Malnutrition Screening Research Articles

Evaluation of the risk of malnutrition in hospitalized children by PYMS, STAMP, and STRONGkids tools and comparison with their anthropometric indices: a cross-sectional study

BackgroundMalnutrition is a determining factor of pediatric mortality and morbidity, especially in low and middle-income countries. Hospitalized children are at a higher risk of malnutrition. Several malnutrition screening tools have been used, among which STAMP, PYMS, and STRONGkids are valid tools with high sensitivity and specificity. The aim of this study was to compare these screening tools to find the best ones in identifying the risk of malnutrition in hospitalized children.MethodsThis is a cross-sectional study performed on hospitalized children aged 1 to 16 years. The questionnaires of PYMS, STAMP, STRONGkids malnutrition risk assessment tools were filled. The weight for height and BMI for age Z-scores were calculated. The data were analyzed by SPSS. Sensitivity, specificity, positive predictive value, and negative predictive values of the risk scores based on weight for height and BMI for age Z-scores were calculated.ResultsNinety-three patients with a mean age of 5.53 ± 3.9 years were included. The frequency of malnutrition was reported as 26% and 39% according to weight for height and BMI for age Z-scores, respectively. A significant relationship was found between PYMS and Weight for height Z-score (P-value < 0.001), and BMI for age Z-score (P-value < 0.001). Moreover, STRONGkids was found to be associated with weight for height Z-score (P-value: 0.017).ConclusionThe PYMS is a practical and beneficial tool in early identifying the risk of severe malnutrition in hospitalized patients. It is a suitable method for patients in our settings.

Comparison of the Suitability Between NRS2002 and MUST as the First-Step Screening Tool for GLIM Criteria in Hospitalized Patients With GIST.

ObjectiveThe Global Leader Initiative on Malnutrition (GLIM) criteria have been recommended for malnutrition diagnosis recently, for which the first step is malnutrition risk screening with any validated tool. This study aims to investigate the incidence of malnutrition risk in gastrointestinal stromal tumor (GIST) inpatients and compare the suitability of Nutritional Risk Screening 2002 (NRS2002) and Malnutrition Universal Screening Tool (MUST) as the first-step screening tool for GLIM criteria.MethodsWe retrospectively analyzed the clinical data of GIST inpatients in our hospital from January 2015 to December 2019. NRS2002 and MUST were used to screen malnutrition risk at the time of admission. The diagnostic consistency of these two tools with GLIM criteria for malnutrition was analyzed, and the predictive performance of both tools for the length of hospital stay and the occurrence of complications was also evaluated in surgical and non-surgical inpatients.ResultsA total of 269 GIST inpatients were included in this study, of which 45.7 and 40.9% were at malnutrition risk determined by NRS2002 and MUST, respectively. In non-surgical inpatients, NRS2002 and MUST had similar diagnostic consistency with GLIM criteria in sensitivity (93.0 vs. 97.7%), specificity (81.1 vs. 81.1%), and Kappa value (K = 0.75 vs. 0.80), and high nutritional risk classified by NRS2002 and malnutrition identified by GLIM criteria were found to be associated with the length of hospital stay. In surgical inpatients, MUST had better diagnostic consistency with GLIM criteria in sensitivity (86.1 vs. 53.5%) and Kappa value (K = 0.61 vs. 0.30) than NRS2002, but no factors were found associated with the length of postoperative hospital stay or the occurrence of complications.ConclusionThe malnutrition risk is common in GIST inpatients. NRS2002 is more suitable than MUST for the first-step risk screening of the GLIM scheme in non-surgical inpatients, considering its better performance in screening malnutrition risk and predicting clinical outcomes. MUST was found to have good diagnostic consistency with GLIM criteria for malnutrition in both non-surgical and surgical GIST inpatients, and further studies need to be conducted to investigate its predictive performance on clinical outcomes.

