Malnutrition Universal Screening Tool Research Articles

Malnutrition screening tools in gastrointestinal cancer: A systematic review of concurrent validity

ObjectiveMalnutrition is a significant problem in gastrointestinal (GI) cancer, and accurate screening and identification is essential to ensure appropriate nutrition intervention. This study aims to determine current evidence for concurrent validity of malnutrition screening tools in GI cancer. MethodsA systematic review was undertaken according to PRISMA guidelines, using four databases. Studies investigating the concurrent validity of malnutrition screening tools against a reference standard of Patient Generated Subjective Global Assessment (PG-SGA) or Subjective Global Assessment (SGA) in adult patients with GI cancer were identified. Screening, quality assessment using the QUADAS-2 checklist, and data extraction were performed by two independent reviewers. Concurrent validity ratings were applied using predefined criteria. ResultsSix studies investigating concurrent validity of the Nutrition Risk Index (NRI), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST) and Nutrition Risk Screening 2002 criteria (NRS-2002) were included. There was variation in concurrent validity ratings ranging from poor-good for all tools, depending on treatment type, stage and population characteristics. ConclusionRecommendations regarding the use of one tool over another could not be made. However, in the absence of a clear recommendation specific to GI cancer, screening tools that are well validated in general clinical populations should be utilised. The MST can be recommended based on validity data against the PG-SGA and SGA from other oncology populations. If indicated, malnutrition screening should then be followed by thorough nutritional assessment.

Factors Associated with Malnutrition and Its Impact on Postoperative Outcomes in Older Patients

Malnutrition is associated with dismal treatment outcomes in older patients but its impact in geriatric surgery has not been studied extensively. Herein, we report the prevalence of malnutrition risk, its risk factors and its association with postoperative outcomes in older patients undergoing operations of general surgery. This is a retrospective analysis of a prospectively maintained database including patients older than 65 years who were to undergo general surgery operations between 2012 and 2017. The Malnutrition Universal Screening Tool (MUST) was used for nutritional risk. Demographics, socioeconomic data, site and magnitude of the operation, various measures of comorbidity and functional dependence as well as postoperative complications based on Clavien–Dindo classification and length of stay were recorded. There were 501 patients. A total of 28.6% of them were at intermediate malnutrition risk (MUST = 1) and 14.6% were at high malnutrition risk (MUST ≥ 2). Variables independently associated with malnutrition risk (MUST ≥ 1) were smoking (Odds Ratio, OR:1.6, p = 0.041), upper gastrointestinal (GI) tract surgery (OR:20.4, p < 0.001), hepatobiliary-pancreatic surgery (OR:3.7, p = 0.001), lower GI surgery (OR:5.2, p < 0.001) and American Society of Anesthesiologists (ASA) class III/IV (OR:2.8, p = 0.001). In the multiple regression analysis adjusted for several confounding variables, the MUST score was significantly associated with postoperative death (OR:9.1, p = 0.047 for MUST = 1 and OR:11.9, p = 0.035 for MUST score ≥ 2) and postoperative hospital stay (adjusted incidence rate ratio, 1.3, p = 0.041 for MUST = 1 and 1.7, p < 0.001 for MUST ≥ 2). Malnutrition risk was highly prevalent in this sample, particularly in patients with operations of the gastrointestinal tract, in patients with poor physical status and it was associated with postoperative mortality and length of stay.

The Contribution of Registered Dietitians in the Management of Hyperemesis Gravidarum in the United Kingdom.

Hyperemesis Gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum, which can cause poor oral intake, malnutrition, dehydration and weight loss. The aim of this study is to explore the role of Registered Dietitians (RD) in the management of HG in the United Kingdom (UK). A survey was designed and distributed electronically to members of the British Dietetic Association. There were 45 respondents, 76% (n = 34) worked in secondary care hospitals, 11% (n = 5) were in maternal health specialist roles. The most commonly used referral criteria was the Malnutrition Universal Screening Tool (40%, n = 18), followed by second admission (36%, n = 16). However 36% (n = 16) reported no specific referral criteria. About 87% (n = 37) of respondents did not have specific clinical guidelines to follow. Oral nutrition supplements were used by 73% (n = 33) either ‘sometimes’ or ‘most of the time’. Enteral and parenteral nutrition were less commonly used. There was an inconsistent use of referral criteria to dietetic services and a lack of specific clinical guidelines and patient resources. Further training for all clinicians and earlier recognition of malnutrition, alongside investment in the role of dietitians were recommended to improve the nutritional care of those with HG.

