Phenotype profiling of disease-related malnutrition with inflammation: Document elaborated by the ESPEN special interest group (SIG) ''cachexia-anorexia in chronic wasting diseases''.

In 2010, the definition of cachexia was jointly developed by the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Groups (SIG) "Cachexia-anorexia in chronic wasting diseases" and "Nutrition in geriatrics". Cachexia was considered as a synonym of disease-related malnutrition (DRM) with inflammation by the ESPEN guidelines on definitions and terminology of clinical nutrition. Starting from these concepts and taking into account the available evidence the SIG "Cachexia-anorexia in chronic wasting diseases" conducted several meetings throughout 2020-2022 to discuss the similarities and differences between cachexia and DRM, the role of inflammation in DRM, and how it can be assessed. Moreover, in line with the Global Leadership Initiative on Malnutrition (GLIM) framework, in the future the SIG proposes to develop a prediction score to quantify the individual and combined effect(s) of multiple muscle and fat catabolic mechanisms, reduced food intake or assimilation and inflammation, which variably contribute to the cachectic/malnourished phenotype. This DRM/cachexia risk prediction score could consider the factors related to the direct mechanisms of muscle catabolism separately from those related to the reduction of nutrient intake and assimilation. Novel perspectives in the field of DRM with inflammation and cachexia were identified and described in the report.

Disease-related malnutrition (DRM) is a prevalent condition amongst older people as well as patients in all healthcare settings around the world. Chronic patients with complex health needs (CPCHN defined as those with complex chronic conditions that involve multiple health requirements, complex social support needs, or both) are especially vulnerable to malnutrition. Malnutrition is associated with increased morbidity, a higher hospital admission and readmission rate, increased needs for social resources and even a high mortality.In Catalonia, CPCHN account for 3.5-5 % of the Catalan population (250,000 to 375,000 patients), and we have data pointing to a high prevalence of malnutrition in CPCHN admitted in hospitals for an acute episode (36 % malnourished, 47 % risk of malnutrition). Nevertheless, the prevalence of DRM in CPCHN in the community has been not sufficiently studied. In addition, health and social risk factors for malnutrition are unknown in these population.Taking all these into account, it is necessary to establish an integrated and a collaborative health and social strategy for the screening and management of nutritional care, mainly from a community-based as well as a patient-centered approach.The strategy to tackle against malnutrition in CPCHN is led by the Department of Health of Catalonia (PPAC, PIAISS), the Spanish Society of Parenteral and Enteral Nutrition (SENPE) and the Family and Community Nursing Association (AIFICC), with the support of the University of Vic. This strategy is based on a Decalogue of actions to fight against malnutrition previously identified by a consensus among experts from scientific societies, social services and public health, incorporating the vision of patients and caregivers. Aims:1. Highlight the DRM problem in CPCHN launching a prevalence study of DRM in the CPCHN selecting a representative sample of Catalonian society.2. Establish an integrated and a collaborative intervention plan (nutritional and social) linked to the detection of malnutrition and/or social dysfunction.Results and impact:1. The prevalence study of DRM in the CPCHN is a prospective observational and multicenter randomized study that has been performed in a region of Catalonia, representative of the Catalan society (80 % urban, 20 % rural). The sample size calculated was 384 patients, a total of 404 patients have been participated. A very high prevalence of malnutrition and risk of malnutrition has been found (46.5 % risk, 5.9 % malnutrition) Living alone, polypharmacy and dysphagia were the most important social and health determinants that influence DRM and will allow us to focus strategies to improve patient care.2. The integrated and collaborative intervention plan to tackle against DRM in CPCHN is based on a protocol that includes the clinical, nutritional and social risk screenings. With this aim, Primary Care teams (doctors and nurses) and Social Service professionals (Primary Care and community resources) are coordinated with the Nutritional Support Unit in the reference hospital in a collaborative manner. The first step has been to incorporate mandatory nutritional and social risk factors screenings in patients identified as CPCHN. A positive nutritional or social screening have been linked to comprehensive nutritional and social assessment plans that will allow diagnosing and encoding malnutrition and identifying patients at risk of social dysfunction. Diagnosis of DRM or social dysfunction is linked to an integrated intervention plan (nutritional and social), that includes case-conferences in the case of patients with complex needs.Highlights: Prior to the development of the strategy for dealing with DRM in CPCHN, a low implementation of nutritional screening was detected. This fact was probably due to a low awareness of DRM, but also for lack of a feasible and efficient plan of approach, that must include not only the health aspects but also the social determinants that accompany the disease.Contingencies: The implementation of this strategy is time-consuming, and requires an integrated health and social work.Tutorials have been attached to the shared medical history of Catalonia to guide professionals in the application of the screenings.Timeline: The prevalence study of DRM in the community has been finished at January 2016.The mandatory screening and the validation of the nutritional and social intervention plan will be implemented during 2016.Conclusion: The results of the prevalence study of DRM in CPCHN could be extrapolated to the rest of Catalonia, allowing us to manage effectively the health and social policies. It will also allow us to analyze the impact of different health care quality indicators linked to the strategy to approach to DRM. Nutritional and social community intervention can be cost-efficient, as demonstrated in the hospital setting, and probably will allow reducing unnecessary admissions, readmissions, complications, need for social resources and will help improve the quality of life in CPCHN. The impact of this strategy is based in detecting and treating in an integrated and collaborative manner DRM in CPCHN.

