Early Identification Of Malnutrition Research Articles

Implementation of malnutrition screening tool initiative in community cancer center for cycle 1 day 1, change in regimen, and new metastatic disease patients from Sept.–March 2022.

367 Background: Identification of patients at risk for malnutrition is imperative to provide early nutrition intervention. Patients undergoing cancer therapy are at risk for developing a variety of side effects that impact their intake, absorption, and nutritional status while undergoing antineoplastic therapy. Methods: 2021 Q4 Pilot: Implemented Malnutrition Screening Tool (MST) to identify patients at risk of malnutrition for C1D1 patients only during the Nurse Navigator visit. If the MST score is <2, but a patient requests Dietitian Counseling, a patient would be referred to the RD. If score is clinically significant, > or = 2, Nurse Navigator referred to the RD, including rationale and additional detail (i.e., amount of weight loss, poor appetite, etc.). RD reviewed all referrals related to the MST and completes further assessment and intervention if appropriate. 2022 Q4: Screening utilizing the MST was standardized during Nurse Navigator visits for all C1D1 patients, patients with new metastatic disease, patients with change in regimen and new oral therapy patients. Results: See table. Conclusions: Of the patients screened with the NCCN Distress Thermometer, 67% of those patients were identified to be screened for Malnutrition. Of the patients who were screened with the MST, ~ 26% of the patients were identified to be at risk for malnutrition. Early identification of malnutrition in treatment will result in early intervention and assessment by the dietitian to prevent poor outcomes.[Table: see text]

The Effects of Malnutrition on Inpatient Outcomes in Patients With Gastroparesis: A Nationwide Analysis.

Introduction Gastroparesis (GP) is a chronic debilitating gastric motility disorder defined as delayed emptying of the stomach content without mechanical obstruction. It can result in nutritional deficiencies, leading to poor overall outcomes. We assessed the impact of malnutrition on in-hospital outcomes in patients with gastroparesis. Methods Patients with a primary discharge diagnosis of GP between January 2016 and December 2019 were included in the National Inpatient Sample (NIS) database. Data on patient demographics, hospital characteristics, the Charlson Comorbidity Index (CCI), and the etiology of gastroparesis were collected. The association between malnutrition and outcomes, including mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, acute kidney injury (AKI), length of stay (LOS), and total hospitalization charges (THC), were analyzed using the multivariate regression model. Results A total of 182,580 patients with gastroparesis were included in the analysis. Patients with gastroparesis and malnutrition had a higher risk of mortality (adjusted odds ratio {aOR}, 3.29; p<0.001), sepsis (aOR, 0.43; p<0.001), DVT (aOR, 2.34; p<0.001), and PE (aOR, 2.68; p<0.001) compared to patients with gastroparesis without malnutrition. No significant difference was noted in the rates of AKI. Patients with malnutrition also had a prolonged LOS (2.96 days; p<0.001) and higher THC ($22,890; p<0.001) compared to patients without malnutrition. Conclusion Gastroparesis patients with malnutrition are at a greater risk of worse outcomes than those without malnutrition. The early identification of malnutrition in gastroparesis patients can predict morbidity and mortality and assist in risk stratification to enhance outcomes. Further studies are encouraged to identify factors associated with malnutrition in gastroparesis and the impact of interventions to prevent and treat malnutrition.

Impacto de la diabetes, la desnutrición y la sarcopenia en el pronóstico de los pacientes hospitalizados en Medicina Interna