Frailty and restrictions in geriatric domains are associated with surgical complications but not with radiation-induced acute toxicity in head and neck cancer patients: A prospective study

ObjectivesWe aimed to evaluate the association between frailty screening and geriatric assessment (GA) on short term adverse events in patients treated for head and neck cancer (HNC) for the first time in a prospective study. Materials and methodsNewly diagnosed HNC patients undergoing curative treatment were prospectively included in OncoLifeS, a data biobank. Prior to the start of treatment, frailty was assessed with a GA, Groningen Frailty Indicator (GFI) and Geriatric-8 (G8). The GA included comorbidity (Adult Comorbidity Evaluation – 27), nutritional status (Malnutrition Universal Screening Tool), functional status ((instrumental) Activities of Daily Living), mobility (Timed Up & Go), psychological (Geriatric Depression Scale 15) and cognitive (Mini Mental State Examination) measures. Clinically relevant postoperative complications (Clavien-Dindo ≥ grade 2) and acute radiation-induced toxicity (Common Terminology Criteria for Adverse Events version 4.0 ≥ grade 2) were defined as outcome measures. Univariable and multivariable logistic regression analyses were performed, yielding odds ratios (ORs) and 95% confidence intervals (95%CIs). ResultsOf the 369 included patients, 259 patients were eligible for analysis. Postoperative complications occurred in 41/148 (27.7%) patients and acute radiation-induced toxicity was present in 86/160 (53.7%) patients. Number of deficit domains of GA (OR = 1.71, 95%CI = 1.14–2.56), GFI (OR = 2.54, 95%CI = 1.02–6.31) and G8 (OR5.59, 95%CI = 2.14–14.60) were associated with postoperative complications, but not with radiation-induced toxicity. ConclusionFrailty and restrictions in geriatric domains were associated with postoperative complications, but not with radiation-induced acute toxicity in curatively treated HNC patients. The results of this prospective study further emphasizes the importance of geriatric evaluation, particularly before surgery.

Is There a Better Tool to Identify Patients at Nutritional Risk in Emergency Units?

ObjectivesTo compare nutritional risk in patients admitted to the emergency unit, by the instruments Nutritional Risk Screening-2002 (NRS), Nutritional Risk Emergency-2017 (NRE), and Malnutrition Universal Screening Tool (MUST). MethodsCross-sectional study, carried out in the emergency unit of a public hospital in Brazil. The sample consisted of adult patients (≥ 19 years old), of both sexes. Nutritional risk was assessed within 24 hours after hospital admission. Patients with a score ≥ 3 by the NRS, ≥ 1.5 by the NRE and, ≥ 2 by the MUST were classified with risk. The NRE is a tool made up of 6 subjective questions, while the NRS and MUST use objective measures of analysis. The data were expressed in absolute (n) and relative (%) frequencies and the analysis of agreement between the instruments was performed using the Kappa test. Results432 patients were assessed (age 57.31 ± 15.6 years and 54.4% women). The prevalence of nutritional risk by NRS, NRE, and MUST tools was 36%, 45%, and 46%, respectively. There was moderate agreement between the tools, NRS and NRE (Kappa = 0.599 p < 0.01), MUST and NRE (Kappa = 0.594 p < 0.01), MUST and NRS (Kappa = 0.558 p < 0.01). When stratifying the data for elderly patients (age ≥ 60 years), the prevalence of nutritional risk increased for all screening instruments, in particular, the NRE obtained the highest value (61%). ConclusionsMUST and NRE were very similar in identifying patients at nutritional risk, however NRE was found to be superior in elderly patients. In addition, the fact that it does not require direct measurements, makes NRE the most suitable screening tool for emergency units. Funding SourcesResearch and Events Incentive Fund (FIPE) of Hospital de Clínicas de Porto Alegre.

