Identification Of Nutritional Risk Research Articles

Identification of nutritional risk in the acute care setting: progress towards a practice and evidence informed systems level approach

BackgroundTo improve nutritional assessment and care pathways in the acute care setting, it is important to understand the indicators that may predict nutritional risk. Informed by a review of systematic reviews, this project engaged stakeholders to prioritise and reach consensus on a list of evidence based and clinically contextualised indicators for identifying malnutrition risk in the acute care setting.MethodsA modified Delphi approach was employed which consisted of four rounds of consultation with 54 stakeholders and 10 experts to reach consensus and refine a list of 57 risk indicators identified from a review of systematic reviews. Weighted mean and variance scores for each indicator were evaluated. Consistency was tested with intra class correlation coefficient. Cronbach's alpha was used to determine the reliability of the indicators. The final list of indicators was subject to Cronbach’s alpha and exploratory principal component analysis.ResultsFifteen indicators were considered to be the most important in identifying nutritional risk. These included difficulty self-feeding, polypharmacy, surgery and impaired gastro-intestinal function. There was 82% agreement for the final 15 indicators that they collectively would predict malnutrition risk in hospital inpatients.ConclusionThe 15 indicators identified are supported by evidence and are clinically informed. This represents an opportunity for translation into a novel and automated systems level approach for identifying malnutrition risk in the acute care setting.

Nutritional risk and dietary intake among newly enrolled meals on wheels participants

This study aimed to gain a better understanding of the nutritional risk (NR) and nutritional needs of newly enrolled Meals on Wheels (MOW) participants. This cross-sectional study in a Midwest state assessed the NR and dietary intake frequencies (DIF) of 167 newly enrolled MOW participants ages 60 years and older using the Dietary Screening Tool. Participants were primarily female (62.9%) and enrolled in MOW during the winter (85%). Over half (53.9%) classified “at NR,” 43.7% “at possible NR,” and 2.4% “not at NR.” “Low” DIF of dairy, lean protein, and processed meat were detected. “Moderate” DIFs of vegetable, total and whole grains, whole fruit and juice, and added fats, sugars, and sweets were also found. Male participants experienced higher NR (p < 0.0005) and consumed lower fruit and vegetable DIFs (p < 0.030) than females. Lean protein DIFs were lower in the winter than in the summer (p = 0.04). Early identification of NR and factors influencing NR can help community food programs better address OA nutrition concerns.

Perfil nutricional e socioeconômico de idosos admitidos no pronto atendimento médico de um hospital universitário

A população mundial passa por processo de envelhecimento, sendo o idoso mais susceptível a alterações do estado nutricional, devendo ser sempre avaliado para que haja intervenção precoce. Objetivou-se traçar o perfil nutricional e socioeconômico de idosos admitidos no pronto atendimento médico de um hospital universitário. Trata-se de estudo transversal, prospectivo, amostra por conveniência, realizado nas primeiras 48 horas de internação nas áreas verde, amarela e vermelha do Sistema Único de Saúde. Foram avaliados 100 idosos de ambos os sexos, por meio de formulário socioeconômico, triagem MNA®-SF e avaliação nutricional. Observou-se uma maioria desnutrida ou sob risco nutricional, com prevalência masculina e forte relação com perda de peso, diminuição da ingesta, estresse ou doença aguda. Assim, constatou-se maior sensibilidade da MNA®-SF na identificação precoce do risco nutricional mesmo nos pacientes eutróficos ou em sobrepeso pelo IMC. Sugerem-se mais estudos associando transtornos neuropsicológicos em idosos e sua influência no estado nutricional na hospitalização.

Nutritional risk and clinical outcomes in patients diagnosed with COVID-19 in a high-complexity hospital network