Quality of Nutritional Care Assessment among Critically-ill Patients in a Tertiary Government Hospital

Background and Objectives. Malnutrition is prevalent both at baseline admission and because of hospitalization. It is aggravated by adverse hospital practices and results in poor outcomes, reduced quality of life, and higher treatment costs. Improving quality of care involves nutritional intervention as a low-risk, cost-effective strategy which guides providers in improving practices systems-wise. This study aims to assess the quality of nutritional care and the nutritional status of critically- ill patients admitted in a low-resource setting.&#x0D; Materials and Methods. This is a mixed methods study among adults admitted in intensive care units (ICUs) of a tertiary government hospital. Anthropometric and biochemical indicators were obtained through chart review. The degree of malnutrition was assessed using the Subjective Global Assessment. Quality indicators under Donabedian domains were assessed and compared to current standards. The length of ICU stay and mortality rate were recorded. Dietary prescription and provision practices of healthcare providers were supplemented by a focus group discussion (FGD). Factors causing provision interruptions were also identified.&#x0D; Results and Discussion. Sixty-four ICU admissions were included. Staff-to-patient ratio was not ideal. Under process-related factors, out of 49% with actual anthropometric documentations (rest were estimates), 24% had normal body mass indices (BMI), 17% were underweight, and the rest were either overweight or obese. The baseline ICU malnutrition rate was 69%. Malnutrition screening, and assessment of risk and biochemical indicators were not done routinely. Majority (92%) had baseline dietary prescription but only 69% had specific energy and macronutrient breakdown, all done through predictive weight-based equations. Nutritional supplies arrived within 8 hours in 65% of patients. Feeding was initiated within 24–28 hours in 94% of patients. Commercial formula was the preferred type of enteral nutrition (EN). Total duration on nothing-by-mouth (NPO) (hours) throughout ICU stay was significant. Supportive measures to improve gastro-intestinal (GI) tolerance were not standardized. Common factors in delaying feeding initiation were hemodynamic instability, fasting for procedures and GI bleeding. Throughout the ICU stay, fasting for procedures, hemodynamic instability and mechanical ventilation (MV)-related factors were common. ICU mortality rate was 19% and average length of ICU stay was 5 days.&#x0D; Conclusion. Malnutrition is still prevalent in our ICUs and is affected by suboptimal healthcare practices. Staff - to-patient ratios, malnutrition risk screening and assessment, dietary referrals, documentation and minimizing interruptions in nutritional care provision needs improvement. A system review and establishment of a nutrition team is imperative.

Managing malnutrition in older people living in residential care

Nursing and Residential CareVol. 24, No. 4 Clinical ReviewManaging malnutrition in older people living in residential careOmorogieva OjoOmorogieva OjoCorrespondence to: Omorogieva Ojo; E-mail Address: [email protected]Senior Lecturer in Primary Care, Faculty of Education and Health, University of Greenwich, Greenwich, London, UKSearch for more papers by this authorOmorogieva OjoPublished Online:2 May 2022https://doi.org/10.12968/nrec.2022.0014AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Dietetic Association. Malnutrition: food fact sheet. 2022. https://www.bda.uk.com/resource/malnutrition.html (accessed 11 March 2022) Google ScholarBrook S. Oral nutritional supplements: an integral part of malnutrition treatment. 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Is There a Correlation Between NRS-2002 and EAT-10 Score?

Dysphagia may play a significant role in the development and progression of malnutrition and may lead to prolonged hospital stay. A group of 187 patients was screened with the NRS-2002 to evaluate nutritional status and the EAT-10 for dysphagia screening. A statistically significant correlation was found between the EAT-10 and NRS scores at hospitalization (initial NRS score) and the final NRS score (P = .014 and P = .007, respectively). To prevent or minimize the adverse outcomes of dysphagia and malnutrition, it is necessary to perform routine dysphagia and malnutrition screening in hospitals.

Malnutrition risk and severity: Impact on patient outcomes and financial hospital reimbursement in a tertiary teaching hospital.

Despite its negative impact on patients and health care expenditures, malnutrition remains an under-recognized problem in hospitals. The objectives were thus: 1) to study the prevalence of malnutrition risk, protein-calorie malnutrition and cachexia in a Belgian tertiary care hospital, 2) to evaluate the impact thereof on patient outcomes, and 3) to evaluate the impact of optimizing malnutrition screening, diagnosing, registration and coding on hospital reimbursement. Data was included from all multi-day admissions between January 1, 2017 and December 31, 2019. The NRS2002 was used as screening tool. Patient outcomes were modeled using (generalized) linear mixed models, with pathology and severity of illness as random effects. The financial impact of the screening, diagnosing and registration process was evaluated comparing net revenues related to a malnutrition diagnosis in the year before (2017) and the year after (2019) the optimization process. 55,345 patients were evaluated for malnutrition risk at admission of whom 23.6% are considered malnourished or at risk for malnutrition, 0.6% have cachexia and 4.6% protein-calorie malnutrition. Overall length of stay is 2.2 days (p<0.001) longer in the at-risk population, and 6.2 and 5.0 days longer in patients with cachexia and protein-calorie malnutrition as compared to patients not at risk. Odds ratio for in-hospital mortality is 2.9 (p<0.001) for the at-risk patients and 3.0 (p<0.001) for patients with cachexia. Optimization of dietetic workflow and registration, specifying malnutrition severity and facilitating malnutrition coding can increase hospital reimbursement, with approximately 0.4% of all justified beds. Malnutrition still affects both patients and health care finances. Patients at risk for, or having malnutrition at admission have worse outcomes than those without. Importantly, hospital reimbursement for these patients can effectively be increased by implementing an automated nutritional screening and diagnosing protocol with optimized dietetic registration and enhanced nutritional coding.

