Implementation Of Nutritional Support Research Articles

Nutritional status in patients with tuberculosis and diabetes mellitus: A comparative observational study

BackgroundIndia has been estimated to have 14 % of malnourished population and a high TB incidence burden with a 26.9 lakh cases. Malnutrition and diabetes mellitus are major risk factors for tuberculosis infection. Malnutrition in patients with both tuberculosis and diabetes (TB-DM) population worsens the disease severity, treatment outcomes and increases morbidity and mortality risk. ObjectiveTo assess the nutritional status in patients with TB-DM compared with patients with TB and DM alone. MethodRecords from January 2016 to November 2020 for patients admitted to Kasturba Hospital, Manipal were assessed. Data pertaining to glycemic parameters, nutritional parameters, and other relevant laboratory parameters were extracted for assessment. The study population were divided into three groups i.e. patients with TB-DM, TB and DM. The statistical association was carried out with one-way ANOVA method, considering p < 0.05 as statistically significant. ResultsA total of 291 patients were included, with 97 patients in each group; among those, male and female were 86.27 % and 13.73 % respectively. Cardiovascular co-morbidity was predominant in the DM (68.04 %) and TB-DM (26.8 %) group. The mean value of HbA1c (10.47 %) was found to be highest for the TB-DM group. Low levels of albumin were reported by 71.91 % of patients of the TB group, whereas 73.68 % patients in TB-DM group had vitamin D deficiency. Moreover, higher prevalence of low MCV and MCH in the TB-DM group suggest an increased risk of iron-deficiency anemia. ConclusionThe findings of our study reflect the need for implementation of nutritional support in patients with TB-DM.

Organizational aspects of nutritional support for patients in a multidisciplinary emergency hospital

Nutritional support, which is a process of substrate provision with all the nutrients necessary for life for various categories of patients who do not have the opportunity for proper natural nutrition, is a mandatory basic component of their intensive treatment. The practical implementation of nutritional support has two aspects: clinical and organizational. Currently, all components of the clinical aspect are well developed and tested and there are no reasons not to use them in everyday clinical practice. The least resolved and worked out in the majority of our medical institutions remains the organizational aspect, which often does not allow for the proper realization of this type of medical treatment. The article contains the main organizational options for decision the existing problem and many years of practical experience in implementing nutritional support in a multidisciplinary emergency hospital.

Suspected hindlimb peripheral nerve damage in a feline patient

Peripheral nerve disorders affecting the hindlimb in the feline are an uncommon reason for presentation for rehabilitation therapies. This article describes how suspected cases may be approached and presents a case report of a feline patient that was referred for physiotherapy following hindlimb monoparesis with a presumed diagnosis of peripheral nerve injury.

Nutritional management of critically ill and hospitalised patients

Nutrition plays an important role in the management of critically ill and other hospitalised patients, such as patients undergoing routine post-operative care. However, nutrition is often overlooked as an important part of patient care. Identifying patients at risk for malnutrition, addressing malnutrition, considering medical aspects of a case that contribute to malnutrition, completing a nutritional assessment, determining how much to feed and what to feed a hospitalised patient and monitoring a patient after implementation of nutritional support are all important components of managing critical care and hospitalised patients. Creating a customised nutritional support plan is integral to supporting these dogs and cats.

Sipping as a Nutritional Supplement in Ambulatory Palliative Oncology Care: A Pilot Study with Noninvasive Methods.