Combining hand grip strength with nutritional screening tools in elderly patients with chronic kidney disease

Malnutrition in vulnerable patient populations must be rapidly detected using techniques that are easy to incorporate into everyday clinical practice. The new recommendations defined the 7-point Subjective Global Assessment (SGA) as optimal for nutritional assessment in chronic kidney disease (CKD), while Geriatric Nutrition Risk Index (GNRI) demands additional examination in elderly. This study aimed to determine the accuracy of several concise tools used in the clinical practice and the correlation of this tools with functional method hand grip strength (HGS) in elderly patients with CKD. In this cross-sectional study, anthropometric and functional data for 50 elderly hemodialysis patients were analyzed using numerous survey-based tools for screening nutritional status (Malnutrition Screening Tool – MST, Nutritional Risk Screening 2002 - NRS2002, Malnutrition Universal Screening Tool - MUST, Mini Nutritional Assessment - MNA, GNRI), which we compared to the standard 7-point SGA nutritional assessment tool. The sensitivity, specificity, and accuracy of these tools for detecting malnutrition were compared with the standard by using receiver operating characteristic (ROC) curve analysis. 7-point SGA classified 36.6% of participants as well nourished, and 63.4% as mildly to moderately malnourished, while the simplest alternative methods showed lower accuracy, classifying much higher proportions of participants as well nourished (MST, 92.0%; NRS2002, 80.4%). MNA had the highest accuracy based on receiver operating characteristic curves. HGS correlated moderately with 7-point SGA (r = 0.331), MNA (r = 0.410), and GNRI (r = 0.320). Our small study suggests that MNA is the best tool for malnutrition risk screening in elderly with CKD. Combining HGS with concise tools, such as GNRI, may provide better results and unburden healthcare professionals.

Relationship Between Risk, Nutritional Status and Functional Capacity and Clinical Outcomes in Cancer Patients: A Systematic Review

Abstract Objectives To systematically review the published evidence on nutritional risk screening instruments, nutritional assessment and functional capacity used in hospitalized cancer patients and possible associations with unfavorable clinical outcomes. Methods A systematic search was performed in EMBASE, PubMed/MEDLINE, LiLACS and SciELO (publications from January 2010 to January 2021) databases by search terms related to “nutritional risk”, “nutritional assessment”, functional capacity” and “cancer”. Results 3753 articles were identified, and 321 duplicates were excluded. Of the 3432 articles analyzed by title/abstract, 109 were selected for full reading and 28 studies meeting the inclusion criteria. The agreement analysis between the researchers generated a Kappa of 0.813. The evaluated studies included comparison of tools: 1) nutritional screening, 2) nutritional screening based on laboratory parameters, 3) nutritional assessment, 4) nutritional diagnosis and, 5) functional capacity. The higher nutritional risk, worst nutritional status and low functional capacity assessed by the Nutritional Risk Screening 2002 (NRS- 2002), Patient-Generated Subjective Global Assessment (PG-SGA); Subjective Global Assessment (SGA) and lower handgrip strength, respectively, were associated with longer of hospital stay. The worst nutritional status, identified by the SGA scores, Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Index (NRI) were significant predictors of postoperative mortality. Conclusions The studies included in this systematic review showed that higher nutritional risk, worse nutritional status and low functional capacity are associated with unfavorable outcomes such as longer hospital stay and mortality. The combination of the tools can be recommended for a complete assessment of the nutritional status of hospitalized cancer patients. Funding Sources Fundo de Incentivo à Pesquisa (FIPE) do Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil. (number# 2019/0708).

Nutritional risk assessed by the Malnutrition Universal Screening Tool as a predictor of frailty in acutely hospitalised older patients: An observational study.