Introduction: the identification of nutritional risk at hospital admission is important to establish timely interventions in the COVID-19 patient care cycle, due to a high risk of it being associated with complications. Objective: to determine the association between the level of nutritional risk upon admission and in-hospital mortality at 28 days in patients diagnosed with COVID-19 treated between March and October 2020 in two hospital institutions in Colombia. Methods: a retrospective, observational study. Hospitalized patients with a diagnosis of COVID-19 were included and assessed by the Nutrition Service using the nutritional risk identification in emergencies scale, adapted from the NRS 2002 scale. In-hospital mortality at 28 days was analyzed as the primary endpoint, and hospital stay, admission to Intensive Care Unit (ICU), and requirement for mechanical ventilation as secondary endpoints. Results: a total of 1230 patients were included, with a mean age of 65.43 ± 15.90 years, mainly men (57.1 %, n = 702). A high nutritional risk (≥ 2 points) was identified in 74.3 % (n = 914). Patients with a high nutritional risk had a greater probability of in-hospital death at 28 days (HRadj: 1.64; 95 % CI: 1.11-2.44), and a greater risk of requiring mechanical ventilation (OR = 1.78; 95 % CI: 1.11-2.86) or ICU admission (OR = 1.478; 95 % CI: 1.05-2.09), as well as hospital stay longer than 7 days (OR = 1.91; 95 % CI: 1.47-2.48). Conclusions: patients with a diagnosis of COVID-19 at high nutritional risk had a significantly higher in-hospital mortality at 28 days and a higher probability of requiring mechanical ventilation, ICU admission, and prolonged hospital stay.

A Review of Nutrition Support Guidelines for Individuals with or Recovering from COVID-19 in the Community.

COVID-19 negatively impacts nutritional status and as such identification of nutritional risk and consideration of the need for nutrition support should be fundamental in this patient group. In recent months, clinical nutrition professional organisations across the world have published nutrition support recommendations for health care professionals. This review summarises key themes of those publications linked to nutrition support of adults with or recovering from COVID-19 outside of hospital. Using our search criteria, 15 publications were identified from electronic databases and websites of clinical nutrition professional organisations, worldwide up to 19th June 2020. The key themes across these publications included the importance in the community setting of: (i) screening for malnutrition, which can be achieved by remote consultation; (ii) care plans with appropriate nutrition support, which may include food based strategies, oral nutritional supplements and referral to a dietitian; (iii) continuity of nutritional care between settings including rapid communication at discharge of malnutrition risk and requirements for ongoing nutrition support. These themes, and indeed the importance of nutritional care, are fundamental and should be integrated into pathways for the rehabilitation of patients recovering from COVID-19.

NutriDia Brasil: retrato dos cuidados nutricionais em um hospital de alta complexidade do Rio Grande do Sul

ntroduction: Hospital malnutrition is considered a public health problem, whose prevalence ranges from 40% to 60% on admission, reaching figures of 80% during the course of hospitalization. In this context, the nutriDia Brasil project aims to highlight nutritional problems that hospitalized patients have, as well as resources available for the management and knowledge of health professionals in this regard. Methods: Longitudinal observational study, using data from the multiprofessional nutritional therapy team at Hospital São Vicente de Paulo, in Passo Fundo, RS, an institution participating in nutriDia Brasil, in November 2017. For the composition of the study, variables such as gender, age, diagnosis, length of hospital stay, body mass index (BMI), weight loss, identification of nutritional risk, type of nutritional therapy, acceptance of diet, consumption of food outside the hospital routine and clinical outcome after 30 days. Results: 136 patients were evaluated, with a mean age of 57 ± 3.2 years, most of whom were male (53%). The main causes of hospitalization were diseases of the musculoskeletal system (21.1%), circulatory (15.8%), digestive (13.9%) and genitourinary (10%). Regarding nutritional status, the mean BMI was 25.9 ± 4.8 kg/m² and weight loss was reported in 55% of cases, with an average reduction of 6.7 ± 2.1 kg. 39.2% of those evaluated and only 51.9% managed to ingest the entire hospital diet prescribed. Among the causes of reduced food intake, 13.2% reported symptoms such as nausea or vomiting and 9.1% loss of appetite. 71.3% received an exclusive oral diet; 17.4% used nutritional supplements in combination with hospital foods and 11.3% received artificial nutrition. Conclusion: Weight loss, inadequate food intake and the presence of nutritional deviations were the most relevant factors, suggesting the need to implement improvements that contribute to safe and quality care for the patient.

NUTRIC Score: Isolated and Combined Use With the NRS-2002 to Predict Hospital Mortality in Critically Ill Patients.

