Malnutrition Score Research Articles

Comparison of nutritional screening tools in pediatric oncology patients receiving chemotherapy treatment

BackgroundMalnutrition in pediatric oncology patients is a complex and multifactorial process, and the most appropriate screening tool to determine the risk of malnutrition is not clear. The study aimed to compare the Screening Tool for Risk on Nutritional Status and Growth (StrongKids), Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), which are commonly used in the general pediatric population, with the Nutrition Screening Tool for Childhood Cancer (SCAN), which was specifically validated for pediatric cancer, in determining the risk of malnutrition. MethodsThis cross-sectional study included 92 children aged 2–18 years who were admitted to the hematology-oncology unit and were receiving chemotherapy. The prevalence of nutritional risk was determined using the SCAN, StrongKids, PYMS, STAMP, and anthropometric assessments were performed. Sensitivity and specificity values, and the degree of agreement between screening tools were calculated. ResultThe SCAN identified nutritional risk in 69.6 % of the children. According to StrongKids, PYMS and STAMP, the high nutritional risk in children was 43.5 %, 56.5 % and 64.1 %, respectively. The sensitivity of STAMP (81.2 %) was higher than that of StrongKids (60.9 %) and PYMS (79.7 %). The specificity of StrongKids, PYMS and STAMP was 96.4 %, 96.4 %, and 75.0 %, respectively. There was substantial agreement between SCAN and PYMS. ConclusionPYMS has the best specificity and sensitivity in identifying patients at risk of malnutrition as determined by SCAN. Implications for practiceIn addition to anthropometric measurements, population-specific or highly sensitive nutritional screening tools should be used to determine the risk of malnutrition.

The impact of a pediatric malnutrition telehealth clinic on anthropometric measurements in children aged 6-59 months in rural Guatemala.

Guatemala, a country with high rates of pediatric malnutrition, has significant challenges including food and potable water insecurity and a lack of health care providers. This study examined the impact of telehealth clinic attendance on pediatric malnutrition scores. A sample of 42 Guatemalan children aged 6-59 months with malnutrition were recruited to participate in eight clinic events, including two in-person and six telehealth clinics. Six telehealth clinics were held at 4- to 6-week intervals, bookended by an initial and concluding in-person event. Nonparametric tests were used to analyze changes between baseline and last visit z-scores for height, weight for length, mid-upper arm circumference (MUAC), and body mass index (BMI) and to examine the relationship between the number of telehealth visits and z-score measurements at baseline and last visit. The number of children with severe malnutrition at baseline by weight for length, BMI, and MUAC decreased by the last visit. A decrease occurred in the number of children with stunted height. Changes in z-scores for height, weight for length, BMI, and MUAC between study onset and last visit did not reach statistical significance. Statistically significant relationships existed between clinic attendance and baseline and last visit weight for height/length z-scores and baseline MUAC z-scores. Positive improvements in nutritional status occurred, especially among children with severe malnutrition. Children with severe malnutrition had significantly better telehealth attendance. Studies with larger sample sizes are needed. Study results indicate that telehealth may be a tool to battle global pediatric malnutrition.

The prognostic impact of malnutrition on the outcomes of patients with vertebrobasilar artery occlusion following endovascular treatment

Background and purposeMalnutrition is associated with poor outcomes in different diseases. Our aim was to investigate whether measures of malnutrition could be used to predict 90-day outcomes in patients with vertebrobasilar artery occlusion (VBAO) undergoing endovascular treatment (EVT). MethodsWe retrospectively analyzed patients with VBAO who received EVT at three comprehensive stroke centers. Malnutrition was assessed using the controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI). Primary outcome was good functional outcome defined as modified Rankin Scale (mRS) 0–3 measured at 90 days. ResultsA total of 285 patients were enrolled, of which 260 (91.22 %) met the requirements. According to the CONUT, GNRI, and PNI scores, the proportions of patients classified as moderately or severely malnourished were 7.3 %, 3.08 %, and 35 %, respectively. In the multivariate regression model after adjusting for potential confounders, malnutrition (severe risk versus normal nutritional status) was significantly associated with an increased risk of poor prognosis for CONUT scores (adjusted odds ratio [OR]14.91, 95 %CI, 1.69 - 131.71; P = 0.015), GNRI scores (adjusted [OR] 10.67, 1.17 - 96.93; P = 0.036) and PNI scores (adjusted [OR] 4.61, 2.28 - 9.31; P < 0.001). Similar results were obtained when malnutrition scores were analyzed as continuous variables. Adding the 3 malnutrition measures to the risk reclassification that included traditional risk factors significantly improved the predictive value of 3-month poor prognosis. ConclusionsOur study showed that malnutrition may be associated with poor prognosis within 3 months of EVT in patients with VBAO.

