives and experiences of communal dining in subacute care, and the impacts on staff mealtime practice. Using qualitative, ethnographic methodology, 94 hours of fieldwork were conducted across two subacute care wards. Participants were staff involved in nutrition care or present on the ward at mealtimes. Ninety-one semistructured and ethnographic interviews were conducted with 59 staff, and 54 episodes of observation captured more than 190 staff. Interviews and field notes were thematically analyzed using an inductive approach. Three themes were identified: (i) benefits to patients; (ii) logistical and practical challenges; and (iii) supportive cultural factors. While staff recognized how communal dining benefited patients, logistical and practical challenges impacted their ability to facilitate it in practice. Healthcare organizations seeking to embed communal dining into the mealtime routine should recognize that clear delineation of staff roles and responsibilities, and cultural change involving normalization, setting expectations, and collective advocacy may be needed to optimize benefits for patients.
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Affiliation(s)
- Jessica Jong
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Ella Ottrey
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia.,Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Clayton, Victoria, Australia
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45
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Beck AM, Knudsen AW, Østergaard TB, Rasmussen HH, Munk T. Poor performance in nutrition risk screening may have serious consequences for hospitalized patients. Clin Nutr ESPEN 2021; 41:365-370. [PMID: 33487291 DOI: 10.1016/j.clnesp.2020.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM Finding patients at nutrition risk and securing sufficient nutritional intake, is vital to decrease risk of adverse outcomes and all-cause mortality. The aims of this study were therefore to investigate the prevalence of patients being screened for nutrition risk, to determine nutritional coverage in at-risk patients and assess the prevalence of readmissions and mortality within 30 days. METHODS A one-day cross-sectional study was performed at Herlev Hospital, Denmark in June 2019. Patients >18 y and hospitalized for ≥4 days were enrolled. Exclusion criteria were admission to the intensive, palliative, acute medical or maternal ward. If a patient was not screened by the ward a clinical dietitian screened the patient. Patients found to be at nutrition-risk underwent a 24-h dietary recall to assess energy and protein intake. Data on length of stay, readmissions, and mortality within 30 days were collected from the hospital patient register. RESULTS In total 197 (F:52%) patients were included. Median (IQR) age 74y (65-81). At the audit day n = 76 (39%) had a primary screening, and n = 42 (21%) were screened within 24 h. A NRS-2002-score ≥ 3 was found in 111 patients (63%). At-risk patients were more likely to be readmitted within 30 days (45% vs. 27%, p = 0.024) and had a higher mortality within 30 days after discharge (23% vs. 10%., p = 0.0285). In patients at nutrition risk 23% covered ≥75% of their energy- and protein requirement the last 24 h. More patients covered their energy- and protein-need if they were supplemented with enteral and/or parenteral nutrition fully or partly (63% vs. 15%, p < 0.001 or had been in contact with a clinical dietitian during the admission (33% vs. 15%, p = 0.0337. There were no differences in prevalence of readmissions and mortality between those patients at nutrition risk, who covered their energy and protein need and those who did not. CONCLUSIONS The results demonstrate that the current nutritional care process is inadequate and may have serious consequences for hospitalized patients. Further effort is needed on the awareness of screening patients and how to fulfil their requirements during hospitalization. An abstract with part of the results has been accepted as a poster to ESPEN 2020.
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Affiliation(s)
- Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark.
| | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark
| | - Tanja Bak Østergaard
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark
| | - Henrik Højgaard Rasmussen
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark; Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Denmark
| | - Tina Munk
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark
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46
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Harris CM, Wright SM. Malnutrition in Hospitalized Adults With Cerebral Palsy. JPEN J Parenter Enteral Nutr 2021; 45:1749-1754. [PMID: 33438229 DOI: 10.1002/jpen.2067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Malnutrition among hospitalized adults with cerebral palsy (CP) has not been extensively explored. We sought to identify impacts of malnutrition on clinical and resource outcomes among hospitalized adults with CP. METHODS This retrospective cohort study surveyed years 2016 and 2017 from the National Inpatient Sample database. Regression models evaluated mortality and resource utilization. RESULTS 154,219 adults with CP were hospitalized. Among them, 21,064/154,219 (13.5%) had malnutrition. Patients with and without malnutrition were similar in age (mean age ± SEM, 45.1 ± 0.30 vs 45.2 ± 0.18 years; P = .70). Patients with malnutrition were more likely male (12,175/21,604 [57.8%] vs 72,929/133,155 [54.8%], P < .01) and had higher comorbidity scores (Charlson comorbidity score ≥ 3; 2,464/21,064 [11.7%] vs 14,380/133,155 [10.8%]; P = .01). Mortality rates were higher among patients with malnutrition (905/21,064 [4.3%] vs 2,796/21,064 [2.1%], P < .01), and they had higher odds for mortality (adjusted odds ratio [aOR] = 2.1; CI, 1.7-2.5; P < .01). Those with malnutrition were less likely discharged home (aOR = 0.52; CI, 0.48-0.56; P < .01). Hospital charges were higher (adjusted mean difference [aMD] = +$42,540; CI, $36,934-48,146; P < .01) and length of stay longer (aMD = +4.3 days; CI, 3.9-4.7; P < .01) among patients with malnutrition. CONCLUSION Malnutrition in hospitalized patients with CP is associated with increased mortality and hospital resource utilization. Flagging these patients as being "high risk" when they are hospitalized may result in heightened attentiveness about clinical outcomes in this vulnerable population.