ObjectiveTo describe patients hospitalized in internal medicine in terms of malnutrition and sarcopenia, depending on the presence or absence of type 2 diabetes mellitus (DM2), as well as to evaluate short- and long-term mortality related to both. MethodsCross-sectional, single-center study, which included consecutive patients admitted to internal medicine in May and October 2021. Malnutrition was determined using the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia using SARC-F and handgrip strength. Patients hospitalized for more than 48h are excluded. ResultsFive hundred and 11patients were analyzed, 49.1% male, mean age 75.2±15 years, 210 (41.1%) DM2. Six groups (2×3 design) are generated based on the presence of DM2 and the nutritional status according to the result of the MNA-SF: 12–14 points, without risk; MNA-SF 8–12 points, high risk; MNA-SF 0–7 points, malnourished. Malnourished patients with DM2 had significantly higher sarcopenia, comorbidity, inflammation, and pressure ulcers. The main determinants of in-hospital mortality were sarcopenia (OR 1.27, 95% CI: 1.06–1.54, p=0.01), comorbidity (OR 1.27, 95% CI: 1.08–1.49, p=0.003) and inflammation (OR 1.01, 95% CI: 1.00–1.02, p=0.02). The 120-day prognosis was worse among malnourished patients (p=0.042). ConclusionPatients admitted with DM2 have a similar degree of malnutrition than the rest, but with greater sarcopenia. This sarcopenia, together with inflammation and comorbidity determine a worse prognosis. The active and early identification of malnutrition and sarcopenia and their subsequent approach could improve the prognosis of patients.

Impact of diabetes, malnutrition and sarcopenia on the prognosis of patients admitted to internal medicine

ObjectiveTo describe patients hospitalized in internal medicine in terms of malnutrition and sarcopenia, depending on the presence or absence of type 2 diabetes mellitus (DM2), as well as to evaluate short- and long-term mortality related to both. MethodsCross-sectional, single-center study, which included consecutive patients admitted to internal medicine in May and October 2021. Malnutrition was determined using the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia using SARC-F and handgrip strength. Patients hospitalized for more than 48 h are excluded. Results511 patients were analyzed, 49.1% male, mean age 75.2 +/− 15 years, 210 (41.1%) DM2. 6 groups (2 × 3 design) are generated based on the presence of DM2 and the nutritional status according to the result of the MNA-SF: 12–14 points, without risk; MNA-SF 8–12 points, high risk; MNA-SF 0–7 points, malnourished. Malnourished patients with DM2 had significantly higher sarcopenia, comorbidity, inflammation, and pressure ulcers. The main determinants of in-hospital mortality were sarcopenia (OR 1.27, 95%CI 1.06–1.54, p = 0.01), comorbidity (OR 1.27, 95%CI 1,08−1,49, p = 0.003) and inflammation (OR 1.01, 95%CI 1.00–1.02, p = 0.02). The 120-day prognosis was worse among malnourished patients (p = 0.042). ConclusionPatients admitted with DM2 have a similar degree of malnutrition than the rest, but with greater sarcopenia. This sarcopenia, together with inflammation and comorbidity determine a worse prognosis. The active and early identification of malnutrition and sarcopenia and their subsequent approach could improve the prognosis of patients.

Prevalence and Impact of Malnutrition in Hospitalizations Among Celiac Diseases: A Nationwide Analysis.

Celiac disease (CD) is a T-cell-mediated gluten sensitivity that results in villous atrophy in the small intestine, leading to chronic malabsorption. Patients with celiac disease are prone to malnutrition. We assessed the impact of malnutrition on in-hospital outcomes in patients with CD. Patients with a primary discharge diagnosis of CD between January 2016 and December 2019 were included in the National Inpatient Sample Database. Data were collected on patient demographics, hospital characteristics, the Charlson Comorbidity Index (CCI), and concomitant comorbidities. The association between malnutrition and outcomes, including mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, acute kidney injury (AKI), length of stay (LOS), and total hospitalization charges (THC), was analyzed using the multivariate regression model. A total of 187310 patients with CD were included in the analysis. Patients with CD and malnutrition had a higher risk of mortality (adjusted odds ratio [aOR], 2.08; p<0.001), AKI (aOR=1.18, p=0.003), and DVT (aOR=1.53; p<0.001) compared to patients with CD without malnutrition. No significant difference was noted in the rates of sepsis and PE. Patients with malnutrition also had a prolonged LOS (2.89 days; p<0.001) and higher THC ($22252.18; p<0.001) compared to patients without malnutrition. Patients with CD and malnutrition are at high risk of worse outcomes. Early identification of malnutrition in CD can help prevent morbidity and mortality.Even strict adherence to a gluten-free diet has been associated with malnutrition. Further studies identifying factors associated with malnutrition in CD and the impact of interventions to prevent and treat malnutrition are encouraged.