Identification of nutritional risk in critically ill patients is a challenge because each nutritional screening tool has its specific characteristics. The objective was to evaluate the performance of the modified Nutrition Risk in Critically ill (mNUTRIC) score, used alone or in combination with the Nutritional Risk Screening 2002 (NRS-2002) score, to predict hospital mortality in critically ill patients. A prospective study was performed with patients admitted to the intensive care unit (ICU) from October 2017 to April 2018. Multiple logistic regression analysis was used to test for complementarity between the mNUTRIC and NRS-2002. A receiver operating characteristic (ROC) curve was used to identify the performance of the instruments to predict mortality. This study was conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. 384 patients were evaluated (51.8% female mean age 59.6 ± 16.7 years). High nutritional risk was detected in 54.4% by the NRS-2002 and 48.4% by mNUTRIC. The overall mortality rate was 36.5% (n = 140). Patients in whom nutritional risk was identified both by mNUTRIC and by NRS-2002 (score ≥5) had a twofold greater risk of in-hospital mortality (RR = 2.29; 95%CI: 1.42-3.68; p = 0.001). The area under the ROC curve to predict mortality was 0.693 for mNUTRIC; 0.645 for NRS-2002; and 0.666 for mNUTRIC and NRS-2002 combined. The mNUTRIC and NRS-2002 scores had similar performance in predicting hospital mortality. The mNUTRIC has better discriminant ability to quantify the risk of mortality in critically ill patients.

Nutritional risk and associated factors of adult in-patients at a teaching hospital in the Copperbelt province in Zambia; a hospital-based cross-sectional study

BackgroundNutritional risk and undernutrition are common problems among medical and surgical patients. In hospital, malnutrition is frequently under-diagnosed and untreated thereby contributing to morbidity and mortality. The purpose of this study was to determine the prevalence of nutritional risk among adult inpatients at a teaching hospital in Zambia. In addition, the study sought to establish factors associated with nutritional risk.MethodsA hospital-based cross-sectional study comprising of 186 consecutive in-patients aged 18–64 years admitted in medical and surgical wards was conducted at a teaching hospital. Out of one hundred and ninety eight (198) patients eligible to participate, complete data were collected from 186, representing a response rate of 93.9%. The Malnutrition Universal Screening Tool was used to collect data over a period of six months. Evaluated patients were dichotomized into no risk and nutritional risk. Binary logistic regression was performed to identify variables associated with nutritional risk.ResultsThe mean age of adult in-patients was 40.72 ± 14.4 years. Majority of the patients were male (61.8%), while 38.2% were female. Results indicate that 59.7% of hospitalized patients were at nutritional risk. Vomiting, weakness, appetite decrease, dysphagia and weight loss were significantly associated (p = 0.019, p = 0.008, p < 0.001, p = 0.007, and p < 0.001 respectively) with nutritional risk. However, weight loss and appetite decrease were the most significant factors associated with nutritional risk (OR = 50.16, 95% CI = 5.75–36.70, p < 0.001 and OR = 28.06, 95% CI =1.49–8.12, p = < 0.001 respectively).ConclusionFindings of our study suggest that close to 60% of adult inpatients at the teaching hospital were at nutritional risk. Nutritional risk is an issue of major concern at the teaching hospital and is associated with a number of variables. Identification of nutritional risk using Malnutrition Universal Screening Tool among adult inpatients is feasible in resource-poor settings like ours.

Nutrition screening in public hospital emergency rooms: Malnutrition Universal Screening Tool and Nutritional Risk Screening-2002 can be applied

To evaluate the agreement between two nutritional screening tools (Malnutrition Universal Screening Tool [MUST] and Nutritional Risk Screening-2002 [NRS-2002]) and Subjective Global Assessment (SGA) to identify nutritional risk in patients admitted to public emergency rooms. Cross-sectional study. Patients aged ≥18 years who were admitted to an emergency room of a tertiary public hospital were evaluated. A nutritional risk assessment was performed in the first 48h following hospital admission, through MUST, NRS-2002, and SGA. The Cohen's kappa coefficient was calculated. The study included 577 patients, with an average age of 53.9±15.8 years; 56% of whom were women. Prevalence of nutritional risk was 35.3% and 28.5% according to MUST and NRS-2002, respectively, and malnutrition prevalence was equal to 32.9% according to SGA. The Cohen's kappa coefficient between SGA and MUST was 0.67 and between SGA and NRS-2002 was 0.62. MUST and NRS-2002 showed good agreement with SGA in identification of nutritional risk, suggesting that both tools have similar applicability for nutritional screening in adults or older patients admitted to public emergency rooms.