The impact of frailty and its associations among a sample of community-dwelling older adults

Frailty, sarcopenia and fragility fractures are powerful correlated and all of them are predictors of clinical adverse outcomes. Elderly individuals with have a fragility fracture should be assessed for frailty and sarcopenia to better develop a care plan. For these reason interventions are necessary to determinate and treat frailty. The present study investigates the prevalence of frailty and associated factors among the older adults who were assessed within the scope of a geriatric study in the Fatih District of the Istanbul Province. The study included community-dwelling older adults aged 61-101 years who were living in the Fatih District of the Istanbul Province between November 2014 and May 2015. The number of drugs regularly used by the participants and the number of diseases were recorded. It was evaluated whether the participants experienced falling / risk of falling / fear of falling in the last 1 year. Visual analog scale (VAS) was used in the assessment of chronic pain. The other instruments used for assessment included the FRAIL scale for frailty screening; the 6-item KATZ Activities of Daily Living (ADL) scale; the 8-item LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL) for the measurement of functional capacity; the European Quality 5 Dimensions (EQ-5D) questionnaire for the assessment of quality of life; the Mini-Cog test for cognitive screening; the Geriatric Depression Scale-Short Form (GDS-SF) for depression screening; the Mini Malnutrition Assessment-Short Form (MNA-SF) for malnutrition screening; and the Romberg test and postural instability test for walking. Hand grip strength (HGS) was measured using a Jamar hydraulic hand dynamometer and the thresholds for hand grip strength were evaluated < 27 kg < 16 kg in men and women, respectively, based on the European Working Group on Sarcopenia in Older People (EWGSOP2) definition. Muscle mass was measured through a bioimpedance analysis (TANITA-BC532). Low muscle mass (young adult mean-2SD) and the thresholds for muscle mass were evaluated as < 9.2 kg/m2 vs 7.4 kg/m2 in men and women, respectively, based on national data. Sarcopenia was defined as a reduction in muscle mass and muscle function [usual gait speed (UGS) or muscle strength] based on the European Working Group on Sarcopenia in Older People (EWGSOP2) definition. The study included 204 older adults (94 men and 110 women), with a mean age of 75.4±7.3 years. Of the cases, 30.4% were robust, 42.6% were pre-frail and 27% were frail. Significant differences were recorded in number of diseases (p=0.006), frail score (p=0.002), malnutrition (p=0.004) and the results of a clock-drawing test (CDT)(p=0.040), number of drugs, chronic pain(p=0.001), as well as in the fear of falling, IADL, GDS-SF, -EQ-5D scores, BIA fat, BIA muscle and hand grip strength (p< 0.001) between the groups. The frailty groups differed significantly in terms of the presence of malnutrition, fear of falling, urinary incontinence (UI), chronic pain, Romberg sign, postural instability, level of ambulation, presence of depression, dementia, falls within the last one year (p< 0.001) and gender (p=0.004). A regression analysis evaluating independent frailty-associated factors [dependent variable: frailty (robust vs. prefrail +frail)], revealed an association with the number of drugs (OR=1.24, p=0.036), cognitive disorder (OR=0.30, p=0.016) and EQ-5D (OR=1.53, p=0.017). The present study established the prevalence of frailty in the Fatih district community, in which the most prominent associated factors were cognitive dysfunction, low quality of life, and multiple drug usage. Nationwide population studies involving multiple centers are required.

Treatment Outcome and Associated Factors of Acute Malnutrition Among Children in the Therapeutic Feeding Center of Public Hospitals in Addis Ababa, Ethiopia: An Institutional-Based Cross-Sectional Study.