Objective: The implementation of nutritional support is a basic need of patients in palliative oncological care. This pilot study optimized the use of sipping to improve the nutritional status of cancer patients in palliative care. Materials and Method: The pilot study included 63 patients, 61.3 years of age on average (range: 32-82 years of age). The patients were assigned to either group A (no nutritional support n = 39 patients) or group B (sipping as nutritional support n = 24 patients). The patients were evaluated through by noninvasive methods: body weight, waist and arm circumference, and triceps skinfold, bioimpedance analysis, and dynamometry. Quality of life was assessed through modified questionnaires. Results: In contrast with group A, group B did not have a significant weight loss, that is, A: 81.9 ± 15.8-80.5 ± 15.8 kg (P = .028) and B: 73.9 ± 14.9-73 ± 16 kg. Body mass index A: 29 ± 5-28.5 ± 5 kg/m2 (P = .007) and B: 25.3 ± 4.7-25 ± 4.9 kg/m2 (P = .614). Waist circumference A: 93.5 ± 15.1-92.5 ± 14.8 cm (P = .008) and B: 80.1 ± 13.2-80.6 ± 12.3 cm (P = .234). Triceps skinfold A: 12.3 ± 7.2-11 ± 6.7 mm (P = .001) and B: 8.2 ± 6.1-7.9 ± 5.7 mm (P = .207). Fat free mass A: 54.8 ± 11.5-52.8 ± 11.6 kg (P = .018) and B: 54.7 ± 10.9-52.8 ± 11.5 kg (P = .207). Significantly lower dynamometer values were recorded in both groups; A: 25.6 ± 10.4-23.1 ± 10.3 kg (P = .010) and B: 27.4 ± 9.9-24.3 ± 9.1 kg (P = .009). In contrast to group B, the patients in group A showed slight variations in their health status, thus decreasing their scores into the significance limit (P = .072). Conclusion: Our results suggest that providing nutritional support in the form of sipping (∼12 g proteins, 300 kcal) on a daily basis prevents the loss of active tissue mass in palliative oncology patients. Based on these results, we recommend the inclusion of this simple nutritional support to prevent malnutrition in cancer patients in palliative care. The clinical study was registered by the internal ethics committee under the heading of its approval - Institutional Ethics Committee of the Hradec Králové Faculty Hospital, number 201311S2OP.

Evaluation of diagnostic and therapeutic procedures in patients with acute pancreatitis

&#x0D; Introduction and purpose: Acute pancreatitis remains a clinically significant problem worldwide and in Poland, where its incidence is observed to be twice as high as in the global population. The aim of this study is to describe the latest available guidelines for managing patients diagnosed with acute pancreatitis, including diagnostic methods, radiological approaches, as well as conservative and invasive therapeutic treatment.&#x0D; &#x0D; &#x0D; Materials and Methods: The literature available on PubMed, Scopus, Google Scholar databases, and guidelines from the Polish Society of Gastroenterology was reviewed using the words: „acute pancreatitis”, „pancreas", "AP treatment", and „acute pancreatitis management”.&#x0D; &#x0D; &#x0D; Description of the state of knowledge: Patients with suspicion of acute pancreatitis are mainly diagnosed based on their symptoms using the Revised Atlanta Classification comprising of clinical symptoms, elevated pancreatic enzymes level, and imaging test results. The recommended therapeutic management for patients with acute pancreatitis underlines the importance of conservative treatment before the implementation of invasive procedures, the choice of which should be based on the severity and form of the condition. &#x0D; &#x0D; &#x0D; Summary: The existing recommendations regarding the diagnostic approach in acute pancreatitis emphasize the importance of correlating symptoms with radiological findings obtained through ultrasound, which is a quick and widely accessible diagnostic tool. In therapeutic management, conservative treatment remains significant with the early implementation of nutritional support, along with the appropriate method and timing of surgical intervention depending on the form of acute pancreatitis and the presence of infection.&#x0D;

6. Swallowing dysfunction following oral cancer resection: an external validation study

Swallowing dysfunction is a complication of oral cancer resection, particularly in the context of flap reconstruction. In 2021 in BJOMS, we demonstrated that risk of swallowing dysfunction could be reliably predicted from pre-operative characteristics alone, to facilitate pre-operative implementation of nutritional support. The current study aimed to validate a model of swallowing dysfunction using an additional dataset collected since July 2020.