EARLY IDENTIFICATION OF MALNUTRITION RISK AMONG FREE-LIVING ELDERLY PERSONS IN ATHENS, GREECE

Background: Malnutrition is a serious problem, which cannot be easily detected among free-living elderly people, and may lead to various health and social problems and deteriorate their quality of life. Objectives: To determine the prevalence of malnutrition and malnutrition risk among free-living elderly in the community of an urban municipality of Attica and to identify socio-economic, health and dietary factors that may increase malnutrition risk. Design: Cross-sectional. Setting: Elderly people attending the Open Care Community Centers at N. Philadelphia (an urban municipality of Attica). Participants: 151 free-living people aged over 65 years (78 women and 73 men). Measurements: Mini Nutritional Assessment (MNA) questionnaire was completed, as well as socio-demographic, medical history, physical activity and alcohol consumption data was collected through a personal interview with the participants. Results: None of the individuals was found to be malnourished, but 25,8% of the sample was at risk of malnutrition. After performing backward regression analysis recent appetite (p&lt;0,009) and weight loss (p&lt;0,003), latest development of psychological stress or acute disease (p&lt;0,0001), number of full-course meals (p&lt;0,0001), protein intake index (p&lt;0,002), minimum daily consumption of 2 portions of fruits or vegetables (p&lt;0,0001), daily consumption of liquids (p&lt;0,004), individual's self-evaluation of health (p&lt;0,0001) and nutritional status (p&lt;0,0001) all correlated significantly with MNA Screening Score. Conclusions: A significant number of free-living elderly persons were found at risk of malnutrition. Several dietary variables were found to correlate significantly with malnutrition risk. Early identification of nutritional risk of malnutrition in the community could ameliorate the nutritional status of seniors and consequently their health and quality of life.

Association of early life health conditions, nutritional status, and feeding practices with caries prevalence in preschool children

This study aimed to determine whether health conditions in the first year of life, nutritional status and dietary habits throughout life are related to the prevalence of early childhood caries (ECC). Material and methods: Sample consisted of 338 children from public schools. The prevalence of dental caries was assessed by dmf-t index. An anthropometric analysis was conducted for identification of nutritional risk. Data were analyzed using Chi-square and Poisson regression analysis, considering the dependent variables: a) presence of ECC (dmft ≥ 1); b) presence of severe ECC (dmft ≥ 6). Results:It was observed that 64% of the children exhibited ECC (mean dmft 2.97) and 23% suffer from severe ECC (mean dmft 8.2). 28 (11%) were at nutritional risk and more than 30% consumed sweets one or more times a day. It was observed that 8% showed low birth weight, 9% used antibiotics frequently in the first year of life and 67% maintained the habit of nocturnal bottle/breast-feeding after this period. Nocturnal feeding for prolonged time, frequent use of antibiotics and nutritional risk were associated with higher prevalence and severity of caries in the multivariate analysis. Conclusion: These results reinforce the relationship between early life events, nutritional status, and dental caries in primary teeth.

Australian general practitioners' views regarding providing nutrition care: results of a national survey

BackgroundThe prevalence of chronic disease is considerable, and dietary behaviours influence the progression of many chronic diseases. Practice guidelines recommend that general practitioners (GPs) promote healthy dietary behaviours in relevant consultations with patients in order to improve health outcomes at a population level. ObjectiveTo describe GPs' perceived interest, confidence and barriers to support patients to have a healthy diet. MethodA 24-item online and written survey was distributed in a national weekly newsletter to GPs in Australia. Results were descriptively analysed and investigated for associations with GPs' demographic characteristics. ResultsA total of 322 GPs responded to the survey. Nearly all (n = 295, 91.6%) were interested in supporting patients to eat well, and most (n = 231, 71.7%) reported moderately high confidence for providing nutrition care with clear public health messages for conditions, such as cardiovascular disease. Many GPs (n = 170, 52.8%) cited lack of time as the biggest barrier to providing nutrition care, and the overwhelming majority (n = 289, 89.8%) were interested in receiving additional education and training to enhance their nutrition knowledge and skills. DiscussionMany GPs are interested in nutrition and would benefit from educational programmes that improve their competence to provide nutrition care. Professional development opportunities should focus on the identification of nutritional risk and the promotion of healthy dietary behaviours within the time constraints of a standard consultation.

