Malnutrition in an Academic Health Sciences Centre: Applying results from nutritionDay 2011 to the proposed Global Leadership Initiative on Malnutrition approach to diagnosing malnutrition

Abstract

BackgroundMalnutrition remains a significant ongoing issue in hospitalized patients, with cancer patients having one of the highest rates of malnutrition. Early identification with appropriate intervention is vitally important. nutritionDay is an international nutrition research study that was launched in 2006 to improve malnutrition awareness, education and research. The Canadian Nutrition Screening Tool [CNST] is validated to screen and identify patients at risk of malnutrition. In 2016, the Global Leadership Initiative on Malnutrition [GLIM] was convened to address the urgent need for simple and relevant clinical care guidelines for screening and diagnosing malnutrition.AimThe primary aim was to determine malnutrition prevalence at the three sites of an Academic Health Sciences Centre [AHSC] by applying data gathered from nutritionDay 2011 to the GLIM two-step approach to diagnosing malnutrition. The secondary aim was to compare malnutrition prevalence between the three sites, with a specific interest in the results from AHSC-a, the cancer center, since cancer patients are known to have one of the highest rates of malnutrition The tertiary aim was to explore possible reasons for poor intake in AHSC overall.MethodsA one-day cross-sectional audit involving 264 patients at three AHSC sites was conducted in 2011 as part of the international nutritionDay research study. The unintentional weight loss and food consumption data were applied to CNST. Malnutrition diagnosis was determined using data for body mass index [BMI] and the fraction of study meal consumed. The nutritionDay adaptation of GLIM criteria to fit the nutritionDay survey was used.Statistical analysisCategorical data are presented as actual numbers or percentages, with the groups compared by the Chi square test. Continuous variables expressed as mean ± SEM were used. One-way analysis of variance and Student t-tests were used to compare variables of interest. Significance p < 0.05, SPSS v.26 was used for analysis.Results44% (264/600) of patients at the AHSC participated in the nutritionDay 2011 study. 59% of patients at AHSC-a screened positive for risk of malnutrition compared to the other two sites (AHSC-b and AHSC-c),p = 0.002 and 0.014 respectively. Overall, 23% of patients would have been diagnosed as malnourished with AHSC-b at 56% compared to 17% AHSC-c [p = 0.041).ConclusionUsing the GLIM two-step approach, we report 38% of patients were at risk for malnutrition using the CNST and 1 in 4 of those identified at risk would be diagnosed as malnourished. As well, more patients at the cancer site were found to be at risk for malnutrition. Malnutrition remains a significant ongoing issue in hospitalized patients, with cancer patients having one of the highest rates of malnutrition. Early identification with appropriate intervention is vitally important. nutritionDay is an international nutrition research study that was launched in 2006 to improve malnutrition awareness, education and research. The Canadian Nutrition Screening Tool [CNST] is validated to screen and identify patients at risk of malnutrition. In 2016, the Global Leadership Initiative on Malnutrition [GLIM] was convened to address the urgent need for simple and relevant clinical care guidelines for screening and diagnosing malnutrition. The primary aim was to determine malnutrition prevalence at the three sites of an Academic Health Sciences Centre [AHSC] by applying data gathered from nutritionDay 2011 to the GLIM two-step approach to diagnosing malnutrition. The secondary aim was to compare malnutrition prevalence between the three sites, with a specific interest in the results from AHSC-a, the cancer center, since cancer patients are known to have one of the highest rates of malnutrition The tertiary aim was to explore possible reasons for poor intake in AHSC overall. A one-day cross-sectional audit involving 264 patients at three AHSC sites was conducted in 2011 as part of the international nutritionDay research study. The unintentional weight loss and food consumption data were applied to CNST. Malnutrition diagnosis was determined using data for body mass index [BMI] and the fraction of study meal consumed. The nutritionDay adaptation of GLIM criteria to fit the nutritionDay survey was used. Categorical data are presented as actual numbers or percentages, with the groups compared by the Chi square test. Continuous variables expressed as mean ± SEM were used. One-way analysis of variance and Student t-tests were used to compare variables of interest. Significance p < 0.05, SPSS v.26 was used for analysis. 44% (264/600) of patients at the AHSC participated in the nutritionDay 2011 study. 59% of patients at AHSC-a screened positive for risk of malnutrition compared to the other two sites (AHSC-b and AHSC-c),p = 0.002 and 0.014 respectively. Overall, 23% of patients would have been diagnosed as malnourished with AHSC-b at 56% compared to 17% AHSC-c [p = 0.041). Using the GLIM two-step approach, we report 38% of patients were at risk for malnutrition using the CNST and 1 in 4 of those identified at risk would be diagnosed as malnourished. As well, more patients at the cancer site were found to be at risk for malnutrition.