Nutritional impact on quality of life among people living with HIV/AIDS: An observational study

Limited evidence exists about the relation between nutrition, and quality of life among PLHIV. The study aimed to estimate the prevalence of under-nutrition, identify risk factors and assess correlations with PLHIV and their quality of life. The proper implementation of nutritional support and its integration with the highly active antiretroviral therapy package demands a clear picture of the magnitude and associated factors of malnutrition. The objective of this study is to assess the prevalence and factors associated with malnutrition among PLHIV.Institutional based observational study conducted on PLHIV. Anthropometry indices and biochemical parameters such as serum total protein, serum albumin, serum globulin, albumin: globulin ratio and CD4 cell count were analyzed and expressed as Mean ± standard deviation and p value less than 0.05 was considered to be significant.: This study contained 208 PLHIV with almost equal proportion of both the gender. It was found that the males had better BMI than females. The mean serum total protein levels, mean albumin levels and CD4 cell count were lower than the normal range showing impaired nutritional status of PLHIV. It was also found that there was direct correlation between serum albumin levels and CD4 cell count.Nutritional status was found to be positively correlated with quality of life. The results prove that the existing care for PLHIV is impaired for their well-being. Nutritional support should form a fundamental part of treatment for PLHIV, including more efforts.

Barriers and potential facilitators to implement nutrition care program in athletes' training centers in Indonesia.

Background: In order to improve national sport achievement in Indonesia, a new policy of nutritionist placement in every training center in Indonesia was proposed. The understanding of barriers and potential facilitators was needed to identify problems and arrange policy implementation strategies. Aim: This study aims to determine the barriers in nutrition intervention practices for athletes and opportunities in implementing the proposed policy of sport nutritionist placement in athlete training centers. Methods: The study was conducted using Consolidated Framework of Implementation Research (CFIR) as the guideline for data collection and analysis. In-Depth Interview (IDI) and Focus Group Discussion (FGD) were conducted on 9 participants from the Ministry of Youth and Sport, the Republic of Indonesia. Results: This study indicates that there are several potential barriers, which are influential on the implementation of nutrition support for athletes. These include the lack of facilitation of athletes' nutritional needs, lack of supervision for food catering service, lack of communication, and limited funding. In contrast, the potential facilitators are strong relationship with sport-related stakeholders, compatibility with the existing policy, relative advantages, and trialability of the proposed policy. Conclusions: The Indonesia Ministry of Youth and Sports should utilize these facilitators as opportunities to design, develop, and implement a policy that requires nutrition support available for all athletes at every PPLP in Indonesia.

Food intake and weight loss of surviving inpatients in the course of COVID-19 infection: A longitudinal study of the multicenter NutriCoviD30 cohort

ObjectivesNutriCoviD30 is a longitudinal multicenter cohort study that aimed to provide nutritional objective data of inpatients during COVID-19 infection. The aims of this study were to describe the nutritional effects of COVID-19 infection on adult inpatients on the short- to mid-term (≤30 d after hospital discharge), using food intake and weight measurements and to identify factors associated with a decrease in food intake and weight. MethodsFood intake and weight trajectories, as well as clinical signs of the disease, preexisting chronic diseases, and nutritional strategies were collected and analyzed during the course of the disease. Their association was estimated using mixed-effect regression modeling. Patients were recruited from French university hospitals from May to July 2020. For the 403 included patients (mean 62.2 ± 14.2 y of age; 63% men), median (interquartile range [IQR]) hospital length of stay was 13 d (IQR = 8, 20), and 30% of patients were admitted to the intensive care unit. ResultsPatients declared a median 70% food intake decrease in the acute phase, and the disease resulted in an average loss of 8% of predisease weight (corresponding to –6.5 kg). Although most patients recovered their usual food intake 1 month after hospital discharge, they only regained half of their weight loss, such that malnutrition, which affected 67% of patients during hospitalization, persisted in 41%. Patients with overweight, obesity, and diabetes reported an additional weight loss of >1.5% of their initial bodyweight during hospitalization and recovery phase. ConclusionsTo prevent malnutrition and its long-term effects, mainly combined with a rapid weight loss predominantly affecting lean body mass, implementation of nutritional support is needed for COVID-19 inpatients. It should be started early in the course of the infection, and be extended up to the recovery phase.

Audit of the provision of nutritional support to mechanically ventilated dogs and cats.