Anthropometric and Nutritional status of Chronic Obstructive Pulmonary Disease presenting in Acute Exacerbation in Tertiary care Hospital in Eastern Nepal

Background: There is scarcity of data regarding the nutritional status of COPD patients presenting in exacerbation in our setup, thus this observational study was conducted. Methods: We performed an observational study of patients with acute exacerbation of COPD, who were admitted in the Department of Pulmonary, Critical care and Sleep Medicine in tertiary hospital in eastern Nepal from April 2023 to June 2023. Results: During the study period, a total of 154 patients of COPD with exacerbations were admitted in our department. The baseline anthropometric parameters, lab parameters as well as the malnutrition scores were determined. The mean BMI was 21.82 ± 3.92 kg/m2 and only 29% had BMI &lt; 18.5 kg/m2.The mean hemoglobin, mean cell volume, serum protein, serum albumin, serum calcium, phosphorus and vitamin D level were 12.43 ± 2.32 g/dL, 84.4 ± 9.41 fL, 6.42 ± 1.74 g/ dL, 3.32 ± 0.34 g/dL, 8.98 ± 0.63 mg/dL, 3.02 ± 0.42 mg/dL, 18.48 ± 8.22 pg/mL and 40%, 12%, 28%, 41%, 31%, 42% and 49% of these values were below the lower normal limit respectively. The nutritional status tool used NRS-2002, MUST and MNAS-F screened malnutrition in about 68%, 51% and 54% respectively. There shows a discrepancy between the evaluation of the malnutrition assessed by BMI with that of nutritional assessment score. Conclusion: COPD who present in exacerbations are malnourished, but use of sole BMI to rule out malnutrition in such group of patients can cause false negative result.

Sarcopenia, frailty prevalence, and related factors in patients with stroke: A cross-sectional analytical study from Turkey.

Sarcopenia and frailty may develop at varying rates depending on the metabolic, structural, and functional changes in the muscle structure after stroke. To evaluate the prevalence of sarcopenia and frailty in patients with stroke and affecting clinical parameters. This was a cross-sectional and analytical study. Twenty-six (49.1%) women and 27 men (50.9%) with stroke with an average age of 60.2 ± 10.3 (median = 62) years were included in the study. To evaluate physical performance, balance, and mobility, we used the 4-meter walk test (4-MWT), timed up and go test, chair sit and stand test, and the Berg Balance Scale (BBS). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. The SARC-F scale was used for sarcopenia. The average stroke duration was 21.6 ± 18.2 months. Prefrailty was present in 14 (26.4%) patients, frailty was present in 34 (64.2%) patients, and two (3.8%) patients were normal. Sarcopenia was detected in 28 (52.8%) patients. According to handgrip strength, the prevalence of low muscle strength was 17% (n= 9). In the sarcopenic group, female sex (p= 0.005) was more frequent, 4-MWT was longer (p= 0.003), chair stand test results were lower (p< 0.001), the clinical frailty scale (CFS) was higher (p< 0.001), fall risk was higher compared with the BBS (p< 0.001), there was lower HG strength (p= 0.009), lower malnutrition scores (PNI, prognostic nutritional index, p< 0.001), and lower lymphocyte counts (p= 0.037). EAT-10 scores and dysphagia presence (p= 0.026), the presence of malnutrition (p< 0.021) and Nottingham Health Profile score (p< 0.001) were higher in the sarcopenic group. Sarcopenia and frailty frequently develop in patients with chronic stroke, with low lymphocyte counts, physical performance, muscle strength, and mobility and balance scores, and it is associated with poor prognostic factors including high disease severity, dysphagia, malnutrition, risk of falling, and poor quality of life.