International study on the prevalence of malnutrition in centralized care for colorectal cancer patients.

Patients with different diseases may show signs of malnutrition both before and during the hospital stay. The presence of malnutrition may impact the recovery and length of stay and consequently the costs. Early identification of malnutrition is thus a critical factor. The objective of this multicenter study is to determine the prevalence of malnutrition in colorectal cancer centers. Another objective is to investigate possible consequences, such as complications or length of stay. In addition, the study aims to demonstrate the relevance of nutrition management in colorectal cancer centers. At the same time, relevant requirements clearly demanded by the Certification Commission for Certified Colorectal Cancer Centers are met through implementation of the study. Between 2019 and 2021, patients incolorectal cancer centers were examined in the preoperative phase. In addition to questions about patients' state of health and nutrition, the validated screening forms-Subjective Global Assessment (SGA) and Nutritional Risk Screening Tool 2002 (NRS 2002)-were used to assess malnutrition. The data were processed by univariate analysis. In total, data records of 3,102 patients were evaluated. The mean age of the participants was 68.5 ± 11.9 years, and their average body mass index (BMI) was 26.8 ± 5.3 kg/m2. The SGA questionnaire indicated that 23 % of the participants suffered from malnutrition and 38 % were at risk of malnutrition (NRS≥3). Malnutrition was found more frequently in patients with colorectal carcinomas than in patients with rectal carcinomas (53.1 vs. 32.1 %). The length of stay in hospital and the rate of complications were significantly higher when malnutrition was identified. Approximately one in three to four patients with a colorectal carcinoma has an increased risk of malnutrition. The two screening methods calculated a different prevalence (23 and 38 %). Any malnutrition that is present demonstrably has a significant impact both on the rate of complications and the length of stay and may therefore have a decisive influence on the costs. The results of this multicenter study underscore the need for systematic screening for malnutrition and at the same time should increase clinics awareness of the importance of establishing a nutrition management policy.

Malnutrition and sarcopenia worsen short- and long-term outcomes in internal medicine inpatients.

This work aims to describe patients hospitalized in internal medicine wards in terms of nutrition and sarcopenia. It also seeks to evaluate short- and long-term mortality related to malnutrition and sarcopenia. This cross-sectional study collected data on consecutive patients admitted to a single center's internal medicine ward. Patients were recruited in May and October 2021. Malnutrition was determined by the Mini-Nutritional Assessment-Short Form (MNA-SF) and sarcopenia by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F scale) and handgrip strength test. Patients who were hospitalized for >48hours were excluded. The sample included 619 patients with a mean ± SD age of 76.0 ± 14.8 years of which 50.6% were women. Patients were classified into three groups based on malnutrition: group 1 (MNA-SF 12-14 points) (no risk) included 158 patients, group 2 (MNA-SF 8-12 points) (high risk) included 233 patients, and group 3 (MNA-SF 0-7 points) (malnourished) included 228 patients. Malnourished patients had more dysphagia, significantly lower protein and albumin levels, and significantly higher inflammatory marker levels and pressure ulcers. In-hospital mortality was significantly higher in groups 2 and 3 (p < .00001). The worst outcome (mortality and readmissions or mortality) was more common among malnourished patients (p = .0001). Inflammation, comorbidity, and sarcopenia were most closely associated with negative outcomes. Malnutrition upon admission is associated with worse short- and long-term outcomes in internal medicine inpatients. Sarcopenia, multimorbidity, and inflammation-measured by albumin, C-reactive protein, or their ratios-are key risk factors. Early identification of malnutrition and sarcopenia through active screening is important in caring for internal medicine patients.