BackgroundSevere acute malnutrition is the most prevalent reason for admission to a pediatric unit, and it is a leading cause of mortality in many countries, including Ethiopia, at 25% to 30%, where it affects both developed and developing countries. The objective of this study was to assess treatment outcomes and associated factors among children aged 6–59 months with severe acute malnutrition.MethodsA cross-sectional study was conducted using secondary data from medical records of patients enrolled in the therapeutic feeding center from January 2016 to March 2019. There were 385 samples collected at 3 public referral hospitals in Addis Ababa, which were selected by simple random sampling. A structured questionnaire was used to collect data from the available individual folders and registers. The data analysis was performed using binary and multivariable logistic regression models. The odds ratio with 95% CI was used to identify predictor variables. Variables that have a p-value <0.05 were considered significant.ResultsChildren who had tuberculosis were 79% less likely to recover than those who had no tuberculosis. In this study, deaths accounted for 9.1%, recovered were 72.2%, and defaulters accounted for 11.6% with a mean length of stay of 18.6 (CI: 16.9, 20.2) days and an average weight gain of 7.2 g/kg/day (CI: 5.7, 8.2).ConclusionTreating comorbidities on time can help children to recover early and reduce readmission. Integration of severe acute malnutrition screening into all service delivery points can help early identification and treatment. In the meantime, treating them with ready-to-use therapeutic feeding has a significant change in recovery.

Three Nutritional Indices Are Effective Predictors of Mortality in Patients With Type 2 Diabetes and Foot Ulcers.

IntroductionMalnutrition has been associated with mortality in various diseases. This retrospective cohort study aimed to investigate the relationship between three nutritional indices and all-cause mortality in patients with diabetic foot ulcers (DFUs).Materials and MethodsA total of 771 patients diagnosed with DFUs in the First Affiliated Hospital of Wenzhou Medical University from 2015 to 2019 were included in this retrospective cohort study. Patients were classified as high nutritional risk groups or low nutritional risk groups according to the optimal cut-off values of the geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT), respectively. The associations of three nutritional indices with all-cause mortality were evaluated by multivariable Cox regression analyses.ResultsLog-rank tests indicated that patients with high nutritional risk had lower overall survival rates (all p < 0.001). The multivariable Cox regression revealed that low GNRI (adjusted HR 2.01, 95% CI: 1.37–2.96, P < 0.001), low PNI (adjusted HR 2.04, 95% CI: 1.29–3.23, P = 0.002) and high CONUT (adjusted HRs 1.54, 95% CI: 1.07–2.23, P = 0.021) were independently associated with high all-cause mortality. In subgroup analyses, only GNRI predicted higher all-cause mortality in patients with severe DFUs, while all of the three indices persisted as independent prognostic factors in patients with no severe DFUs.DiscussionThe present study demonstrated that three nutritional indices were effective predictors of all-cause mortality in patients with DFUs. Routine screening for malnutrition using any of the three nutritional indices might be a simple and effective way to identify high-risk patients with DFUs. GNRI can be used as an independent prognostic indicator in patients with severe DFUs.

Qualitative evidence syntheses of attitudes and preferences to inform guidelines on infant feeding in the context of Ebola Virus Disease (EVD) transmission risk.

BackgroundBreast-feeding holds considerable potential to reduce infant mortality. Feeding choices, already complex, take on additional complexity against a backdrop of the risk of transmissible Ebola Virus. This review describes the factors that influence infant feeding and attitudes of pregnant women, mothers, family members and health practitioners, policy makers and providers (midwives) concerning infant feeding when there is a risk of Mother-to-Child (MTC) transmission of Ebola Virus Disease (EVD).MethodologyA systematic review of qualitative studies identified through rigorous searches of thirteen online databases and additional citation searches of included studies was undertaken. Search terms included breast-feeding, breast-feeding, infant feeding; Ebola; and qualitative, interview(s) and findings. Independent extraction of data by two reviewers using predefined extraction forms. Studies were assessed using the CASP Qualitative checklist.Principal findings5219 references were screened. 38 references related specifically to Ebola, and five papers met the inclusion criteria with data gathered from two settings: Guinea and Sierra Leone. The EVD outbreak had a significant impact on beliefs, attitudes, and resources to support infant feeding practices negatively affecting the nutritional status of children. The evidence from these studies highlight the need for guidance and appropriate psychosocial support need to be available to mothers who display symptoms and become infected and to front-line staff who are giving advice. Communities need to be engaged because stigma and fear may hinder uptake of appropriate interventions. The EVD outbreak caused multi-level system disruption akin to that seen following a natural disaster, meaning that logistics and coordination are critical and need adequate resourcing. Food production and distribution, and malnutrition screening are also disrupted and thereby compounding compromised nutritional status. The limited number of relevant studies highlights the need for further primary research, particularly in translation of messages to local settings.ConclusionsAn EVD outbreak causes multi-level disruption that negatively impacts infant feeding and child care practices. Negative impacts have multiple causes and successful planning for Ebola outbreaks requires that nutrition of infants and young children is a priority. Lessons from the Ebola pandemic have wider applicability to other pandemic contexts including Covid-19.