Exploring the Influence of Concurrent Nutritional Therapy on Children with Spinal Muscular Atrophy Receiving Nusinersen Treatment.

Background This study examines spinal muscular atrophy (SMA), a neuromuscular disease associated with malnutrition. Our goals are to assess how effectively screening tools can detect malnutrition and evaluate the impact of nutritional interventions on neurological outcomes, particularly motor functions. Methods Thirty-seven genetically diagnosed SMA patients (types 1, 2, and 3) under nusinersen therapy were included in the study. The nutritional status of these patients was assessed by using anthropometric measurements, including height for age (HFA), weight for height (WFH), and body mass index (BMI) before and after the study. Additionally, the risk of malnutrition was determined using screening tools, namely the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP). Nutritional counseling followed the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines and considered the patients' dietary history, including content and administration method. Motor functions were assessed by validated tests: the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) and the Hammersmith Functional Motor Scale-Expanded (HFMSE). Result The study showed an improvement in HFA, by a change from -0.95 to -0.65 (p = 0.015). Conversely, BMI scores decreased from 0.08 to -0.54 (p = 0.015), while WFH and MUAC showed no significant alterations (p = 0.135, p = 0.307). Following nutritional interventions, HFMSE demonstrated a median increase from 29.5 to 30.5 (p = 0.023). Patients identified as being at high risk for malnutrition based on PYMS and STAMP belonged to the moderate-to-severe malnutrition group (BMI Z-score ≤ -2, p = 0.001). Conclusions Use of screening tools in SMA patients is highly beneficial for the early detection of malnutrition. Future research should highlight the importance of combining nutritional management with nusinersen therapy to potentially alter the disease trajectory, especially in motor and neurological functions.

Assessment of Nutrition Screening Tools in Pediatric Oncology: A Systematic Review

Introduction: The global prevalence of children with cancer continues to increase, reaching 186.6 per 1 million children aged 0-19 years. Children with cancer face challenges in fulfilling nutrition due to increased energy needs due to disease and treatment side effects. Nutritional assessment using nutrition screening tools is currently highly variable and varies across health institutions. This study aims to critically describe the assessment of nutritional screening tools in ensuring suitability and sensitivity as well as advantages and disadvantages in identifying the nutritional needs of children with cancer. Methods: PRISMA was used as a guide in preparing a systematic literature review based on inclusion criteria to determine research articles, search strategies, and research findings. Databases used in this study included Pubmed and Science Direct. Results: The use of appropriate nutrition screening tools is essential for assessing the nutritional status of pediatric patients with cancer. Appropriate nutrition screening tools have a positive impact on the nutritional fulfillment of children with cancer. There are five different nutrition screening tools in assessing the sensitivity of nutrition screening tools in children with cancer and their advantages and disadvantages. The sensitivity of the Screening Tool for Childhood Cancer (SCAN) and the Pediatric Yorkhill Malnutrition Score (PYMS) was highly accurate in correctly identifying children with cancer at risk of malnutrition. Conclusions: This finding is expected to be a recommendation for health workers in choosing the right nutrition screening tool to monitor the nutritional status of pediatric patients with cancer during treatment.

Relationship between altered taste and smell with malnutrition among hemodialysis patients.