Association of Circulating Trimethylamine-N Oxide With Malnutrition and the Risk of Coronary Artery Disease in Patients With Maintenance Hemodialysis

Malnutrition is a serious complication frequently observed in dialysis patients. Therefore, nutrition status evaluation and the early identification of malnutrition are clinically important. Trimethylamine N-oxide (TMAO) is reportedly associated with deteriorating metabolic profiles and cardiovascular diseases. The aim of our study was to investigate correlations between circulating TMAO levels and malnutrition and the risk of major adverse cardiovascular events in patients on maintenance hemodialysis. This retrospective observational study involved 228 subjects. Fasting plasma TMAO levels were detected using liquid chromatography-tandem mass spectrometry. TMAO levels were significantly elevated in patients with malnutrition (8728.78±704.12ng/mL) when compared with those without (6532.1±570.41ng/mL, P<.01). TMAO levels were positively correlated with Subjective Global Assessment scores (ρ=0.56, P=.02) and were independent risk factors for malnutrition after adjustment for multiple traditional risk factors (odds ratio=2.07, 95% confidence interval: 1.41-3.62, P<.01). Furthermore, TMAO levels were good predictors of major adverse cardiovascular events in a 2-year follow-up period (area under the curve=0.68, P<.01) and accuracy was increased to 74% when TMAO levels were combined with Subjective Global Assessment scores (area under the curve=0.74, P=.02). Elevated TMAO levels were independently associated with a risk of malnutrition and cardiovascular disease, and could be a useful predictive biomarker for risk stratification and cardiovascular disease management for patients on dialysis.

Nutritional Support in Pancreatic Diseases.

This review summarizes the main pancreatic diseases from a nutritional approach. Nutrition is a cornerstone of pancreatic disease and is sometimes undervalued. An early identification of malnutrition is the first step in maintaining an adequate nutritional status in acute pancreatitis, chronic pancreatitis and pancreatic cancer. Following a proper diet is a pillar in the treatment of pancreatic diseases and, often, nutritional counseling becomes essential. In addition, some patients will require oral nutritional supplements and fat-soluble vitamins to combat certain deficiencies. Other patients will require enteral nutrition by nasoenteric tube or total parenteral nutrition in order to maintain the requirements, depending on the pathology and its consequences. Pancreatic exocrine insufficiency, defined as a significant decrease in pancreatic enzymes or bicarbonate until the digestive function is impaired, is common in pancreatic diseases and is the main cause of malnutrition. Pancreatic enzymes therapy allows for the management of these patients. Nutrition can improve the nutritional status and quality of life of these patients and may even improve life expectancy in patients with pancreatic cancer. For this reason, nutrition must maintain the importance it deserves.

Screening for malnutrition with malnutrition inflammation score and geriatric nutritional risk index in hemodialysis patients.

Screening malnutrition, which is the most common complication in hemodialysis patients, is extremely important for these patients. Malnutrition inflammation score (MIS) and geriatric nutritional risk index (GNRI) are malnutrition screening tests used in hemodialysis patients in recent years. The purposes of this study are to evaluate the nutritional status of hemodialysis patients with different screening tests and to determine the cutoff values for this disease-specific MIS and GNRI. The study was conducted with 194 adult patients including 98 males and 96 females whose mean age was 53.1 ± 10.96. Subjective global assessment (SGA) and MIS tests were applied, and the GNRI value was calculated for screening malnutrition. MIS and GNRI cutoff values were obtained by adopting the SGA scores as a standard and drawing a receiver operating characteristic curve. The tatistical Package for the Social Sciences-22.0 package program was used in the analysis. According to SGA, 70.7% of the patients were nourished, 21.1% were mildly-moderately malnourished, and 8.2% were found to be severely malnourished. The optimal cutoff value predicted for malnutrition was 6.5 points (94.7% sensitivity and 98.5% specificity) for MIS and 86.0 points (64.9% sensitivity and 62.8% specificity) for GNRI. Based on these cutoff values, 28.9% of the patients were determined to be malnourished according to MIS and 45.4% according to GNRI. In conclusion, screening tests are very important in the early identification of malnutrition in hemodialysis patients. This study was conducted to evaluate the malnutrition of hemodialysis patients with different screening tests. At the end of the study, the availability of MIS was found to be high in detecting malnutrition in hemodialysis patients because of its high accuracy and sensitivity of MIS. The cutoff points we identified for both MIS and GNRI are thought to facilitate the determination of malnutrition.