AND/ASPEN and the GLIM malnutrition diagnostic criteria have a high degree of criterion validity and reliability for the identification of malnutrition in a hospital setting: A single-center prospective study.

Multiple malnutrition diagnostic tools are available in clinical practice, yet, evidence on their validity and reliability is limited. We aim to assess and compare the validity and reliability of the different combinations of indicators of the three most used diagnostic tools with two validated malnutrition screening tools. Nutrition risk screening was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF) and the Nutrition Risk Screening-2002 (NRS-2002). Nutrition assessment was conducted using different combinations of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Concurrent criterion validity and inter-rater reliability of the overall and the different combinations of indicators in the diagnostic tools were evaluated and compared. Sensitivity, specificity, positive predictive value, negative predictive value, and Cohen kappa were calculated to determine tool validity and reliability. The AND/ASPEN (132 [22.8%]) combination and GLIM-1 (133 [23.0%]) (weight loss + compromised food intake) predicted the highest number of malnourished patients and reported a high degree of concurrent criterion validity, agreement, and reliability. On the contrary, overall ESPEN (using any combination) and GLIM-2 (reduced body mass index [BMI] + compromised food intake) reported only moderate criterion validity and low agreement and reliability. Different combinations of diagnostic criteria led to varying validity and reliability, with the lowest validation results rising from the combinations of indicators using BMI as a criterion for malnutrition diagnosis.

Disease-related malnutrition in chronic kidney disease.

Disease-related malnutrition has complex and multifactorial pathophysiology. It is common in patients with chronic kidney disease (CKD) and has a devastating impact on morbidity and mortality. Given the rising numbers of patients diagnosed with CKD, disease-related malnutrition is an escalating clinical challenge. This review summarises current knowledge in relation to the development, screening and treatments for disease-related malnutrition in CKD. New research has identified other potential causes for the development of malnutrition in CKD, including changes in taste and smell, and effects of polypharmacy. Screening and assessment studies have investigated different tools in relation to the new Global Leadership Initiative on Malnutrition (GLIM) criteria. Different modalities of low protein diets and the potential use of pre and probiotics are being explored. Furthermore, the importance of nutritional support, and possibly exercise during dialysis is being examined in terms of reducing anabolic resistance and catabolism. Further research is required to better understand the nuances of the pathophysiology of disease-related malnutrition in CKD. This work should inform not only consistent terminology and the application of assessment tools specific to disease-related malnutrition in CKD but also the development of novel interventions that reflect its multifaceted pathophysiology and impact.

Validity of the Malnutrition Universal Screening Tool for Evaluation of Frailty Status in Older Hospitalised Patients.

The malnutrition-universal-screening-tool (MUST) is commonly used for screening malnutrition in hospitalised patients but its utility in the detection of frailty is unknown. This study determined the utility of MUST in detection of frailty in older hospitalised patients. This prospective-study enrolled 243 patients ⩾65 years in a tertiary-teaching hospital in Australia. Patients with a MUST score of ⩾1 were classified as at-risk of malnutrition. Frailty status was determined by the Edmonton-Frail-Scale (EFS) and patients with an EFS score of >8 were classified as frail. We validated the MUST against the EFS by plotting a receiver-operating-characteristic-curve (ROC) curve and area-under-the-curve (AUC) was determined. The mean (SD) age was 83.9 (6.5) years and 126 (51.8%) were females. The EFS determined 149 (61.3%) patients as frail, while 107 (44.1%) patients were at-risk of malnutrition according to the MUST. There was a positive linear but weak association between the MUST and the EFS scores (Pearson’s correlation coefficient= .22, 95% CI .12– .36, p < .001). The sensitivity, specificity, positive and negative predictive value of MUST in the detection of frailty was 51%, 67%, 78.5% and 37%, respectively and the AUC was .59 (95% CI .53–.65, p < .001). The MUST is moderately sensitive in detection of frailty in older-hospitalised patients.