Avaliação nutricional subjetiva global: instrumentos para triagem em crianças hospitalizadas

Introduction: Over the past few years, several nutritional screening tools have been developed for application in hospitals. Those have, as main objective, the early identification of nutritional risk, which allow theevaluation and previous nutritional diagnosis enabling the professional to intervene before the worseningof malnutrition, preventing its consequences. The choice of a uniform and validated tool is an importantissue in the execution of nutritional screening. Objectives: To present four methods of nutritional screeningin pediatrics and discuss their advantages and disadvantages. Methodology: Survey of scientific articlespublished in databases like SciElo, LILACS, PubMed and MedLine from 1995 to 2015, in English,Portuguese and Spanish. The keywords used were: “nutritional screening”, “nutritional risk”, “nutritionalassessment” and “children”. Studies on nutritional screening tools developed for children and teenagerswere included and the studies concerning adults and elderly were excluded. Those which dealt with toolsdesigned for specific diseases were also excluded. Result: Of the four nutritional screening tools studied,the Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids) was presented asthe easiest and most practical tool to use compared to others, and may be applied by any health professionalin the moment of the patient’s admission. Conclusion: Based on the characteristics of each screeningmethod studied might not elect the most suitable because all of them have limitations in their application.

MON-PP135: Concordance between NRS-2002, must and SGA in the Identification of Nutritional Risk in Patients Admitted to the Emergency Service of a Public Hospital in Southern Brazil

MON-PP135: Concordance between NRS-2002, must and SGA in the Identification of Nutritional Risk in Patients Admitted to the Emergency Service of a Public Hospital in Southern Brazil

Identification of nutritional risk by nursing staff in secure psychiatric settings: reliability and validity of St Andrew's Nutrition Screening Instrument

Nutrition screening is the first-line approach to addressing the nutritional needs of service users and has been recommended as best practice by several authoritative and regulatory bodies. A simple and comprehensive screening tool, the St Andrew's Nutrition Screening Instrument (SANSI), was developed for use in an inpatient secure psychiatric setting. The aim of this study was to test the screening tool for reliability and validity. This study identified SANSI as reliable and valid for use in secure psychiatric settings for adolescents and adults. This should give confidence to regulatory and commissioning organizations, that the nutritional risk for patients in an organization which serves a diverse mental health population is being correctly identified, raising staff awareness and allowing appropriate action to be planned.

Nutrition Risk Assessment and Blood Transfusion

As a measure of physiological fitness, serum albumin aids in the identification of nutrition risk and, therefore potential for effective intervention. This study was undertaken to determine differences in the likelihood of blood transfusion among patients screened for nutrition risk including comparison of serum albumin levels.One hundred and ninety-eight nutrition assessment records, complete with admission values for serum albumin, were retrospectively reviewed for patients admitted to a rural referral center in North Central Ohio. A comparison of serum albumin, red blood cell transfusion, and nutrition risk assessment was completed. The standard screening criteria used by dietitians to evaluate a patient's nutritional status for purposes of assigning nutrition risk categories included, a) weight less than 80% ideal body weight or recent weight loss of 5% or more in 30 days, b) serum albumin less than 3.5g/dl, or c) diagnosis of malnutrition or other diagnosis routinely associated with prolonged poor oral intake. Absence of these risk factors placed a patient in nutrition risk levels I or II, while presence of one or more risk factors placed a patient in nutrition risk levels III or IV Statistical analysis was performed using Student's t-test.Eighty-one percent (n= 161) of the records reviewed showed evidence of nutrition risk, placing the patients in nutrition risk levels III or IV Serum albumins for level HI and IV patients were not significantly different from those of level I and II patients Twenty patients, all level III and IV nutrition risk, received red blood cell transfusions during the hospital course. As a group, the transfused patients had significantly lower serum albumin levels on admission than non-transfused patients (p<0.01).The results of this study indicate that transfusion of blood products during hospital stay are associated with patients in higher nutrition risk categories. Patients with increased nutrition risk, who subsequently receive transfusions, have overall lower serum albumin levels than non-transfused patients.