To evaluate the use of enteral and parenteral nutrition in a population of mechanically ventilated cats and dogs, identify factors associated with implementation of nutrition, and assess the frequency of nutritional support within 72hours of absent caloric intake. Retrospective, single-center audit from June 2013 to June 2016. ICU of a veterinary university teaching hospital. Fifty-eight animals (50 dogs, 8 cats) that underwent mechanical ventilation for ≥6hours with complete medical records. None. Data collected included nutritional provision, time to initiation of nutrition, period of absent caloric intake, percentage of caloric intake obtained, and possible factors contributing to the delay or failure to implement nutrition. Thirty-one percent of patients (dogs 16/50, 32%; cats 2/8, 25%) received nutritional support during mechanical ventilation with all but 2 dogs receiving parenteral nutrition. Of those patients that did not receive nutrition (dogs 34/50, 68%; cats 6/8, 75%), documented contraindications or notations within the medical record for its omission were present in 16 of 34 dogs (47%) and 4 of 6 cats (66.7%). Thirteen animals (11 dogs, 2 cats) had>72hours of absent caloric intake with only a small number of these receiving nutrition (dogs 4/11, 36.4%; cats 0/2, 0%). Only 18 of 58 (31%) mechanically ventilated dogs and cats at our institution received nutritional support, and the majority of these were fed parenterally (16/18, 88.9%). For animals that did not receive nutrition, there was no clear reason for its absence in many cases. Animals with absent caloric intake>72hours had poor implementation of nutritional support in contrast to current guidelines. A repeat audit after implementing changes to institutional protocols for nutritional provision is warranted to assess the impact on morbidity and mortality.

Nutritional support for critically ill patients with COVID-19

Nutritional support is an indispensable part in the treatment of critically ill patients with coronavirus disease 2019 (COVID-19). Critically ill COVID-19 patients are often in a state of high inflammation, high stress, high catabolism, and their energy consumption increases significantly. All critically ill patients with COVID-19 should be screened for nutritional risk with NRS-2002 or Nutric tool in the early stage. If there is a risk of malnutrition, subjective global assessment (SGA) or Global Leadership Initiative on Malnutrition (GLIM) are further used for malnutrition assessment. After assessment, the daily energy, protein, electrolyte and liquid quantity needed by the patients should be determined according to the actual condition. Then, according to the degree of gastrointestinal function impairment in patients, the oral nutrition supplement, enteral nutrition, parenteral nutrition or their combination are selected for nutritional support. For patients with normal gastrointestinal function who require prone position ventilation or receive extracorporeal membrane oxygenation (ECMO) treatment, enteral nutrition is recommended as the first choice. In addition, in the process of nutrition implementation, it is necessary to closely monitor the adverse reactions such as abdominal distention, diarrhea, regurgitation, phlebitis and liver function damage, timely adjust the nutrition program to ensure the smooth implementation of nutritional support. Based on the metabolic characteristics of critically ill patients with COVID-19, this paper makes a summary and suggestion on the following perspectives such as nutritional risk screening and assessment, target amount of nutritional treatment, nutritional intervention and treatment, nutritional support of special populations, and common adverse reactions in nutritional support treatment, so as to provide reference for individualized nutritional support therapy of critically ill patients with COVID-19.