Frailty and malnutrition are overlapping geriatric syndromes and leads to poor clinical outcomes in older patients. This study determined whether Malnutrition Universal Screening Tool (MUST) can predict frailty in older hospitalised patients. This prospective study recruited 243 patients ≥65 years in a tertiary-teaching hospital in Australia. Frailty assessment was performed by use of the Edmonton-Frail-Scale (EFS), while malnutrition-risk was determined by use of the MUST. Patients with an EFS score >8 were classified as frail, while patients with a MUST score of 1 as at moderate malnutritionrisk and ≥2 as at high malnutrition-risk. Multivariable logistic regression determined whether malnutrition-risk predicts frailty after adjustment for various co-variates. The mean (SD) age was 83.9 (6.5) years) and 126 (51.9%) were females. One-hundred and forty-nine (61.3%) patients were classified as frail, while 66 (27.2%) were found to be at high malnutrition-risk according to the MUST. Frail patients were more likely to be older with a higher Charlson-index and on polypharmacy than non-frail patients. Patients who were at high malnutrition- risk were more likely to be living alone and on vitamin D supplementation than those at low malnutritionrisk. Patients who were at a high malnutrition-risk but not those who were at moderate malnutrition-risk, were more likely to be deemed frail (aOR 2.6, 95% CI 1.2-5.5, p=0.015) when compared to those who were at low malnutrition-risk. Only patients who were classified as at high malnutrition-risk according to the MUST are more likely to be deemed frail.

P511 Disease-specific risk factors for malnutrition development in IBD

Abstract Background Patients with inflammatory bowel diseases (IBD) are at risk of malnutrition, which is associated with considerable disease related complications. Most available screening tools for malnutrition risk such as the malnutrition universal screening tool (MUST), do not incorporate malnutrition-promoting characteristics of IBDs. Therefore, we aimed to detect disease-specific risk factors for malnutrition development in IBD, which may be incorporated in future malnutrition screening tools. Methods A retrospective case-control study, in which detailed information regarding IBD patients treated at the IBD clinic of the Tel-Aviv Medical Center between 2010–2020 was collected. Cases were patients who developed malnutrition between clinic visits (defined as BMI≤18.5/ weight loss ≥5% of body weight during 3 months/≥10% of body weight during 6 months) and controls were those who maintained a normal nutritional status. Cases and controls were matched by age, gender, disease and disease duration. Data was collected from medical files included reported medical history, clinical manifestations of disease, disease activity, and nutritional status including MUST evaluation during clinic visits. The association between the clinical data and malnutrition development was evaluated using a logistic regression model, with adjustment for MUST components: weight loss of ≥5% of body weight and multiple (≥2) reasons for inadequate nutritional intake. Results We collected data from 118 IBD patient (cases, n=59 and controls n= 59, Crohn’s disease n=76, ulcerative colitis n=28, pouchitis patients n=14). All patients were at normal nutritional status at baseline. Patients were followed for a period of 6.2±3.0 months during which, cases lost 5.3±2.3 kg (10.4±4.8 % body weight) and controls gained 0.2±2.3 kg )0.2±3.5 % body weight) (p&amp;lt;0.001). MUST screening misclassified 34% of cases as low risk for malnutrition. Development of malnutrition was positively associated with baseline endoscopic disease activity [Odds ratio (OR)=6.06, 95% Confidence interval (CI) 1.91–19.18], repeated physician/nurse clinic visits ≥4/year (OR=5.26, 1.20–22.98), and negatively associated with advanced therapy (biologics and small molecules) (OR=0.151, 0.03–0.70), and BMI at baseline (OR=0.24, 0.13–0.44). The fit of this model was evaluated by an area under the curve of AUC=0.961 CI 0.93–0.99, p&amp;lt;0.001. Conclusion Current tools for prediction of malnutrition among IBD patients are not sensitive enough. Parameters, such as increased disease activity should prompt nutritional assessment among patients to prevent mal-nutrition. The importance of these findings should be evaluated in prospective studies.