Effectiveness of a Screening Tool for Early Identification of Malnutrition in Patients with Head and Neck Cancer

The purpose of this study was to evaluate the impact of the Malnutritional Universal Screening Tool (MUST) assessment on effects of postoperative surgical site infection (SSI) and length of hospitalization stay (LOS) for patients undergoing oncologic resection for head and neck cancers. A pre-posttest design was used to evaluate the effects of preoperative nutritional screening on postoperative SSI and LOS rates in patients undergoing oncologic resection. A purposive sampling was used to recruit participants for the study. Pre- and post-implementation data were collected over a period of 8 weeks. All patients in the post-implementation group were assessed using the MUST and pre-surgery nutritional optimization was instituted. All participants were monitored for incidences of SSI until discharge. Of the 36 patients in the post-implementation group, 23(63.9%) had a MUST score of moderate to high and 13 (36.1%) had a score of low risk. There was a statistical significance observed between the pre-and post-implementation groups, with both postoperative surgical site infection (SSI) reduced from 50% to 22% and length of hospitalization stay from 28 to 17 days (p = 0.014) between the groups. Patients who were non-smokers (p = 0.010) and without reconstruction after surgery (p = 0.007) were less likely to develop postoperative SSI. Use of the MUST for preoperative nutritional screening has demonstrated that it is a feasible and easy to implement tool for assessment of malnutrition and it has demonstrated positive outcomes in reduction of both postoperative SSI and length of hospitalization stay.

Considerations about the importance of nutritional status in the treatment of advanced colorectal cancer.

In patients with gastrointestinal malignancies, i.e. cancers of the stomach, colon, liver, biliary tract or pancreas, progressive undernutrition can be regularly observed during the course of illness. Undernutrition significantly affects the patients' quality of life, morbidity and survival. In patients with gastrointestinal malignancies, i.e. cancers of the stomach, colon, liver, biliary tract or pancreas, progressive undernutrition can be regularly observed during the course of illness. Undernutrition significantly affects the patients' quality of life, morbidity and survival. In patients with gastrointestinal malignancies, i.e. cancers of the stomach, colon, liver, biliary tract or pancreas, progressive undernutrition can be regularly observed during the course of illness. Undernutrition significantly affects the patients' quality of life, morbidity and survival. Recently (2019) reported literature focusing on colorectal cancer(CRC), further outlines these concepts and seems to offer new tools for both screening and intervention. Early identification of malnutrition should allow for more effective interventions to reduce morbidity and mortality of CRC pts.

Effectiveness of Krishna Laddoo in treating malnutrition in anganwadi children

Background: This was a prospective pilot study to estimate the burden of malnutrition in the age group of 2.5–5 years and to evaluate the usefulness of dietary changes in them. This research was conducted by the Department of Paediatrics Krishna Institute of Medical Sciences, Karad in selected Anganwadi at Rethare Bk., This study was undertaken to combat the issue of malnutrition of children’s in the age group of 2.5 to 5 years. According to WHO-Moderate Acute Malnutrition is defined by a weight-for-height indicator between -3 and -2 z-scores (standard deviations) of the international standard or by a mid-upper arm circumference (MUAC) between 11 cm and 12.5 cm. Severe Acute Malnutrition is defined by very low weight for height below -3z scores of the median WHO growth standards by visible severe wasting. The children identified with SAM & MAM were started on a high nutrition laddu called the Krishna laddu which was specially designed by the Krishna Institute of Medical Sciences Deemed To be University to cater to the deficiencies in malnourished children. The aim of the study was to determine the effectiveness of Krishna laddu in treating malnutrition in children aged between 2.5–5 years. Methods: This was a prospective study. Total of 43 children attending the 2 selected anganwadi adopted by the Krishna Institute of Medical Sciences, Karad (aged between 2.5–5 years) were screened for malnutrition and graded according to Severe Acute Malnutrition and Moderate Acute Malnutrition and were given Krishna Laddu on a daily basis. Their anthropometry was serially recorded on a weekly basis over a period of 1.5 years to determine the effectiveness of the Krishna Laddu in improving the nutritional status in the malnourished children. Results: The prevalence rate of malnutrition was 23% (21% MAM and 2% SAM) in the children aged between 2.5–5 years the given population which was reduced to 8% MAM after their diet was added with Krishna Laddu. Conclusions: Krishna Laddu proved to be beneficial in the nutritional rehabilitation of malnourished children. The highlights of this research were: 1) early identification of malnutrition 2) prompt initiation of a nutritious diet to improve outcome 3) serial monitoring of these children to plot the outcome. 4) All the ingredients used for making the laddu are easily available in the kitchen. 5) The preparation is low cost, making it feasible for use in any setup.

