Malnutrition In Hospitalized Patients Research Articles

Coexistence of overweight and malnutrition in hospital patients and association with clinical outcomes: A double burden?

Coexistence of overweight and malnutrition in hospital patients and association with clinical outcomes: A double burden?

Hastanede yatan hastalarda malnütrisyonu etkileyen faktörler

Hastalık ilişkili malnütrisyon gelişmiş ve gelişmekte olan ülkeler için önemli bir sağlık sorunudur. Günümüzde gelişmiş ülkelerde çeşitli nedenlerle hastaneye yatırılan hastaların %50’sinden fazlasında değişen derecede malnütrisyon vardır. Malnütrisyon morbidite ve mortalite ile yakın ilişkilidir. Organ fonksiyonlarındaki bozulma nedeniyle, hastanede kalış süresi, komplikasyon gelişimi, tekrarlayan hastane başvurusu, erken yaşta bakım kurumlarında yaşayan birey sayısında artışa ve azalmış yaşam süresine neden olmaktadır. Sonuç olarak; geriatrik yaş grubu, malignitesi olanlar, yoğun bakımda yatanlar başta olmak üzere hastanede yatan hastalarda malnütrisyon fazladır. Bu nedenle, hastaneye yatan tüm hastalar malnütrisyon riski açısından değerlendirilmeli, malnütrisyon saptananlara erken müdahale edilmeli, saptanmayanlarda da malnütrisyon gelişmemesi için gereken önlemler alınmalıdır.

Prevalence of nutritional risk and malnutrition in hospitalized patients with different stages of lung cancer in a tertiary hospital in Chongqing: a cross-sectional survey

Objective To investigate the prevalence of nutritional risk and malnutrition in hospitalized lung cancer patients in a tertiary A hospital in Chongqing. Methods From December 2013 to July 2017, 2 735 consecutive lung cancer patients were admitted to the Department of Pneumology at Daping Hospital for planned anti-cancer treatment. Patients who did not complete a nutritional status assessment and who had repeated admission were excluded from the study. The demographic and tumor characteristics were investigated in the 548 lung cancer inpatients who completed the study. The nutritional risk screening 2002 (NRS 2002) was used to evaluate the nutritional risk. The individual nutritional status was also evaluated using the patient-generated subjective global assessment (PG-SGA) questionnaire, anthropometry measurements and hematological measurements. The physical status was assessed by the Karnofsky performance status (KPS). Results According to the NRS 2002 score, 29.56% (162/548) of the cancer patients had nutritional risk (score ≥3). The prevalence of nutritional risk was 17.39%, 15.00%, 22.00% and 36.86%, respectively, for patients with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ lung cancer. Forty-four patients (9.67%) had a body mass index<18.5 kg/m2 and poor general condition, and the prevalence was 6.52%, 5.00%, 8.67% and 11.22%, respectively, for stages Ⅰ, Ⅱ, Ⅲ and Ⅳ. A total of 107 cases (19.53%) had impaired nutritional status (indicated by a severity score of 3 in the NRS 2002). The prevalence by different stages was 10.87% (stage Ⅰ), 5.00% (stage Ⅱ), 14.67% (stage Ⅲ) and 25.00% (stage Ⅳ). One hundred and twenty-five patients (22.81%) had PG-SGA scores ≥9, with 2.19%, 2.50%, 12.67%, and 33.33% of patients in stages Ⅰ, Ⅱ, Ⅲ and Ⅳhaving these high scores. The KPS scores were lower in the patients with nutritional risk and malnutrition than in the patients with a normal nutritional status. Conclusions The prevalence of nutritional risk and malnutrition in patients with lung cancer were medium. Nutritional risk screening and nutritional status assessment should be considered at the time of admission for lung cancer patients in order to ensure better outcomes of treatment. Key words: Lung cancer; Cancer stage; Nutritional risk screening 2002; Nutritional status assessment; Patient-generated subjective global assessment; Malnutrition

Detecting and managing malnutrition in hospital patients: the battle continues.