To evaluate the nutritional status of patients with diabetes mellitus type 2 in out-patient department of a mutli-specialty hospital in Mumbai using malnutrition universal screening tool assessment score

To evaluate the nutritional status of patients with diabetes mellitus type 2 in out-patient department of a multi-specialty hospital in Mumbai using malnutrition universal screening tool assessment score - IJNMHS- Print ISSN No: - 2582-6301 Online ISSN No:- 2582-628X Article DOI No:- 10.18231/j.ijnmhs.2021.005, IP Jour

Nutritional risk screening in noninvasively mechanically ventilated critically ill adult patients: A feasibility trial

BackgroundMalnutrition rates for critically ill patients being admitted to the intensive care unit (ICU) are reported to range from 38% to 78%. Malnutrition in the ICU is associated with increased mortality, morbidity, length of hospital admission, and ICU readmission rates. The high volume of ICU admissions means that efficient screening processes to identify patients at nutritional or malnutrition risk are imperative to appropriately prioritise nutrition intervention. As the proportion of noninvasively mechanically ventilated patients in the ICU increases, the feasibility of using nutrition risk screening tools in this population needs to be established. ObjectivesThe aim of this study was to compare the feasibility of using the Malnutrition Universal Screening Tool (MUST) with the modified NUtriTion Risk In the Critically ill (mNUTRIC) score for identifying patients at nutritional or malnutrition risk in this population. MethodsA single-centre, prospective, descriptive, feasibility study was conducted. The MUST and mNUTRIC tool were completed within 24 h of ICU admission in a convenience sample of noninvasively mechanically ventilated adult patients (≥18 years) by a trained allied health assistant. The number (n) of eligible patients screened, time to complete screening (minutes), and barriers to completion were documented. Data are presented as mean (standard deviation), and the independent samples t-test was used for comparisons between tools. ResultsTwenty patients were included (60% men; aged 65.3 [13.9] years). Screening using the MUST took a significantly shorter time to complete than screening using the mNUTRIC tool (8.1 [2.8] vs 22.1 [5.6] minutes; p = 0.001). Barriers to completion included obtaining accurate weight history for the MUST and time taken for collection of information and overall training requirements to perform mNUTRIC. ConclusionsThe MUST took less time and had fewer barriers to completion than mNUTRIC. The MUST may be the more feasible nutrition risk screening tool for use in noninvasively mechanically ventilated critically ill adults.

789 Improving Compliance of The MUST Tool Through Multiple Interventions, Improves Documentation and Assessment of Nutritional Status in Trauma and Orthopaedic Patients Undergoing Surgery

Abstract Introduction The Malnutrition Universal Screening Tool (MUST) is a nationally validated risk tool, used to identify adults who are malnourished. 40% of surgical patients are malnourished which significantly impacts the outcomes of elderly patients. The primary aim of this study was to ascertain its utilisation in elderly patients undergoing trauma and orthopaedic surgery in a district general hospital. Method We completed a closed-loop audit from October2019-June2020 over two, three-week periods Inclusion criteria was age ≥65 years, and patients undergoing surgery. Data collected included MUST score, nutritional support, pre-operative fasting time, and prescription of fluids. Our intervention included departmental teaching sessions, posters, and the addition of the MUST tool to clerking proformas. Results We included analysis of 70 patients. Following our intervention, admission MUST score calculation improved by 8%, and providing nutritional support increased by 21%. However, there was no improvement in reducing pre-operative fasting time and prescription of pre-operative fluids. Conclusions Through our intervention’s documentation and assessment of nutritional status in elderly patients has improved. However further work must be completed to reduce time spent ‘nil-by-mouth’ and prescribe fluids for maintenance before surgery. This requires better pre-operative planning and communication between the surgical and ward-based teams.

Mealtime and patient factors associated with meal completion in hospitalised older patients: An exploratory observation study.