Assessment of malnutrition and enteral feeding practices in the critically ill: A single-centre observational study.

Background and Aims:Early identification of malnutrition among hospitalised patients is essential to institute appropriate patient-specific nutritional strategies. This study was conducted to evaluate the nutritional status of medical patients at admission to the adult intensive care unit (ICU) and to identify factors which prevent attainment of daily feeding goals in them.Methods:This was a 1 year prospective, observational study on 200 medical adult ICU patients. The study was carried out based on daily documentation. The primary outcome was the nutritional status of medical Patients at admission to the adult ICU. The tests for statistical analysis used were independent t test, Chi-square test, Fisher's exact test and multivariate logistic regression analysis.Results:Out of the 200 patients in our study, 45%, 48.5% and 9% of patients had mild, moderate and severe malnutrition, respectively, corresponding to subjective global assessment (SGA) rating A,B and C, respectively. The most common reasons for non-attainment of daily feeding goals were delayed feed procurement (17.57%), and feeds being held for procedures (16.36%). The overall mean length of ICU stay was 8.63 ± 7.26 days, and the ICU mortality rate was 47.5% (95/200). Patients with SGA rating B and C at admission had higher risk of mortality in the ICU, with an adjusted odds ratio of 3.54 (95% confidence interval [CI]- 1.71–7.33, P = 0.001) and 11.11 (95% CI-2.26–54.66, P = 0.003), respectively.Conclusion:Malnutrition is commonly present at admission among medical ICU patients, and is associated with higher ICU mortality.

Nutrition Assessment in Oncology

Malnutrition is a frequent, undiagnosed complication in cancer patients and is associated with a negative prognosis. Screening allows for early identification of malnutrition and appropriate nutrition assessment may lead to beneficial outcomes in nutritional status and quality of life. The author conducted a review of the literature to identify tools for the screening and assessment of nutritional status in cancer patients. An overview of the relevance of these tools in clinical practice is discussed. This article is designed to help dietitians choose the appropriate tools for screening and assessment of nutritional status in oncology patients.

A Study to Compare the Nutritional Status Assessed by CAN Score and Ponderal Index against WHO Intrauterine Growth Curves among Newborns at Birth in Selected Hospital of Ambala, Haryana

The neonatal morbidity and mortality is closely related to the nutritional status of newborn at birth and early identification of malnutrition with appropriate tool and technique can reduce the mortality rate. Descriptive and comparative survey design was used to assess and compare the Nutritional status of newborns at birth by CAN Score and Ponderal Index against WHO Intrauterine growth curves at MMIMS&R Hospital, Mullana Ambala. Sixty newborns were selected by purposive sampling from NICU and postnatal wards. The data was collected by Performa for newborn and maternal characteristics, WHO Intrauterine Growth Curves, Ponderal Index and observation sheet of CAN Score. Findings revealed that Ponderal Index (48.4%) classified more newborns as malnourished as compared to CAN Score (25%) with regard to WHO Intrauterine growth curves (21.6%). Ponderal Index has higher Sensitivity (76.9%) and lower Specificity (59.5%) than CAN Score (38.4%, 78.7%) respectively whereas Positive predictive value and Negative predictive value of Ponderal Index (34.4%, 90.3%) was higher than CAN Score (33.3%,82.2%). The likelihood ratio of Positive test of Ponderal Index (1.89) was higher than CAN Score (1.80) and likelihood ratio of Negative test of Ponderal Index (0.38) was lower than CAN Score (0.78) test indicating that Ponderal Index can act more sensitive indicator of assessing malnutrition than CAN Score. The main conclusion of the study is that Ponderal Index may be a simple clinical index but sensitive predictor for identifying malnutrition and for prediction of neonatal morbidity associated with it, without the aid of any sophisticated equipments.