Nutritional management in children with disease-related malnutrition : what’s the guideline?

Background: Disease-related malnutrition (DRM) is one of the most common problems in pediatric patients. Both cancer and congenital heart diseases (CHD) are commonly associated with DRM. Altered nutrition utilization, reduced intake, malabsorption, and hypermetabolism are the main pathophysiology in DRM.&#x0D; Method: A systematic literature searching was performed through Pubmed and Google Scholar websites. Thirty-six articles were included into the study.&#x0D; Results: Malnutrition screening should be performed as soon as possible since early feeding can benefit the patients. One of the most commonly used tools is Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), which was proven to be valid, reproducible, and applicable in pediatric patients with malnutrition. Following screening and assessment, nutrition support can ensue, preferably in the form of enteral nutrition, unless contraindicated. Nutrient-dense formula, also known as protein and energy-enriched formula, aims to aid infants to reach nutrition target rapidly and stimulate anabolism. This formula has been studied in various population, mostly infants with CHD and studies showed favorable outcomes with its administration, namely faster improvement, reduced diuretics use and oxygen supplementation, decreased length of hospital stay, and less antibiotic use. Nutrient-dense formula is also safe and well-tolerated.&#x0D; Conclusion: Proper screening and management should be performed with multidisciplinary approach to achieve the best outcome in children with DRM.

Anthropometric diagnosis of 6-59 months Children with Severe Acute Malnutrition: Weight for Height-Z scores Versus Mid Upper Arm Circumference

An unhealthy dietary habit leads to excess calorie consumption (overnutrition) or inadequate supply of one or more essential micronutrients (undernutrition).This nutritional imbalance is assessed by Anthropometric measurements, Biochemical estimations, Clinical examination and assessment of Dietary intakes. Anthropometry is an inexpensive, rapid and non-invasive method that provides details on different components of body structure and is highly sensitive to the broad spectrum of nutritional status. Hence, it has always been an important tool for screening and early diagnosis of malnutrition. Undernutrition in below 5 year children is life-threatening epidemic contributing to about 45% of under 5 child deaths. Children with Severe Acute Malnutrition (SAM) are nine times more likely to die, compared to their healthy counterparts. Therefore, early and accurate diagnosis of children with SAM is crucial for its management and prevention of morbidity and mortality from the same. SAM is defined as weight-for-height Z scores (WHZ) below -3SD of the median or a mid upper arm circumference (MUAC) of &lt;115mm in children of 6-59 months age. The cut-offs for MUAC and WHZ are scientifically approximated to each other and both are used to diagnose children with SAM (Severe Wasting). However, the research findings from various countries revealed that the agreement between WHZ and MUAC is poor as both indices classify the children with SAM differently, with a small overlap, which varies greatly among countries. These discrepancies have an implication when using either one alone for measuring the prevalence of acute malnutrition. Therefore, it is pertinent to adopt both WHZ and MUAC indices to assess the burden of severe acute malnutrition (SAM) in the community.

A252 DO GLIM CRITERIA FOR DIAGNOSING MALNUTRITION AGREE WITH SGA IN HOSPITALIZED PATIENTS RECEIVING TPN?