Detecting and managing malnutrition in hospital patients: the battle continues.

Progress in nutrition screening and management models of hospitalized patients

This review outlined the status of malnutrition in hospitalized patients around the world, introduced the application of various nutritional screening tools and elaborated the important effects of nutrition risk evaluation and intervention on clinical outcome of patients. To solve the problem of shortage of systematic and cooperative work in clinical nutrition management in China, software of nutrition screening and management was designed so as to simplify the nutrition management process and provide a powerful guarantee for promoting clinical nutrition treatment work. Key words: Review; Hospitalized patient; Nutrition assessment; Nutritional risk screening; Multidisciplinary team

Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture

IntroductionOne percent of falls in over-75years old cause hip fracture (HF). Protein-energy malnutrition (PEM) is associated with falls and fracture. PEM screening and perioperative nutritional management are recommended by the European Society of Parenteral and Enteral Nutrition, yet data on nutritional status in elderly HF patients are sparse. The Mini Nutritional Assessment (MNA) score is presently the most effective screening tool for PEM in over-75years old. ObjectiveThe principal objective of the present study was to determine the prevalence on MNA of PEM in patients aged over 75years admitted for HF. Secondary objectives were to identify factors associated with PEM and its role as a factor of evolution. Materials and methodsA prospective observational epidemiological study included 50 patients aged over 75years admitted for HF in an 8-bed orthopedic surgery department with a geriatric follow-up unit. PEM was defined by MNA<17/30. Assessment systematically comprised associated comorbidity (Cumulative Illness Rating Scale-Geriatric [CIRS-G]), cognitive status on the Mini Mental State Examination (MMSE), functional status on activities of daily life (ADL), and mean hospital stay (MHS). Scores were compared on quantitative tests (Student t) with the significance threshold set at P<0.05. ResultsMean age for the 50 patients was 86.1years (range, 77–94years). Prevalence of PEM was 28%; a further 58% of patients were at risk for PEM. PEM was associated with elevated CIRS-G (P<0.006), greater numbers of severe comorbidities (P=0.006), more severe cognitive disorder (P=0.005) and functional dependence (P=0.002), and 8 days’ longer MHS (P=0.012). DiscussionThe present study confirmed the high prevalence of PEM in HF patients aged over 75years, supporting longer hospital stay. MNA is a diagnostic gold standard, not to be replaced by albuminemia or body-mass index in this perioperative clinical situation. Given the present economic stakes relating to geriatric trauma patients’ hospital stay, it is essential to prevent, diagnose and treat PEM in elderly subjects. Level of evidenceLevel IV; prospective cohort study.

Desnutrición y factores asociados en adultos mayores hospitalizados

Objectives: To investigate the frequency of malnutrition and associated factors in patients over 65 years of age in a hospital. Methods: We conducted an observational, crosssectional and descriptive study. Department of Nutritional Support, Hospital Medica Sur, Mexico, we evaluated patients over 65 years of age within the first 24 hours of admission Results: We evaluated 769 patients, 49% of whom were women and 51% were men, with an average age of 75.3 ± 7.7 years. Among the patients evaluated, 53.6% exhibited an altered nutritional state. In addition, 9% were diagnosed as obese and 15% as overweight. Their risk of malnutrition was determined to be 22.5%, and at the time of admission, 7% were malnourished. Conclusion: The prevalence of malnutrition in hospitalized patients over 65 years of age was high. Thus, the early diagnosis of patients who are at risk for malnutrition or who are malnourished is essential and allows for prompt treatment.