Prevalence of frailty and its associations with blood pressure and anthropometric measurements in elderly Egyptians

emergency conditions were included. Comprehensive geriatric assessment, including nutritional and functional assessmentswere done according to nutritional checklist and Barthel index, respectively. Informationwere gathered from the patients, from theward nurse responsible for the patient and from family members who reviewed. Results.– According to nutritional checklist, 56% of participants were at high risk, 18% were at moderate risk of malnutrition, and 26% had good nutrition. There was high nutritional risk in patients with low income, and good nutrition in patients with moderate income. Also, there was a high nutritional risk in rural residents (61.9%) in comparison with urban residents (25%). Barthel index score was significantly lower in those at high risk of malnutrition compared to those at moderate risk and those with good nutrition. Conclusions.– Results in this study suggest that hospitalized elderly are exposed to malnutrition which emphasizes the importance of early identification of malnutrition among them. Malnourished hospitalized patients are candidate for functional impairment. Significant associations were noticed between both nutritional and functional status and specific sociodemographic variables. These interrelationships require further studies to elucidate.

Predictive validity of ‘Malnutrition Universal Screening Tool’ (‘MUST’) and Short Form Mini Nutritional Assessment (MNA-SF) in terms of survival and length of hospital stay

Summary Background & aims The high prevalence of malnutrition and associated adverse outcomes in older people is well documented. Early identification of malnutrition and intervention in hospital patients may improve clinical outcome. ‘Malnutrition Universal Screening Tool’ (‘MUST’) is the preferred screening method for malnutrition in UK. The Short Form Mini Nutritional Assessment (MNA-SF) has been developed specifically for older populations. Little information is available regarding the comparability of these commonly used screening instruments. The aim of this study was to compare these nutrition screening tools and evaluate their predictive validity. Method A prospective cross sectional study of nutritional status in 149 inpatients aged 65–99 years was carried out. Exclusion criteria were terminal illness, active malignancy, and lack of capacity to consent. Main nutritional measures were weight, height, body mass index, mid arm circumference, hand grip strength, and serum albumin levels. Data on mortality, length of stay (LOS) and hospital readmissions were collected retrospectively and related to ‘MUST’ and MNA-SF scores. Results The main findings were that there was a ‘moderate’ agreement between ‘MUST’ and MNA-SF [ κ = 0.50, 95% CI (0.39, 0.60)], that both ‘MUST’ and MNA-SF scores predicted mortality ( p = 0.013 and 0.009 respectively), and that LOS increased progressively with MNA-SF category. Conclusion The MNA-SF categorises many more older people admitted to hospital as at risk of malnutrition than the ‘MUST’. Both tools have predictive validity with regard to mortality but MNA-SF better predicts length of stay and readmission rates. These findings support screening all older hospital patients for malnutrition, with either tool.