Legacies begun, legacies continued

Evaluation of clinical outcomes after an intervention in malnourished hospitalized patients.

Introduction: Disease related malnutrition (DRM) affects at least one in four inpatients, increasing both morbidity and mortality during admission and after discharge.Nevertheless, its repercussion on hospital activity is not properly quantified.Objective: To determine the impact of an adequate coding of DRM and procedures employed to reverse it in the hospital average weight and other hospital indicators.Methods: Comparative study carried out in every patients requiring nutritional support and followed up by the Clinical Nutrition and Dietetics Unit of the Endocrinology and Nutrition Department in Complejo Asistencial Universitario de Len (Spain) in 2008 and 2013.A nutritional coding report at discharge including diagnosis, nutritional treatment and access was performed following ICD-9-MC.Average weight, average length of stay adjusted by case-mix and case-mix index were compared before and after coding.Results: Hospital average weight increased after coding, both in 2008 (+4.1%) and 2013 (+1.7%) and especially in those departments in which nutritional screening is performed (Hematology, +10.5%).Average length of stay adjusted by case-mix was reduced under 1 (-5.7% and -0.2% in 2008 y 2013), pointing out to better functioning, and functioning index also decreased (-5.6% y -0.4% in 2008 and 2013), what means a higher efficiency.Conclusion: Adequate coding of nutritional diagnosis and treatment of patients with DRM increases the average weight of our hospital and improves average length of stay adjusted by case-mix and functioning index.

Introduction: Disease related malnutrition (DRM) affects at least one in four inpatients, increasing both morbidity and mortality during admission and after discharge.Nevertheless, its repercussion on hospital activity is not properly quantified.Objective: To determine the impact of an adequate coding of DRM and procedures employed to reverse it in the hospital average weight and other hospital indicators.Methods: Comparative study carried out in every patients requiring nutritional support and followed up by the Clinical Nutrition and Dietetics Unit of the Endocrinology and Nutrition Department in Complejo Asistencial Universitario de Len (Spain) in 2008 and 2013.A nutritional coding report at discharge including diagnosis, nutritional treatment and access was performed following ICD-9-MC.Average weight, average length of stay adjusted by case-mix and case-mix index were compared before and after coding.Results: Hospital average weight increased after coding, both in 2008 (+4.1%) and 2013 (+1.7%) and especially in those departments in which nutritional screening is performed (Hematology, +10.5%).Average length of stay adjusted by case-mix was reduced under 1 (-5.7% and -0.2% in 2008 y 2013), pointing out to better functioning, and functioning index also decreased (-5.6% y -0.4% in 2008 and 2013), what means a higher efficiency.Conclusion: Adequate coding of nutritional diagnosis and treatment of patients with DRM increases the average weight of our hospital and improves average length of stay adjusted by case-mix and functioning index.

Consensus definition of sarcopenia, cachexia and pre-cachexia: Joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”

Continuity of care in disease-related malnutrition and nutritional medical treatment

Nutrition care as a health policy in the 21st century: A phenomenological study.

BackgroundHealth policies promote optimal care, yet policies that address disease-related malnutrition (DRM) are lacking. The purpose of this study was to conduct a scoping review to identify literature on existing...

Phase angle: Differences between disease-related malnutrition, obesity and healthy people

Ángulo de fase: diferencias entre desnutrición relacionada con la enfermedad, obesidad y población sana

Inflammatory bowel disease (IBD) patients might experience disease-related malnutrition (DRM), but prevalence and risk factors are not well defined. The primary aim of the study was to define the prevalence of DRM and micronutrient deficiency in IBD patients; the secondary aim was to assess variables related to DRM. A multicenter, cross-sectional study was performed including consecutive adult IBD patients during a period of 2 weeks. Nutritional status was assessed with the body mass index (BMI) and the Malnutrition Universal Screening Tool. DRM was defined according to European Society for Clinical Nutrition and Metabolism guidelines. Among the 295 enrolled patients, the prevalence of DRM was 23%, with no statistical difference between Crohn's disease and ulcerative colitis. Compared with well-nourished patients, patients with DRM showed higher rate of hospitalization in the previous month, were more often receiving systemic steroids, and had lower hemoglobin, albumin, and prealbumin levels and higher median C-reactive protein levels. At univariate logistic regression, current hospitalization, hospitalization in the previous month, low serum albumin, low BMI, high C-reactive protein, high Crohn's Disease Activity Index, and female sex were variables related to DRM. At the multivariate logistic regression, low BMI, current hospitalization and hospitalization in the previous month were significantly associated with DRM. In 23% of IBD patients, a deficiency of at least 1 micronutrient was observed, with no difference between ulcerative colitis and Crohn's disease. DRM and microelements malnutrition are frequent conditions in the IBD population. DRM seems to be associated with disease activity and hospitalization.

Anabolic competence: Assessment and integration of the multimodality interventional approach in disease-related malnutrition.

Cancer patients frequently experience the occurrence of cachexia, a syndrome characterized by several components, such as bodyweight loss, skeletal muscle wasting, depletion of the adipose depots, and marked alteration of the physiological homeostasis [1]. While being well aware that the only effective treatment of cachexia would be the complete eradication of the tumor, delaying the onset of this complex syndrome should be regarded as a crucial goal in the management of cancer patients. Indeed, the presence of cachexia generally results in impaired tolerance and response to antineoplastic treatments, bad quality of life and reduced survival rates, being responsible for the deaths of approximately 20% of cancer patients.