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Affiliation(s)
- Ché Matthew Harris
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Scott Mitchell Wright
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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OPSFELDER LAK, WENDT GW, SILVA DRPD, MASSAROLLO MD, FERRETO LED, VIEIRA AP. Nutritional response and clinical complications in patients with post-pyloric and gastric enteral tubes. REV NUTR 2021. [DOI: 10.1590/1678-9865202032e200283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective The present study assessed the differences in nutritional markers (albumin, transferrin, total body fat, and body mass index) and clinical complications (diarrhea, vomiting, and diet interruptions) associated with enteral nutrition. Methods This is an open-label, randomized, two-arm parallel-group controlled clinical trial. Out of 105 patients assessed for eligibility, 35 adult patients were randomly divided into two groups and followed for 28 days. The sample comprised a heterogeneous group of severely ill individuals initially treated in the intensive care units. Neurological conditions (i.e., strokes and brain tumours) were the most common reasons for hospitalization. Patients had one singularity: the clinical need for exclusive enteral nutrition therapy. One group received the diet via gastric tube and the other via a post-pyloric tube. Results The groups presented increases in the calories prescribed and administered, as well as reduced diet discontinuation. Although similar values were observed up to day 21, the post-pyloric group showed increased albumin levels compared to the gastric group on Day 28. Transferrin levels increased over time in both groups. Conclusion There were no differences in the complications recorded between groups, albeit serum albumin significantly increased in the post-pyloric group.
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Phase angle is associated with length of hospital stay, readmissions, mortality, and falls in patients hospitalized in internal-medicine wards: A retrospective cohort study. Nutrition 2020; 85:111068. [PMID: 33545536 DOI: 10.1016/j.nut.2020.111068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the predictive value of bioimpedance phase angle (PA) on selected clinical outcomes in patients hospitalized in internal-medicine wards. METHODS This was a retrospective observational study of 168 patients admitted to the internalmedicine service (52.9% women, 47.1% men), with a mean (± SD) age of 73.9 ± 15.9 y. Anthropometric examination, laboratory tests, and bioelectrical impedance analysis were performed. Bioimpedance-derived PA was the study's parameter. Length of hospital stay, prospective all-cause hospital readmission, mortality, and falls were the clinical endpoints. RESULTS Across the four PA quartile groups, age was incrementally higher (P ≤ 0.001). Multivariate linear regression models showed that PA quartile 1 was significantly associated with length of hospital stay (β, SE) in both crude and adjusted models-respectively, β (SE) = 6.199 (1.625), P ≤ 0.001, and β = 2.193 (1.355), P = 0.033. Over a 9-mo follow-up period, the hazard ratios for readmission, in-hospital falls, and mortality were associated with the lowest phase angle (PA quartile 1 versus quartiles 2-4)-respectively, 2.07 (95% confidence interval [CI], 1.28-3.35), 2.36 (95% CI, 1.05-5.33), and 2.85 (95% CI, 1.01-7.39). Associations between narrow PA and outcomes continued to be significant after adjustments for various confounders. CONCLUSIONS In internal-medicine wards, bioimpedance-derived PA emerged as a predictor of length of hospital stay, hospital readmission, falls, and mortality. The present findings suggest that in the hospital setting, PA assessment could be useful in identifying patients at higher risk who need specific nutritional support.
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Eglseer D, Huppertz V, Kammer L, Saka B, Schols J, Everink I. The quality of nutritional care in hospitals: Austria, Switzerland, and Turkey compared. Nutrition 2020; 79-80:110990. [PMID: 32987336 DOI: 10.1016/j.nut.2020.110990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/29/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey. METHODS This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed. RESULTS Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-protein-enriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention. CONCLUSIONS The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies.
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Affiliation(s)
- Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria.
| | - Viviënne Huppertz
- Nutrition and Translational Research in Metabolism (School NUTRIM), Department of Respiratory Medicine, Maastricht University, Maastricht, The Netherlands
| | - Leonie Kammer
- Department of Health, Division of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Bulent Saka
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul, Turkey
| | - Jos Schols
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Irma Everink
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
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Wright C, Shankar B, Marshall S, Pearcy J, Somani A, Agarwal E. Prevalence of malnutrition risk and poor food intake in older adults in Indian hospitals: A prospective observational
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study with novel mapping of malnutrition risk to the Malnutrition Screening Tool. Nutr Diet 2020; 78:135-144. [DOI: 10.1111/1747-0080.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Charlene Wright
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine Bond University Robina Queensland Australia
- Bond University Robina Queensland Australia
| | | | - Skye Marshall
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine Bond University Robina Queensland Australia
- Nutrition Research Australia Sydney New South Wales Australia
| | | | | | - Ekta Agarwal
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine Bond University Robina Queensland Australia
- Bond University Robina Queensland Australia
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