2242 I'm Starving: A Rare Case of Liver Autophagocytosis Secondary to Anorexia Nervosa

INTRODUCTION: Anorexia nervosa is a common eating disorder associated with fear of gaining weight and when severe can cause life-threatening complications. While mild elevations in liver enzymes can occur in anorexia, severe liver injury is rarely reported. Autophagy is a liposomal catabolic pathway that is crucial for cell survival under stressful conditions. We present the case of a young female with anorexia nervosa with severe malnutrition found to have significantly elevated liver enzymes concerning for autophagocytosis of the liver. CASE DESCRIPTION/METHODS: A 19-year-old female with a history of severe anorexia nervosa (BMI 11.5) presented with 3 days of abdominal pain. Basic lab testing was done which revealed significant elevations in LFTs in a hepatocellular pattern with both AST and ALT above 1000. The patient underwent abdominal imaging with no major abnormalities found and viral, drug-induced, and autoimmune causes were also ruled out. However, her LFTs continued to uptrend with a peak AST of 6328 and ALT of 5606 and her hospital course was complicated by hypotension requiring ICU care. Due to severe nutritional deficits and inability to tolerate oral intake, the decision was made to initiate supplemental nutrition first with TPN and subsequently with enteral feeding through a PEJ. Following nutrition initiation, the patient’s liver enzymes started to down-trend and ultimately normalized within a couple weeks of nutritional support. Therefore, it was determined that the patient’s acute liver elevations and abdominal pain were likely secondary to liver autophagocytosis in the setting of severe starvation from anorexia nervosa. Due to the normalization of her LFTS, liver biopsy was not pursued. The patient improved and was discharged to a specialized eating disorder rehabilitation center. DISCUSSION: Autophagy is a physiologic process the body activates under episodes of severe stress which can include severe malnutrition. While mild liver enzyme elevation can occur, there are only a few reported cases of profound LFT elevation such as in this patient. Initiation of enteral/parenteral nutrition appears to improve liver injury and stop autophagy. Therefore, careful implementation of nutritional support and close monitoring of LFTs is essential in anorexic patients with liver injury to help treat the underlying condition, avoid unnecessary invasive diagnostic testing, and prevent further autophagy.

Nutritional Risk Screening and Assessment.

Malnutrition is an independent risk factor that negatively influences patients’ clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients’ nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.

Nutrition support for HIV-TB co-infected adults in Senegal, West Africa: A randomized pilot implementation study.

BackgroundFood insecurity can contribute to poor adherence to both tuberculosis treatment and HIV antiretroviral therapy (ART). Interventions that target food insecurity have the potential to increase treatment adherence, improve clinical outcomes, and decrease mortality. The goals of this study were to compare the feasibility, acceptability, and potential impact of implementing two different forms of nutrition support for HIV-TB co-infected adults in the Casamance region of Senegal.MethodsWe conducted a randomized pilot implementation study among HIV-TB co-infected adults initiating treatment for TB (ClinicalTrials.gov Identifier: NCT03711721). Subjects received nutrition support in the form of a local food basket or Ready-to-Use Therapeutic Food (RUTF), distributed on a monthly basis for six months.ResultsA total of 178 monthly study encounters were completed by 26 HIV-TB co-infected adults; 14 received food baskets and 12 received RUTF. For both the food basket and RUTF, 100% of subjects obtained the supplement at every study encounter, transferred the supplement from the clinic to their household, and consumed the supplement. The food basket had greater acceptability and was more likely to be shared with members of the household. Adherence to TB treatment and ART exceeded 95%, and all outcomes, including CD4 cell count, hemoglobin, nutritional status, and food security, improved over the study period. All subjects completed TB treatment and were smear negative at treatment completion. The total cost of the local food basket was approximately $0.68 per day versus $0.99 for the RUTF.ConclusionThe implementation of nutrition support for HIV-TB co-infected adults in Senegal is feasible and may provide an effective strategy to improve adherence, treatment completion, and clinical outcomes for less than 1 USD per day. Further studies to determine the impact of nutrition support among a larger population of HIV-TB co-infected individuals are indicated.

Development and validation of a questionnaire to evaluate the state of Iranian hospital nutrition support

BackgroundRecently, nutrition support was implemented as a part of clinical services in hospitals. The implementation of nutrition support needs to be assessed for its improvement.ObjectiveThis study aimed to develop and validate a questionnaire to assess the state of nutrition support in Iranian hospitals.MethodsA mixed method approach was used in this study. This study was performed in training hospitals of Iran in 2016. In the development stage, pre-determined keywords were searched on international electronic databases. Additionally, semi-structural interviews were performed with 13 key informants based on purposive sampling. Themes were extracted from articles and interviews by thematic analysis. A primary questionnaire was generated based on extracted themes. In the validating stage, the content validity ratio (CVR) and content validity index (CVI) were used. The reliability of the questionnaire was also computed through a pilot study using Cronbach’s alpha test. SPSS version 16.0 was used for data analysis.ResultsBased on 16 items elicited from the content analysis, 110 questions were generated, out of which, 65 questions were selected. Then, 55 questions showing acceptable CVI and CVR were chosen for the pilot study. The Cronbach’s alpha coefficient of the questionnaire was found to be 0.80. This value remained stable for each item, even after an item was deleted.ConclusionFor the first time, a validated questionnaire for the assessment of the state of nutrition support in hospitals was developed in a methodological approach process with high validity and reliability indexes which intended to be comprehensive based on the mixed method approach.

