Predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition tool in hospitalized adults: a cohort study

The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum-A Conceptual and Systems Approach

The domestic and global diet, nutrition, and health context is becoming increasingly complex. Our ability to effectively address the daunting challenges presented by malnutrition in all its forms-both clinically and from a public health perspective-is constrained by a number of issues that coalesce around our understanding of nutrition and the what, why, and how of its assessment. This complexity is further enhanced when screening, assessment, diagnosis, and care are often performed in different settings (hospital compared with school compared with home), across populations, and with a limited care team (e.g. certain care teams may only have a nurse or dietitian within a school district). In this perspective, we make the case that our ability to improve the precision of assessment, diagnosis, and intervention demands a view of nutrition as a biological variable: a complex system resulting from the interactions between our internal (biology, health status, developmental stage, genetics, etc.) and external (social determinants of health, home, community, physical) environments, i.e. a nutritional ecology. We offer both 1) a conceptual framework for more effectively integrating nutrition in medical assessment and etiology-based care; and 2) suggest solutions to overcome some of the systematic challenges in the clinical care continuum. Leveraging the concept of nutrition as a biological variable that emphasizes the integration of both internal and external variables into an assessment within the Nutrition Care Process model allows for both the identification of the nutrition problem and also the root cause (etiology) of the problem. Suggestions are offered for how to integrate this approach from both a clinical and public health perspective.

2024 Peggi Guenter excellence in clinical practice lectureship: From curiosity and eagerness to passion: Moving the malnutrition needle

Most every new clinician practicing in nutrition support enters their practice environment with wide open eyes and a sense of curiosity as they encounter new patient and clinical experiences. As clinicians expand their expertise, they often identify challenges they are eager to address. Eagerness turns to passion as the desire to affect change grows. Malnutrition has sparked curiosity and interest in many, and, in some, it has become a passion. As a result, many major achievements have occurred both in the United States and globally that have the capability of moving the needle favorably to achieve better outcomes for our patients. This lecture will highlight how curiosity, eagerness, and passion have led to successes in addressing aspects of malnutrition. These successes offer the structure to continue our efforts to move the needle forward. Our patients deserve nothing more.

Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: An Evidence-Based Nutrition Practice Guideline

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.