Alterations in taste and smell are among the most distressing symptoms experienced by haemodialysis patients. There is limited research on the relationship between these two symptoms and malnutrition in haemodialysis patients. This study aimed to investigate alterations in taste and smell in hemodialysis patients and their relationship with malnutrition. This cross-sectional study was carried out with 149 hemodialysis patients at the dialysis centers of three state hospitals. The Taste and Smell Dysfunction Questionnaire was used to assess the changes in patients' taste and smell, and the Prognostic Nutritional Index (PNI), as well as the Controlling Nutritional Status (CONUT) tool, were utilized to evaluate their nutritional status. A substantial percentage (45.6%) of patients reported an altered sense of smell, and 40.2% reported an altered sense of taste. The aspect of taste that was most abnormal was bitterness (46.7%); 53.0% of the patients were at moderate risk of malnutrition by PNI score, and 14.8% were categorized as malnourished by CONUT score. Malnutrition was related to dialysis vintage: a 1-year increase in vintage was associated with an increased risk of malnutrition (OR: 1.17, 95% CI 1.02-1.32, p < 0.001). Altered taste was associated with malnutrition: one-unit increase in the standard deviation of the taste subdimension score was associated with a relative risk of malnutrition (OR: 6.89, 95% CI 1.67-28.39, p < 0.001). A one-unit increase in the standard deviation of the smell subdimension was associated with relative risk of malnutrition (OR: 1.35, 95% CI 1.10-1.64, p < 0.001). Malnutrition was found in a significantpercentage of hemodialysis patients. Altered taste and smell and the durationof dialysis treatment were significantly associated with malnutrition scores It isrecommended that healthcare professionals regularly assess alterations in tasteand smell in hemodialysis patients, as these alterations may be associated withmalnutrition, and manage these alterations accordingly.

#1349 Importance of malnutrition and frailty in kidney transplant waiting list

Abstract Background and Aims Malnutrition and frailty predict postoperative complications. Recently, in an effort to assess nutritional status modified quantitative subjective global assessment (QSGA) systems have been devised in which scores are assigned for items or components of the SGA. This prospective study evaluated relationship QSGA and frailty assessment methods in patients waiting for kidney transplantation. Method We operated a fully quantitative scoring system consisting of 7 variables: weight changes, dietary intake, gastrointestinal symptoms, functional capacity, comorbidity, subcutaneous fat, and sign of muscle wasting. Each component was assigned a score from 1 (normal) to 5 (very severe). The sum of all seven components in this malnutrition score lies between 7 (normal) and 35 (severely malnourished). To evaluate frailty status, Short Physical Performance Battery (SPPB), Revised Risk Analysis Index (RAI), Karnofsky Frailty Score, Hand Grip Strength (HGS) methods were used. Three hundred and sixty patients (143 women and 217 men) were randomly selected from kidney transplant waiting list. Patients were aged between 21 and 82 years (56 ± 12.8) and had undergone hemodialysis for between 0 and 240 months (33.3 ± 34.6). Results The malnutrition score of each patient was assessed by a dietitian within 5-10 min. Pearson correlation coefficients showed positive correlation between the QSGA score and duration of hemodialysis (r = +0.52), age (r = +0.21), EPTS (+0.29) and RAI ((+0.25). QSGA showed negative correlation with Karnofsky score (r = −.30), SPPB (r = −.40), HGS (r = −.20). Multiple regression analysis showed a significant correlation between QSGA score and the combination of duration of hemodialysis, severity of RAI index, BMI and SPPB (R2 = 0.32, p = 0.00). Conclusion In addition to frailty assessment, the QSGA system may be additional method for evaluation of patients on the kidney transplant waiting list. More comparative studies are required to confirm the validity of this scoring system in nutritional evaluation of renal transplant candidates.

Systematic Review and Meta-analysis of the Association Between Malnutrition and Risk of Depression in the Elderly.

To explore the association between malnutrition and risk of depression in the elderly. Relevant studies were searched in PubMed, Web of Science, the Cochrane Library, Scopus, and Embase from the establishment of the database to August 17, 2023. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 software was used for meta-analysis. A total of 8 observational studies were identified with 11 112 participants, of which 2771 elderly patients had depression. The meta-pooled results showed a significant correlation between nutritional status and depression risk (odds ratio (OR) = 2.03, 95% CI = (1.47, 2.81), P < 0.001). Subgroup analysis found that the malnutrition scores of different study types and the diagnostic methods of depression and malnutrition were correlated with the risk of depression. Malnutrition was associated with depression risk in the elderly. Further large-scale multicenter studies should be conducted to test and verify the results.