Protein Feeding in Pediatric Acute Kidney Injury Is Not Associated With a Delay in Renal Recovery.

Critically ill children with acute kidney injury (AKI) are at high risk of underfeeding. Newer guidelines for nutrition support recommend higher protein intake. Therefore, the study evaluated the effects of protein feeding on the resolution of AKI and compared energy and protein intake in patients with and without AKI after implementation of Nutrition Support guidelines. Retrospective study. Five hundred twenty critically ill children from October 2012 to June 2013 and October to December 2013. Energy and protein intake in patients with no AKI, resolved, or persistent AKI. Energy and protein intake was documented for days 1-8 of Pediatric Intensive Care Unit stay and in the postimplementation versus preimplementation period of nutrition support guidelines. AKI was defined by modified pRIFLE. Persistent AKI was defined as patients who did not resolve their AKI during the study period. A higher percentage of patients with resolved and persistent AKI met ≥ 80% of protein needs versus no AKI. After adjustment for Pediatric Risk of Mortality Score, the odds ratio for protein intake of ≥ 80% compared to <80% of estimated protein needs was not significant, which suggests that higher protein intake was not associated with nonresolution of AKI. There were significant improvements in the cumulative protein gap in patients with no AKI in the postimplementation (-1.0 [-1.7 to -0.6] g/kg/day) compared to preimplementation period (-1.3 [-1.7 to -0.9] g/kg/day, P=.001) and persistent AKI in the postimplementation (-0.8 [-1.4 to -0.1] g/kg/day) compared to preimplementation (-1.3 [-1.7 to -0.9] g/kg/day, P=.03). Higher protein intake was not associated with a delay in renal recovery in patients with AKI after adjustment for severity of illness. Protein intake was improved in critically ill children with no AKI, resolved, and persistent AKI after implementation of Nutrition Support Guidelines, but underfeeding persisted in these patients.

Implementation of Nutrition Support Guidelines May Affect Energy and Protein Intake in the Pediatric Intensive Care Unit

BackgroundCritically ill children are at risk of developing malnutrition, and undernutrition is a risk factor for morbidity and mortality. ObjectiveThe study evaluated changes in the energy and protein intake before and after implementation of nutrition support (NS) guidelines for a pediatric critical care unit (PICU). DesignThis retrospective study documented energy and protein intake for the first 8 days of PICU stay. Basal metabolic rate and protein needs were estimated by Schofield and American Society for Parenteral and Enteral Nutrition Guidelines, respectively. Participants/settingThree hundred thirty-five children from August to December 2012 (pre-implementation) and 185 from October to December 2013 (post-implementation). InterventionImplementation of NS Guidelines. Main outcome measuresChanges in actual energy and protein intake in the post- compared with the pre-Implementation period. Statistical analysis performedUnpaired t tests, Pearson’s χ2 (unadjusted analysis) were used. Logistic regressions were used to estimate odds ratios and 95% confidence intervals for protein and energy intake, adjusted for age, sex, and Pediatric Risk of Mortality score. ResultsAfter the implementation of guidelines, significant improvements were seen during days 5 through 8 in energy intake among children 2 years of age and older, and in protein intake in both age groups (P<0.05). For the 8-day period, statistically or clinically significant improvements occurred in the cumulative protein deficit/kg/day, as follows: younger than 2-year-olds, −1.5±0.7 g/kg/day vs −1.3±0.8 g/kg/day, P=0.02; 2-year-olds or older, −1.0±0.6 g/kg/day vs −0.7±0.8 g/kg/day, P=0.01; and for the energy deficit/kg/d in 2-year-olds and older, −17.2±13.6 kcal/kg/day vs −13.3±18.1 kcal/kg/day, unpaired t test, P=0.07, in the pre- vs post-implementation period, respectively. ConclusionsThe implementation of NS guidelines was associated with improvements in total energy in 2-year-olds and older and protein in younger than 2 and 2 years and older children by days 5 through 8, and protein deficits were significantly lower in the post- vs the pre-implementation period. The implementation of NS guidelines may have had a positive effect on improving NS in critically ill children.