BackgroundThe Global Leadership Initiative on Malnutrition (GLIM) proposed a new two-step model for diagnosing malnutrition in 2019. A combination of two etiologic and three phenotypic criteria are used to assess malnutrition. The Subjective Global Assessment (SGA) is the most well validated assessment tool for diagnosing malnutrition in hospitalized patients. Evaluation of the performance of GLIM criteria in comparison to SGA is necessary before implementing this new diagnostic tool in practice.AimsTo compare GLIM criteria to SGA in assessing malnutrition severity in hospitalized patients requiring parenteral nutrition (PN).MethodsThis is a retrospective analysis of a prospectively collected database of malnourished hospitalized adult patients requiring PN admitted between March 2020 and March 2021 to an academic hospital in Winnipeg, Canada. 172 cases were evaluated. GLIM malnutrition screening was considered positive if one etiologic (high CRP or low food intake) and one phenotypic (weight loss or low BMI) criteria were identified. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated and expressed with a Wilson 95% confidence interval.ResultsThe prevalence of malnutrition using SGA B or C criteria was 82.3% (CI 73.8, 85.5). Using GLIM criteria, the prevalence of malnutrition was 33.7% (27.1, 41.1). The prevalence of severe malnutrition using SGA C was 32.6% (26.0, 40.0) and using GLIM criteria the prevalence was 19.2% (14.0, 25.7). Using any combination of GLIM criteria versus SGA B or C combined, the PPV was 100% (90.4, 100) and the specificity was 100% (89.9, 100); NPV was 30.0% (22.0, 38.5) and the sensitivity was 42.0% (34.1, 50.4). Using any combination of GLIM criteria versus only SGA C patients, PPV decreased to 72.4% (59.8, 82.3) and specificity was 86.2% (78.8, 91.3); NPV increased to 87.7% (80.4, 92.5) and sensitivity was 75.0% (62.3, 84.5). Comparing severely malnourished patients by GLIM criteria to only SGA C patients, PPV was 97% (84.7, 99.5) and specificity was 99.1% (95.3, 100). NPV was 82.7% (75.6, 88.1) and sensitivity was 57.1% (44.1, 69.2).ConclusionsUsing SGA as the gold standard for diagnosing malnutrition in hospitalized patients requiring PN, GLIM criteria had a very high PPV but unacceptably low NPV in diagnosing malnutrition. The NPV improved when GLIM criteria was compared only to severely malnourished patients by SGA. Importantly, in comparing severely malnourished patients by GLIM and SGA criteria, the sensitivity was also unacceptably low. Based on these results, GLIM criteria are most useful in confirming the diagnosis of malnutrition or severe malnutrition; a negative result should not reassure clinicians that severe malnutrition is absent. Further studies evaluating GLIM criteria are needed before it replaces SGA as a decision making tool.Funding AgenciesNone

Optimizing the nutrition support care model: Analysis of survey data.

Malnutrition is underrecognized and underdiagnosed, despite high prevalence rates and associated poor clinical outcomes. The involvement of clinical nutrition experts, especially physicians, in the care of high-risk patients with malnutrition remains low despite evidence demonstrating lower complication rates with nutrition support team (NST) management. To facilitate solutions, a survey was designed to elucidate the nature of NSTs and physician involvement and identify needs for novel nutrition support care models. This survey assessed demographics of NSTs, factors contributing to the success of NSTs, elements of nutrition education, and other barriers to professional growth. Of 255 respondents, 235 complete surveys were analyzed. The geographic distribution of respondents correlated with population concentrations of the United States (r = 90.8%, p < .0001). Most responding physicians (46/57; 80.7%) reported being a member of NSTs, compared with 56.5% (88/156) of dietitians. Of those not practicing in NSTs (N = 81/235, 34.4%), 12.3% (10/81) reported an NST was previously present at their institution but had been disbanded. Regarding NSTs, financial concerns were common (115/235; 48.9%), followed by leadership (72/235; 30.6%), and healthcare professional (HCP) interest (55/235; 23.4%). A majority (173/235; 73.6%) of all respondents wanted additional training in nutrition but reported insufficient protected time, ability to travel, or support from administrators or other HCPs. Core actions resulting from this survey focused on formalizing physician roles, increasing interdisciplinary nutrition support expertise, utilizing cost-effective screening for malnutrition, and implementing intervention protocols. Additional actions included increasing funding for clinical practice, education, and research, all within an expanded portfolio of pragmatic nutrition support care models.

Standardized Phase Angle for Predicting Nutritional Status of Hemodialysis Patients in the Early Period After Deceased Donor Kidney Transplantation.