Impact of Oral Nutritional Supplementation in Chronic Kidney Disease Patients on Maintenance Hemodialysis: An Open-label, Single-arm Study among Indian Patients.

Protein-energy wasting (PEW) affects about 50-75% of patients with chronic kidney disease (CKD), particularly those who are on maintenance hemodialysis (MHD). This study evaluated the efficacy and tolerability of an oral nutritional supplement in Indian patients receiving MHD. This was a 3-month, prospective, open-label, and single-centered study. Eligible participants supplemented their regular diet with one sachet (40 gm) of oral nutritional supplement powder twice daily for 90 days. The study efficacy endpoints were mean change in acute phase proteins (albumin and prealbumin), anthropometric measurements [weight, body mass index (BMI), and triceps skin fold thickness], handgrip strength, hemoglobin, total iron binding capacity (TIBC), potassium, and phosphorus levels, malnutrition score (MS)-modified subjective global assessment (modified SGA), malnutrition inflammation score (MIS), and nutritional status. The study population comprised 36 (42.9%) men and 48 (57.1%) women with a mean age of 54.85 ± 15.50 years. A paired sample t-test was used to compare the baseline with end-of-study values for continuous variables. Serum albumin, prealbumin, hemoglobin, and phosphorus levels remained stable throughout the study period. The mean change in weight, BMI, triceps skin fold thickness, handgrip strength, and TIBC for the overall study population was 1.11 kg (1.82%, p < 0.0001), 0.46 kg/m2 (1.98%, p < 0.0001), 3.47 mm (30.78%, p < 0.0001), 6.05 kg (44.98%, p < 0.0001) and 11.80 µg/dL (6.06%, p < 0.0001), respectively. At the end of the study period, there was a significant (p < 0.0001) improvement in the SGA and MIS scores. Further, there was a significant improvement in nutritional status as demonstrated by the overall intake of calories (p < 0.001), proteins (p < 0.0001), carbohydrates (p = 0.003, and fats (p < 0.0001). Protein-energy malnutrition is a strong predictor of morbidity, mortality, and poor outcomes in CKD patients. A scientifically designed formula in accordance with KDOQI standards was able to improve the nutritional status, overall body composition, sarcopenia, and quality of life in CKD patients on MHD.

Dietary acid load and markers of malnutrition, inflammation, and oxidative stress in hemodialysis patients.

The present study was conducted to examine the association between dietary acid load (DAL) and markers of inflammation, oxidative stress, and malnutrition in a group of Iranian hemodialysis (HD) patients. This cross-sectional study was performed on individuals aged ≥18 years who were on HD at least 6 months before their enrollment in the study. A 4-day dietary recall was used for the evaluation of dietary intake. DAL was calculated using two methods including potential renal acid load (PRAL) and net endogenous acid production (NEAP). For assessing the malnutrition status, we used the subjective global assessment (SGA), dialysis malnutrition score (DMS), and malnutrition inflammation score (MIS). Fasting blood samples were collected from each participant to assess serum levels of high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), sE-selectin, malondialdehyde (MDA), nitric oxide (NO), and endothelin-1. In total, 291 patients with a mean age of 57.73 ± 0.88 years and HD vintage of 4.27 ± 0.25 months were enrolled in the current study. Significant positive associations were observed between PRAL and hs-CRP (β = 1.77, 95% CI: 0.88, 2.65), sICAM-1 (β = 83.21, 95% CI: 10.39, 156.04), sVCAM-1 (β = 194.63, 95% CI: 74.68, 314.58), and sE-selectin (β = 6.66, 95% CI: 1.81, 11.50) among participants with the highest PRAL scores, compared to those with the lowest PRAL scores. NEAP was positively correlated with hs-CRP (β = 1.34, 95% CI: 0.46, 2.22), sICAM-1 (β = 88.83, 95% CI: 16.99, 160.67), and MDA (β = 0.35, 95% CI: 0.005, 0.71). Additionally, marginally significant higher odds of SGA (OR = 1.98, 95% CI: 0.95, 4.11) and DMS (OR = 1.94, 95% CI: 0.92, 4.05) were observed in individuals in the third tertile of PRAL vs. the first tertile of PRAL. NEAP had also a marginally significant positive correlation with DMS (OR = 2.01, 95% CI: 0.93, 4.31). This study illustrates that higher consumption of acidic foods is correlated with markers of inflammation, oxidative stress, and malnutrition in HD patients.