PTH-224 A tall order? an audit on the accuracy of recorded and patient-reported height on a university hospital ward

Introduction Patient height is an important anthropometric measurement essential for nutritional assessment and screening. Often a subjective patient-reported height is used and is not objectively measured and recorded. The aim of this audit is to determine the accuracy of patient-reported height and height recorded in patient notes and whether inaccurate reporting impacts on body mass index (BMI) category and nutritional screening. Method The height of patients on the Hepatology ward at a University Hospital on a single day was measured by a Dietitian using an electronic stadiometer. Patient-reported height and height recorded in patient notes were also collected. Results A total of 27 patients were included, 52% female, mean age 64 (range 23–87). Height was recorded in the clinical notes for 15 (56%) patients. In all cases patient reported height was recorded in the notes as height was not objectively measured for any patient. 16 (59%) patients were able to stand to have height measured. It was not possible to measure height for 11 (41%) patients as they were unable to get out of bed due to poor mobility. Of the 16 patients who had height measured: 1 (6%) reported the same height as measured height; 12 (75%) reported their height as greater than measured height (range: 1–5 cm; mean: 3 cm); and 3 (19%) reported height as less than measured height (range: 1–2 cm; mean: 1.3 cm). The difference in measured height and reported height altered BMI by 0.2–2.1 kg/m 2 (mean: 0.86 kg/m 2 ) and changed BMI category according to the World Health Organisation categorisation in 4 (25%) patients, including incorrectly categorising one patient as overweight instead of a healthy weight. Conclusion This audit identifies the disparity between patient-reported and measured height with 75% of patients over-reporting and 19% under-reporting height. Furthermore, clinical staff may be faced with the challenge of estimating height in patients who are unable to stand. Inaccurate measurement of height may result in inappropriate nutritional advice or mask the risk of malnutrition and prevent the implementation of nutrition support. It is essential that all hospital wards have access to a stadiometer and height is accurately measured and recorded for all patients. As a result of this audit the ward stadiometer has been placed in an area easily accessible to patients and nursing staff. Results of the audit have been disseminated to ward staff and training has been provided to accurately measure and record height and estimate height by measuring ulna length for patients unable to stand. A re-audit is planned for 3 months following this training. Disclosure of interest None Declared.

Active nutrition policy in the implementation of the hospital nutritional support; results of an observational study

Malnutrition at hospitals is responsible for high morbidity and mortality** rates. This study aims at describing the results of the implementation of a hospital nutrition program with an eventual deployment of nutritional support. Observational, prospective, single-centre design. All adult patients consecutively admited in our hospital during the period January 2012-September 2013 were registered. The implementation of the nutrion program consisted of: nutritional assessment at admitance; examination of the patient with indications for starting nutritional support; implementation of nutritional support; monitoring and follow-up. 1,268 patients were admited. 1,234 patients (97.3%) underwent a nutritional assesment by means of Subjective Global Assessment. 821 patients (66.5%) were identified with cathegory A, 280 patients (22.7%) with cathegory B, and 60 patients (4.9%) with cathegory C. 269 patients (21.8%) presented indications for nutritional support of which 227 (84.4%) did receive it. A total of 219 patients (64.4%) out of the 340 patients (27.6%) representing the global figure of malnutrition at the hospital (cathegories B + C), presented indications for starting some kind of nutritional support. 181 patients (82.6%) initiated this nutritional support. 28 patients (73.7%) out of the 38 patients (17.3%) who did not initiate it showed EGS C, being the patients ominous prognostic the main reason for not starting the nutritional support. The aplication of a program aimed at the eventual implementation of nutritional support allowed the nutritional assessment of a high percentage of inpatients and the correct use of nutritional support on a high percentage of these patients.