Comparison of five malnutrition screening tools in one hospital inpatient sample

The purpose of this study is to compare five commonly used malnutrition screening tools against an acknowledged definition of malnutrition in one hospital inpatient sample. Early identification and intervention of malnutrition in hospital patients may prevent later complications. Several screening tools have reported their diagnostic accuracy, but the criterion validity of these tools is unknown. A cross sectional study. We compared quick-and easy screening tools [Malnutrition Screening Tool (MST), Short Nutritional Assessment Questionnaire (SNAQ) and Mini-Nutritional Assessment Short Form (MNA-SF)] and more comprehensive malnutrition screening tools [Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS-2002)] to an acknowledged definition of malnutrition (including low Body Mass Index and unintentional weight loss) in one sample of 275 adult hospital inpatients. Sensitivity, specificity, positive predictive value and negative predictive value were determined. A sensitivity and specificity of ≥ 70% was set as a prerequisite for adequate performance of a screening tool. According to the acknowledged definition of malnutrition 5% of patients were at moderate risk of malnutrition and 25% were at severe risk. The comprehensive malnutrition screening tools (MUST, NRS-2002) and the quick-and-easy malnutrition screening tools (MST and SNAQ) showed sensitivities and specificities of ≥70%. However, 47% of data were missing on the MUST questionnaire and 41% were missing on MNA-SF. The MNA-SF showed excellent sensitivity, but poor specificity for the older subpopulation. The quick-and-easy malnutrition screening tools (MST and SNAQ) are suitable for use in an hospital inpatient setting. They performed as well as the comprehensive malnutrition screening tools (MUST and NRS-2002) on criterion validity. However, MUST was found to be less applicable due to the high rate of missing values. The MNA-SF appeared to be not useful because of it low specificity. Insight in what is the most valid and practical nutritional screening tool to use in hospital practice will increase effective recognition and treatment of malnutrition.

Development and validation of 3-Minute Nutrition Screening (3-MinNS) tool for acute hospital patients in Singapore.

It is important to detect and treat malnutrition in hospital patients so as to improve clinical outcome and reduce hospital stay. The aim of this study was to develop and validate a nutrition screening tool with a simple and quick scoring system for acute hospital patients in Singapore. In this study, 818 newly admitted patients aged above 18 years old were screened using five parameters that contribute to the risk of malnutrition. A dietitian blinded to the nutrition screening score assessed the same patients using the reference standard, Subjective Global Assessment (SGA) within 48 hours. Sensitivity and specificity were established using the receiver operator characteristics (ROC) curve and the best cut-off scores determined. The nutrition parameter with the largest area under the ROC curve (AUC) was chosen as the final screening tool, which was named the 3-Minute Nutrition Screening (3-MinNS). The combination of the parameters weight loss, intake and muscle wastage (3-MinNS), gave the largest AUC when compared with SGA. Using 3-MinNS, the best cut-off point to identify malnourished patients is three (sensitivity 86%, specificity 83%). The cut-off score to identify subjects at risk of severe malnutrition is five (sensitivity 93%, specificity 86%). The 3-Minute Nutrition Screening is a valid, simple and rapid tool that identifies acute hospital patients at risk of malnutrition in Singapore. It is able to differentiate patients at risk of moderate malnutrition and severe malnutrition for prioritization and management purposes.

The reported use of dietary supplements (sip feeds) in hospitals in Wessex, UK

Aims: To assess the prevalence of the use of supplements (sip feeds) in district general, psychiatric and community hospitals in the former Wessex health region.Method: Cross sectional study of prevalence and determinants of supplement use in 10 district general hospitals (covering medical, surgical, orthopaedic, and elderly specialities), 4 psychiatric hospitals and 3 community hospitals.Results: Overall 14% of patients were being supplemented although the variation across hospitals and specialities was wide (0%–35%); elderly care patients within district hospitals were most likely to be supplemented (20%; range 12–35%). In 34% of patients there was no documented reason as to why supplements were given. 60% of patients were not weighed on admission; 70% did not have a weight history recorded and 83% did not have a current weight recorded. Documentation regarding supplement use appeared to be recorded in an unsystematic manner.Conclusions: Many patients were not being weighed on admission and appeared to have no documentation as to why supplements were given. Given the importance of malnutrition in hospital patients a more evidence based, objective approach to assessing nutritional requirements, intake and support may be beneficial.

Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients

OBJECTIVE: We assessed nutrition status and prevalence of malnutrition in hospital patients as determined by the Subjective Global Assessment Form, awareness of patients’ nutrition status by health teams, and the use of nutrition therapy. METHODS: We enrolled 4000 hospital patients at least 18 y old who were covered by the Brazilian public health care system in a cross-sectional, multicenter epidemiologic study. We used Student’s t and chi-square tests for univariate and multiple logistic regression analyses. RESULTS: Malnutrition was present in 48.1% of patients and severe malnutrition was present in 12.5% of patients. The prevalence of malnutrition was higher in the northern and northeastern regions of Brazil, where per-capita income is lower. Malnutrition correlated with primary diagnosis at admission, age (60 y), presence of cancer or infection, and longer hospital stay ( P < 0.05). Fewer than 18.8% of patients’ records contained information on nutrition-related issues. Nutrition therapy was used in 7.3% of patients (6.1% enteral nutrition and 1.2% parenteral nutrition). CONCLUSIONS: The prevalence of malnutrition in hospitalized patients in Brazil is high, physician awareness of malnutrition is low, and nutrition therapy is underprescribed.

Malnutrition Awareness Activity

Nutrition professionals are acutely aware of the role of preexisting malnutrition in hospital patients and have developed screening tools for early identification. Given the shorter lengths of stay and increased patient acuity, it is imperative to help expand the skills of other professionals in identifying patients at risk for protein-energy malnutrition before or at admission.

Nutrition: a necessary adjunct to hospital care?

Good nutrition is undoubtedly central to optimum health and to the recovery from illness yet research and clinical surveys repeatedly demonstrate an unacceptably high incidence of malnutrition in hospital patients in whom it delays recovery, increases the incidence of complications and significantly increases the cost of treatment; the human cost is inestimable.

Malnutrition in hospital patients: where does it come from?

This article provides a comprehensive overview of malnutrition in hospital patients. It explores the issues surrounding nutrition and investigates factors that contribute to the malnutrition seen in patients within the community and to the malnutrition that develops while patients are in hospital. It proposes that although patients are at risk of malnutrition in the community, malnutrition can develop while the patient is in hospital, as the result of changes in diet, nutrition not being seen as a high priority, common hospital practices, and lack of knowledge of patients' previous nutritional state.

Nutrition: a hard nut to crack. An exploration of the knowledge, attitudes and activities of qualified nurses in relation to nutritional nursing care

Provision of adequate nutrition is recognized as essential, yet malnutrition continues to be reported in patients admitted to hospital. The effects of malnutrition in hospital patients have been well documented; however, most work relating to nutritional management has been produced by members of Nutrition Support Teams, nurse specialists and interested clinicians, whilst the majority of hospitals are still without such specialist posts. This study used two data collection methods to gain information about the attitudes, nutritional knowledge base and nutrition-related nursing care in a large trust hospital in the South of England. A survey of care plans for documentation of nutrition-related nursing activities, carried out on the day of discharge for all patients from five wards over a period of a fortnight (totalling 141 sets of documentation), was followed by a questionnaire to all qualified nurses on these and a further four wards (110 nurses). Results demonstrated that nurses generally felt that nutritional assessment was primarily their responsibility. Whilst there was evidence of knowledgeable and proactive nursing care, it also appeared that there were fairly widespread deficiencies in the knowledge, communication and co-ordination required to ensure consistent good practice.

Assessing malnutrition - a clarification

Our article on Enteral Feeding1 exaggerated the prevalence of malnutrition in hospital patients. The two surveys we cited used different standards to assess the nutritional status of hospital inpatients,2 3 and neither showed that what was regarded as ‘malnutrition’ actually harmed the patient. It is not known what level of malnutrition impairs wound healing, delays recovery or predisposes to complications. Several studies have related postoperative complications to malnutrition,4 but have failed to distinguish between the effects of malnutrition, and those of age and severe disease (often malignant) which it usually accompanies.