The malnutrition screening tool STRONGKIDS performed better than other screening tools for children hospitalised in Egypt.

To compare the accuracy of three different screening tools, namely, the Paediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), and Screening Tool for Risk on Nutritional Status and Growth (STRONGKIDS), in assessing malnutrition risk in hospitalised children. A cross-sectional study was conducted on 300 children aged 6 months to 15 years at Alexandria University Children's Hospital, Egypt. The sensitivity and specificity of each tool were calculated to detect acute and chronic malnutrition, and an agreement test was conducted between the nutritional screening tools. The patients were classified into different nutritional risk groups, and their classification was compared with anthropometric measures and clinical variables, such as the length of hospital stay (LOS). The prevalence of stunting and wasting on admission was found to be 3% and 6.6%, respectively. Children categorised as high-risk on admission had a longer LOS than those at low risk. The agreement test between the STAMP score and STRONGKIDS score on admission showed the most significant agreement, and STRONGKIDS had the best accuracy in detecting acute and chronic malnutrition. The comparison of the three screening tools revealed that STRONGKIDS exhibited the best accuracy in detecting acute and chronic malnutrition.

Systemic inflammatory response index and monocyte-to-high density lipoprotein ratio- new biomarkers remarking the inflammation in primary sarcopenia: The SIMPS study.

To investigate the relationship of sarcopenia with systemic inflammation response index (SIRI), monocyte to high-density lipoprotein ratio (MHR) and platelet parameters in geriatric patients. We designed across-sectional retrospective study in patients presented to ageriatric outpatient clinic for the first time. The diagnosis of sarcopenia was made in accordance with the EWGSOP2 criteria. SIRI, MHR, mean platelet volume /Platelet count (MPV/Plt), platelet distribution width /Platelet (PDW/Plt), platelet/lymphocyte ratio (PLR) were calculated from fasting blood test results at the time of admission. Among 262 patients, 79 patients (30.1%) with sarcopenia had significantly higher frequencies of delirium, hypothyroidism, chronic kidney disease and probable depression (p=0.010; p=0.018; p=0.034; p<0.001). Malnutrition scores and cognitive impairment scores were significantly lower in sarcopenic group (p<0.001 for both). Patients with sarcopenia had significantly higher MHR, SIRI and C-reactive protein values than patients without sarcopenia (p<0.001; p=0.001 and p=0.006, respectively). No significant difference was found between the groups in terms of MPV/Plt, PDW/Plt, PLR (p=0.605; p=0.920; p=0.510). Area under the curve for MHR was 0.675 (95% CI: 0.604-0.746, p0.99. The finding of higher MHR and SIRI in geriatric sarcopenia patients supports low-grade chronic inflammation in the pathophysiology of sarcopenia. These non-invasive, cost-effective and simple parameters based on traditional peripheral blood cell counts may be warning signs for sarcopenia in the geriatric population (Tab. 3, Fig. 1, Ref. 25). Text in PDF www.elis.sk Keywords: primary sarcopenia, inflammation, systemic inflammation response index, monocyte/high-density lipoprotein ratio, platelet parameters.

An Investigation of the Effectiveness of Distance Learning on Nutrition Quality of Hemodialysis Patients during the COVID-19 Pandemic: A Single-Blind Randomized Clinical Trial.