To examine mealtime and patient factors associated with meal completion among hospitalised older patients. We also considered contextual factors such as staffing levels and ward communication. Sub-optimum nutrition is a modifiable risk factor for hospital associated decline (HAD) in older patients. Yet, the quality of mealtime experiences can be overlooked within ward routinised practice. Cross sectional, descriptive observation study. We undertook structured observation of mealtimes examining patient positioning, mealtime set-up and feeding assistance. The outcome was meal completion categorised as 0, 25%, 50%, 75% or 100%. Data were collected on patient characteristics and ward context. We used mixed-effects ordinal regression models to examine patient and mealtime factors associated with higher meal completion producing odds ratios (OR) and 95% confidence intervals (CI). The study was reported as per STROBE guidelines. We included 60 patients with a median age of 82years (IQR 76-87) and clinical frailty score of 5 IQR (4-6). Of the 279 meals, 51% were eaten completely, 6% three quarters, 15% half, 18% a quarter and 10% were not eaten at all. Mealtime predictors with a weak association with less-meal completion were requiring assistance, special diets, lying in bed, and red tray (indicator of nutrition risk), but were not statistically significant. Significant patient-level factors were higher values for frailty (OR 0.34 [0.11-1.04]) and Malnutrition Universal Screening Tool (OR 0.22 [0.08-0.62]). The average nurse-to-patient ratio was 1:5.5. Patient factors were the strongest predictors for meal completion, but mealtime factors had a subtle influence. The nursing teams' capacity to prioritise mealtimes above competing demands is important as part of a comprehensive nutrition strategy. Nurses are central to optimising nutrition for frail older patients. It requires ward leadership to instil a culture of prioritising assisted mealtimes, improved communication, greater autonomy to tailor nutrition strategies and safe staffing levels.

Protocol for a randomised controlled trial of a primary care intervention to Reverse Frailty and Enhance Resilience through Exercise and dietary protein Education (REFEREE) in community-dwelling adults aged 65 and over.

Introduction: Resistance exercises and dietary protein have been shown to reverse frailty, yet they are not commonly offered in clinical practice. We aim to measure changes in health outcomes, including physical frailty status (SHARE-FI), clinical frailty status (CFS) and muscle mass, as a result of an optimised exercise and dietary intervention versus usual care in a primary care (PC) setting. The intervention has been derived from our systematic review and meta-analysis findings and optimised through patient and public involvement and multidisciplinary team input. Methods: This study is a multicentre randomised controlled parallel arm trial with a three month follow up. 210 eligible people aged 65 and over, no more than mildly frail, will be recruited in seven PC practices in Ireland and randomly assigned to 'intervention' or 'usual care'. Intervention participants will be provided a leaflet with strength exercises, protein dietary guidance and educational discussion. Baseline measurements will include demographics, health indicators, comorbidities, malnutrition universal screening tool (MUST), frailty status (SHARE-FI, CFS) and muscle mass (bioelectrical impedance). Primary outcome will be frailty status measured by SHARE-FI at three months. Secondary outcomes include CFS, muscle mass, in-patient hospitalisation, long term care admission, and subjective ease of intervention and difference to general health. Statistical analysis will be undertaken by an independent statistician. Discussion: The diversity of tested frailty interventions and lack of clear guidance may contribute to low implementation rates. The REFEREE trial focusses on an optimised intervention for a syndrome that poses growing individual and societal challenges. It is hoped results can encourage mainstream adoption of interventions to reverse clinical frailty and build resilience in primary care. Trial registration: ClinicalTrials.gov ID NCT04628754; registered on 13 November 2020.

Risk of sarcopenia in hospitalized patients and related clinical factors: a multicenter study from Turkey.

To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032-1.104, p < 0.001), female gender (OR: 2.414, CI 1.510-3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922-8.632, p < 0.001) were independently associated with sarcopenia risk. Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients.

Malnutrition and cancer, diagnosis and treatment

Summary Background The prevalence of malnutrition in cancer patients ranges from about 20% to more than 70%. However, 10–20% of cancer patients’ deaths are related to malnutrition, not the malignancy itself. To reverse the pattern of weight loss, improve the patients’ quality of life, reduce the treatment toxicity, the psychological stress and the risk of mortality, the diagnosis of malnutrition should be made as early as possible to facilitate the best possible treatment. Methods A systematic literature search was conducted following guidelines of ESPEN (European Society for Clinical Nutrition), DGEM (German Society for Nutritional Medicine) and ASPEN (American Society for Parenteral and Enteral Nutrition). Results and conclusion To assess the risk of malnutrition, all cancer patients should be screened regularly with a valid screening tool (e.g., MUST [Malnutrition Universal Screening Tool], NRS [Nutritional Risk Screening] or PG-SGA [Scored Patient-Generated Subjective Global Assessment]). If risk of malnutrition is present, adequate nutritional therapy is recommended to stop involuntary weight loss. Patients should engage in exercise to maintain and improve muscle mass, strength and function. They should be offered regular dietetic counselling, and their muscle depletion should be monitored by determining fat-free mass. As cachectic patients in particular are at risk, the presence of cachexia should also be recognized at an early stage. Three consensus-based definitions are widely accepted: Fearon et al. and the EPCRC (European Palliative Care Research Collaborative) propose definitions specifically for cancer cachexia, while Evans et al. put forward a definition for cachexia associated with all types of underlying chronic diseases. However, if there is a cancer cachexia diagnosis, additional pharmacological and psychological treatment should be considered.