Using a public hospital funding model to strengthen a case for improved nutritional care in a cancer setting

This study aimed to measure the prevalence of malnutrition risk and assessed malnutrition in patients admitted to a cancer-specific public hospital, and to model the potential hospital funding opportunity associated with implementing routine malnutrition screening. A point-prevalence audit of malnutrition risk and diagnosable malnutrition was conducted. A retrospective audit of hospital funding associated with documented cases of malnutrition was conducted. Audit results were used to estimate annual malnutrition prevalence, associated casemix-based reimbursement potential and the clinical support resources required to adequately identify and treat malnutrition. Sixty-four percent of inpatients were at risk of malnutrition. Of these, 90% were assessed as malnourished. Twelve percent of malnourished patients produced a positive change in the diagnosis-related group (DRG) and increased allocated financial reimbursement. Identifying and diagnosing all cases of malnutrition could contribute an additional AU$413644 reimbursement funding annually. Early identification of malnutrition may expedite appropriate nutritional management and improve patient outcomes in addition to contributing to casemix-based reimbursement funding for health services. A successful business case for additional clinical resources to improve nutritional care was aided by demonstrating the link between malnutrition screening, hospital reimbursements and improved nutritional care. What is known about the topic? It is known that between 20 and 50% of hospital patients are malnourished and oncology patients are 1.7 times more likely to be malnourished than are other hospitalised patients. Despite the existence of practice guidelines for malnutrition screening of at-risk oncology patients, these are not routinely implemented. Identification of malnutrition in hospitalised patients is linked to casemix funding via DRG. Casemix reimbursement for malnutrition can be enhanced if: (1) malnutrition risk is identified; (2) malnutrition is diagnosed; (3) the word 'malnutrition' and an associated action plan is documented in the medical record; and (4) malnutrition is recognised and recorded by the clinical coder. Amendments to the ICD-10-AM in 2008 allowing malnutrition to be recognised as a complication for coding when it is documented by a dietitian in the medical history has hospital reimbursement implications for dietetic practice. Reimbursement potential for malnutrition has been calculated in public hospitals in Australia with varying results. What does this paper add? This paper reports the components of a successful business case made to enhance resources for identification and treatment of malnutrition on the basis of improved treatment as well as enhanced reimbursement potential resulting from changes to the ICD-10-AM. The present study adds to the body of literature showing that malnutrition coding contributes to casemix funding in Australian public hospitals, as well as internationally, and highlights the previously unreported opportunity for a cancer-specific health service. This work demonstrated that reassignment of a DRG based on a diagnosis of malnutrition altered the overall casemix funding value for 12% of audited patients. This compares with the findings of other authors who demonstrated hypothetical DRG changes and financial reallocation. What are the implications for practitioners? This paper highlights that practitioner-centred strategies are needed to enhance malnutrition identification, diagnosis, documentation and coding to maximise casemix reimbursement and better treat malnutrition in hospitals. Strategies include education of the dietetics, medical and health-information workforce. This manuscript provides a description of the conduct of quality-improvement activities that may support successful business cases for increased dietetic resources in future.

The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff

The early identification of malnutrition and nutrition risk through nutrition screening is common practice in adult clinical care but, in children, this has been hampered by the lack of an appropriate nutrition screening tool. The present study aimed to develop and evaluate a simple, child-specific nutrition screening tool for administration by non-nutrition healthcare professionals. In a two-phase observational study, significant predictors of nutrition risk were identified using a structured questionnaire. These were then combined to produce a nutrition screening tool. For evaluation purposes, the reliability, sensitivity and specificity of the newly-developed Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP(©)) were estimated by comparing the classification of nutrition risk using the tool with that determined by a full nutritional assessment by a registered dietitian. A total of 122 children were recruited for development phase and a separate cohort of 238 children was recruited for the evaluation phase. Low percentile weight for age, reported weight loss, discrepancy between weight and height percentile and recently changed appetite were all identified as predictors of nutrition risk. These predictors, together with the expected nutrition risk of clinical diagnoses, were combined to produce STAMP(©). Evaluation of STAMP(©) demonstrated fair to moderate reliability in identifying nutrition risk compared to the nutrition risk classification determined by a registered dietitian (κ = 0.541; 95% confidence interval = 0.461-0.621). Sensitivity and specificity were estimated at 70% (51-84%) and 91% (86-94%), respectively. The present study describes the development and evaluation of a new nutrition screening tool specifically for use in a UK general paediatric inpatient population.