BackgroundThis study was designed to verify whether early posttransplant standardized phase angle (SPhA) determines nutrition status of hemodialysis patients in regard to different nutritional markers and predicts handgrip strength (HGS) 6 months after kidney transplantation.MethodsA total of 82 kidney transplant recipients on maintenance hemodialysis treatment entered the study. Nutritional status was evaluated before kidney transplantation, at the hospital discharge date, and 6 months after. We used bioelectrical impedance analysis (BIA), three different malnutrition screening tools, HGS, and anthropometric measurements. Demographic profiles and biochemical nutritional markers were collected. SPhA values, adjusted for age and BMI, were used in our study.ResultsIn the early posttransplant period, kidney transplant recipients lost muscle mass, gained fat mass, and developed mostly negative SPhA, accompanied by significantly lower albumin levels. The subjects with lower than median (<-1.46) SPhAdis [the SPhA (at discharge) adjusted for hospitalization time and the baseline SPhA] displayed lower values of albumin concentration (43.4 vs. 45.1 g/l, p = 0.010), hemoglobin (124 vs. 133 g/l, p = 0.016), GNRI (113 vs. 118, p = 0.041), and HGS (30 vs. 33 kg, p = 0.043). These patients had higher ferritin concentrations (420 vs. 258 mkmol/l, p = 0.026), longer inpatient stays (32 vs. 21 days, p < 0.001), and higher MIS scores (3 vs. 1, p = 0.001).ConclusionAt the moment of hospital discharge, lower than the median SPhA is related to protein-energy wasting, represented as lower concentrations of nutrition biomarkers and an active inflammatory response. Higher SPhA before kidney transplantation predicts HGS 6 months after kidney transplantation, especially in women.

How does baseline anthropometry affect anthropometric outcomes in children receiving treatment for severe acute malnutrition? A secondary analysis of a randomized controlled trial.

Mid‐upper arm circumference (MUAC) < 11.5 cm and weight‐for‐height Z‐score (WHZ) < −3 are used for screening for severe acute malnutrition (SAM). Underweight and concurrent wasting and stunting may better target those at the highest risk of mortality. We compared anthropometric outcomes in children enrolled in a trial of antibiotics for SAM based on categories of baseline anthropometry, including indicators for programme admission (WHZ < −3, MUAC < 11.5) and alternative indicators (weight‐for‐age Z‐score [WAZ] < −3, concurrent wasting and stunting [WHZ < −3 and height‐for‐age Z‐score < −3]). Participants were followed weekly until nutritional recovery and at 8 weeks. We evaluated changes in weight gain (g/kg/day), MUAC, and WHZ in children admitted by admissions criteria (MUAC only, WHZ only, or MUAC and WHZ) and by underweight or concurrent wasting and stunting. Of 301 admitted children, 100 (33%) were admitted based on MUAC only, 41 (14%) WHZ only, and 160 (53%) both MUAC and WHZ, 210 (68%) were underweight and 67 (22%) were concurrently wasted/stunted. Low MUAC and low WHZ children had the lowest probability of nutritional recovery (17% vs. 50% for MUAC‐only and 34% for WHZ‐only). There was no difference in weight gain velocity or WHZ by admissions criteria (WHZ and/or MUAC). Underweight and concurrently wasted/stunted children had lower MUAC and WHZ at 8 weeks compared with those who were not underweight or concurrently wasted and stunted. Children with both low MUAC and low WHZ had the worst outcomes. Relying on MUAC alone may miss children who have poor outcomes. Other indicators, such as WAZ, may be useful for identifying vulnerable children.

Ability of malnutrition screening and assessment tools to identify computed tomography defined low muscle mass in colorectal cancer surgery.

Malnutrition and low muscle mass are independently associated with poor outcomes in colorectal cancer (CRC). However, tools to identify low muscle mass are limited in the clinical setting. We investigated the ability of existing malnutrition screening and assessment tools to identify low muscle mass assessed by computed tomography (CT). Secondary aims were to determine the feasibility of CT analysis and handgrip strength (HGS). An exploratory study of patients who underwent curative surgery for CRC between February and September 2019. Nutrition tools used included body mass index (BMI), Malnutrition Screening Tool (MST), and Patient-Generated Subjective Global Assessment (PG-SGA). Muscle mass was determined by preoperative CT image at the third lumbar vertebral level (L3), and muscle strength was determined by HGS dynamometry. Fisher's exact and Mann-Whitney U tests were used to compare results of nutrition tools with CT muscle assessment. In total, 57 patients were included. MST classified 18 patients (32%) as at risk of malnutrition, and PG-SGA classified 10 patients (17%) as malnourished. Fifty-one (90%) CT scans were analysable and 21 (47%) had low muscle mass. Of those with low muscle mass, PG-SGA classified 22 patients (92%) as well nourished and MST classified 17 patients (71%) as not being at nutrition risk. No tool was able to identify CT-diagnosed low muscle mass. Inability to complete HGS was associated with malnutrition (P = .001). In this cohort, nutrition screening and assessment tools did not identify CT-diagnosed low muscle mass. Feasible tools to identify low muscle mass in the clinical setting are required.