Association of Adherence to Diabetics Feeding Recommendation with Glycaemic Control and with Malnutrition Risk Among Normal Weight Persons with Type 2 Diabetes in Ghana.

BackgroundDiabetes mellitus (DM) is public health problem. Feeding-recommendations help persons with diabetes control glycaemia. The aim was to access the association between adherence to diabetics’ feeding recommendation with glycaemic control and with malnutrition risk.MethodsCross-sectional study was conducted among 530 baseline normal weight (body mass index [BMI] 18.5 kg/m2–24.9 kg/m2) persons with type 2 diabetes (T2DM) in Brong Ahafo region of Ghana, from August 2018 to September 2019. Adherence to feeding recommendation was evaluated with perceived dietary adherence questionnaire (PDAQ). Malnutrition-risk was assessed using malnutrition universal screening tool. Multinomial logistics regression models were used to assess the association between adherence to diabetics’ feeding recommendation with glycaemic control and with malnutrition risk.ResultsParticipants were generally healthy. Weight (P = 0.011), total cholesterol (P = 0.003) and glycated haemoglobin (HbA1c)% (P < 0.001) were significant with adherence to diabetics feeding recommendation. Low adherence to diabetics’ feeding recommendation (adjusted odds ratio [AOR] 2.56; 95% CI: 1.44, 4.56; P < 0.001), low adherence to fruit and vegetables (AOR 2.71; 95% CI: 1.48, 4.99; P < 0.001), low adherence to whole grain, beans, starchy-fruits and plantain (AOR 3.29; 95% CI: 1.81, 6.02; P < 0.001), and low adherence to foods prepared with walnut, canola, sunflower, cotton seed and fish oils (AOR 2.62; 95% CI: 1.49, 4.58; P < 0.001) were significant with poor glycaemic control. Furthermore, low adherence to food prepared with walnut, canola, sunflower, cotton seed, fish or soy oils (AOR 0.54; 95% CI: 0.31, 0.95; P = 0.034) and low adherence to fish and lean meat (AOR 2.09; 95% CI: 1.14, 3.86; P = 0.017) were significant with moderate malnutrition risk.ConclusionThis study demonstrates that poor adherence feeding recommendation could be related to glycaemic control and malnutrition risk.

Clinical decision-making in older adults following emergency admission to hospital. Derivation and validation of a risk stratification score: OPERA.

Objectives of the studyDemographic changes alongside medical advances have resulted in older adults accounting for an increasing proportion of emergency hospital admissions. Current measures of illness severity, limited to physiological parameters, have shortcomings in this cohort, partly due to patient complexity. This study aimed to derive and validate a risk score for acutely unwell older adults which may enhance risk stratification and support clinical decision-making.MethodsData was collected from emergency admissions in patients ≥65 years from two UK general hospitals (April 2017- April 2018). Variables underwent regression analysis for in-hospital mortality and independent predictors were used to create a risk score. Performance was assessed on external validation. Secondary outcomes included seven-day mortality and extended hospital stay.ResultsDerivation (n = 8,974) and validation (n = 8,391) cohorts were analysed. The model included the National Early Warning Score 2 (NEWS2), clinical frailty scale (CFS), acute kidney injury, age, sex, and Malnutrition Universal Screening Tool. For mortality, area under the curve for the model was 0.79 (95% CI 0.78–0.80), superior to NEWS2 0.65 (0.62–0.67) and CFS 0.76 (0.74–0.77) (P<0.0001). Risk groups predicted prolonged hospital stay: the highest risk group had an odds ratio of 9.7 (5.8–16.1) to stay >30 days.ConclusionsOur simple validated model (Older Persons’ Emergency Risk Assessment [OPERA] score) predicts in-hospital mortality and prolonged length of stay and could be easily integrated into electronic hospital systems, enabling automatic digital generation of risk stratification within hours of admission. Future studies may validate the OPERA score in external populations and consider an impact analysis.