The COVID-19 pandemic has limited hemodialysis patient's attendance in healthcare centers and receiving diet education. This study was conducted to investigate the effectiveness of distance learning on the nutrition quality of hemodialysis patients during the COVID-19 pandemic. In the single-blind randomized clinical trial, 60 patients undergoing hemodialysis were randomly divided into control (n=30) and experimental (n=30) groups. Before and after the intervention, Dialysis Malnutrition Score (DMS), Malnutrition-Inflammation Score (MIS) (primary outcome), albumin, the total iron-binding capacity of the blood (TIBC), and body mass index (BMI) (Secondary outcome) were investigated. The experimental group received educational content through social networks for three months, whereas the control group received routine care and training. There was no significant difference between the two groups in terms of the mean of DMS, MIS, albumin, and TIBC before the intervention. Pre-test BMI had a confounding effect; therefore, an analysis of covariance was performed to eliminate that effect. This analysis showed significant differences in the post-test mean DMS, MIS, TIBC, and BMI between the two groups. In the control group, significant differences were observed in MIS and BMI toward deterioration. The results also indicated a significant relationship between education level and age with TIBC and between marital status and albumin index. Distance learning can be considered by healthcare managers and police makers as a suitable alternative to the classic face-to-face learning method to enhance hemodialysis patients' nutrition quality during the COVID-19 pandemic.

EFFICACY OF MALNUTRITION SCREENING AMONG OLDER VETERANS AT AN URBAN VA HOSPITAL

Abstract Nearly half of the Veteran population is &amp;gt;65 years. Older Veterans are at increased risk of malnutrition associated with increased mortality, morbidity, length of stay, and readmissions. Malnutrition-focused quality measures are needed to combat this public health issue. The purpose of this study was to identify gaps in malnutrition screening at an urban VA facility. Chart auditing was conducted for all medical admissions during 72 hour periods across 14 months. Auditing determined if nutrition screening was completed, with an admission weight, and if nutrition was consulted for nutritionally compromised Veterans. Screening was conducted using the Malnutrition Screening Tool (MST). Additionally, estimated prevalence of nutritionally compromised Veterans was assessed using auditing data from 30 days. Audit data showed that on average only 57.4% (n=458) of Veterans admitted for inpatient care were screened correctly. Of those screened incorrectly, the three most common errors were 1) not collecting a weight on admission (N=82 (42.1%)); 2) inaccurate weight change interpretations (N=41 (21%)); 3) failure to refer nutritionally at-risk Veterans to nutrition services (N=38 19.5%)). Prevalence auditing demonstrated over 1/3 of Veterans were nutritionally compromised at the start of their hospitalization (36.43%, (N=295)). With an increasingly aging population in the United States there is a focus on shifting to value based payment systems. The new CMS Global Composite Malnutrition Score will include evaluation of hospitals malnutrition screening processes. There is a significant opportunity to close these gap areas and to adopt clinically relevant best practices to provide nutrition care earlier to at risk Veterans.

Dialysis Malnutrition Score and Handgrip Strength with Quality of Life Among Patients on Maintenance Hemodialysis in Cebu City, Philippines

Dialysis Malnutrition Score and Handgrip Strength with Quality of Life Among Patients on Maintenance Hemodialysis in Cebu City, Philippines

Comparative Analysis of Tools for Assessment of Protein-Energy Wasting in Chronic Kidney Disease Patients on Maintenance Hemodialysis.

Patients with chronic kidney disease have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. The present study assessed the prevalence of protein-energy wasting in dialysis-dependent chronic kidney disease population and evaluated the validity of various nutritional assessment tools in diagnosing protein-energy wasting. All patients above 18 years undergoing dialysis for more than 3 months without any active infection or malignancy were included in our study. Data from anthropometric measurements, dietary assessment, and blood investigations were collected. Protein-energy wasting was assessed by the International Society of Renal Nutrition and Metabolism 2008 criteria. Diagnostic validity of the nutritional assessment tools to predict protein-energy wasting was estimated by area under the curve, sensitivity, specificity, and accuracy statistics. A total of 146 patients were studied. The prevalence of protein-energy wasting was 56.8%. Protein-energy wasting was significantly associated with socioeconomic status, hospitalization days, and catheter days. Normalized protein catabolism rate had the highest sensitivity (90.4%) for predicting protein-energy wasting. Malnutritional inflammatory score had the highest area under the curve (0.858), specificity (82.5%), and accuracy (82.2%). Mid-upper arm circumference, Dialysis Malnutrition Score, and albumin were also found to be significant predictors of protein-energy wasting. Lack of advanced equipment in suburban and rural centers to detect protein-energy wasting in India can be overcome by using the various stand-alone and combination nutrition assessment tools which have been validated in the present study.