The PREdictor of MAlnutrition in Systemic Sclerosis (PREMASS) Score: A Combined Index to Predict 12 Months Onset of Malnutrition in Systemic Sclerosis.

Objective: Malnutrition is a severe complication in Systemic Sclerosis (SSc) and it is associated with significant mortality. Notwithstanding, there is no defined screening or clinical pathway for patients, which is hampering effective management and limiting the opportunity for early intervention. Here we aim to identify a combined index predictive of malnutrition at 12 months using clinical data and specific serum adipokines.Methods: This was an international, multicentre observational study involving 159 SSc patients in two independent discovery (n = 98) and validation (n = 61) cohorts. Besides routine clinical and serum data at baseline and 12 months, Malnutrition Universal Screening Tool (MUST) score and serum concentration of leptin and adiponectin were measured for each participant at baseline. The endpoint of malnutrition was defined according to European Society of Clinical Nutrition and Metabolism (ESPEN) recommendation. Significant parameters from univariate analysis were tested in logistic regression analysis to identify the predictive index of malnutrition in the derivation cohort.Results: The onset of malnutrition at 12 months correlated with adiponectin, leptin and their ratio (A/L), MUST, clinical subset, disease duration, Scl70 and Forced Vital Capaciy (FVC). Logistic regression analysis defined the formula: −2.13 + (A/L*0.45) + (Scl70*0.28) as the best PREdictor of MAlnutrition in SSc (PREMASS) (AUC = 0.96; 95% CI 0.93, 0.99). PREMASS < −1.46 had a positive predictive value (PPV) > 62% and negative predictive value (NPV) > 97% for malnutrition at 12 months.Conclusion: PREMASS is a feasible index which has shown very good performance in two independent cohorts for predicting malnutrition at 12 months in SSc. The implementation of PREMASS could aid both in clinical management and clinical trial stratification/enrichment to target malnutrition in SSc.

Protocol for a randomised controlled trial of a primary care intervention to Reverse Frailty and Enhance Resilience through Exercise and dietary protein Education (REFEREE) in community-dwelling adults aged 65 and over

Introduction: Resistance exercises and dietary protein have been shown to reverse frailty, yet they are not commonly offered in clinical practice. We aim to measure changes in health outcomes, including physical frailty status (SHARE-FI), clinical frailty status (CFS) and muscle mass, as a result of an optimised exercise and dietary intervention versus usual care in a primary care (PC) setting. The intervention has been derived from our systematic review and meta-analysis findings and optimised through patient and public involvement and multidisciplinary team input. Methods: This study is a multicentre randomised controlled parallel arm trial with a three month follow up. 210 eligible people aged 65 and over, no more than mildly frail, will be recruited in seven PC practices in Ireland and randomly assigned to ‘intervention’ or ‘usual care’. Intervention participants will be provided a leaflet with strength exercises, protein dietary guidance and educational discussion. Baseline measurements will include demographics, health indicators, comorbidities, malnutrition universal screening tool (MUST), frailty status (SHARE-FI, CFS) and muscle mass (bioelectrical impedance). Primary outcome will be frailty status measured by SHARE-FI at three months. Secondary outcomes include CFS, muscle mass, in-patient hospitalisation, long term care admission, and subjective ease of intervention and difference to general health. Statistical analysis will be undertaken by an independent statistician. Discussion: The diversity of tested frailty interventions and lack of clear guidance may contribute to low implementation rates. The REFEREE trial focusses on an optimised intervention for a syndrome that poses growing individual and societal challenges. It is hoped results can encourage mainstream adoption of interventions to reverse clinical frailty and build resilience in primary care. Trial registration: ClinicalTrials.gov ID NCT04628754; registered on 13 November 2020.