Evaluation of malnutrition and screening tools in hospitalized children

Detecting malnutrition and its related risk factors are crucial, in hospitalized children. Anthropometric z scores are used to assess malnutrition. Screening tools also aim to detect the presence of malnutrition and the developing risk of malnutrition in hospitalized children to determine who may benefit from nutritional support. Therefore, the aims of the study are to detect malnutrition and its related demographic and clinical risk factors in hospitalized children and determining the sensitivity of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Pediatric Yorkhill Malnutrition Score (PYMS) screening tools. A total of 130 hospitalized children aged between 0 and 18 years were included in to study. A survey including demographic and clinical characteristics, STAMP and PYMS were applied to parents of the children. Patients were classified into nutritional risk groups through screening tools. Anthropometric measurements (body weight, length/height, and middle upper arm circumference (MUAC) of the children were taken. Body mass index-for-age and height-for-age z scores were calculated to assess acute and chronic malnutrition prevalence. MUAC-for-age z scores were calculated as well. To detect independent risk factors for acute and chronic malnutrition multivariable logistic regression models were constructed. A total of 14.6% of hospitalized children had acute malnutrition, 21.5% of children had chronic malnutrition and 27.7% of them had low MUAC standard deviation score (SDS) (less than-2). The independent risk factors for acute malnutrition were younger maternal age at birth and long length of stay (p<0.05). The independent risk factors for chronic malnutrition were being female, younger maternal age at birth, longer illness duration and having urological or allergy and immunological diseases (p<0.05). However, MUAC for age SDS groups were not related to any demographic and clinical factors, in children of all ages (p>0.05). Regarding the screening tools, PYMS displayed 100% sensitivity against acute malnutrition. While PYMS displayed better sensitivity to identify acute malnutrition than STAMP, STAMP was more sensitive than PYMS to detect chronic malnutrition and low MUAC SDS. Low MUAC for age SDS was not related to any demographic and clinical factors, in hospitalized children of all ages, unlike acute and chronic malnutrition, in this study. Pediatric screening tools mainly PYMS did not have high sensitivity to detect chronic malnutrition and low MUAC SDS, in hospitalized children. Therefore, the tools have to be used along with z scores of anthropometric parameters.

Analysis of the incidence of falls and related factors in elderly patients based on comprehensive geriatric assessment.

To investigate the incidence of falls in elderly aged 65 years and above among outpatients and inpatients, and to analyze its related factors and identify prevention strategies. A retrospective analysis was conducted on 451 patients aged 65 years and above who received comprehensive geriatric assessment in outpatients and inpatients from the Department of Geriatrics in the Second Xiangya Hospital from March 2021 to March 2022. According to whether there had been at least one fall in the past year, the patients were divided into a fall group and a non-fall group. Data were collected from the We-Chat applet of comprehensive geriatric assessment. A t test and chi-square test were performed to compare the difference between the two groups. Logistic regression analysis was then conducted to identify factors associated with falls. (1) The incidence of falls among the outpatient and inpatient was 28.8%. (2) The rate of light, moderate, and heavy dependence on daily living ability and decreased mobile balance ability were higher in the fall group than those in the non-fall group. The average calf circumference in the fall group was significantly lower than that in the non-fall group. (3) The prevalence of diabetes and eye diseases in the fall group was significantly higher than that in the non-fall group. (4) The percentage of insomnia and suspicious insomnia cases in the fall group was higher than that in the non-fall group. The mean scores for dysphagia, frailty, and incontinence were higher and the mean malnutrition score was lower in the fall group than in the non-fall group. (5) Multiple logistic regression analysis showed that frailty, insomnia, and malnutrition were independent influencing factors of fall (OR = 1.955, 1.652, 10.719, P = 0.044, 0.041, 0.025, respectively). The incidence of falls among outpatients and inpatients aged 65 years and above is high. Frailty, insomnia, and malnutrition are the main factors influencing falls in these patients.