Malnutrition Universal Screening Tool Research Articles

Phase angle, nutritional status, and mortality in systemic sclerosis: An exploratory pilot study

ObjectivesSystemic sclerosis (SSc) is a rare autoimmune disease characterized by microvascular damage and fibrosis of the skin and internal organs. Among SSc complications, changes in nutritional status have a negative effect on quality of life and predispose patients to malnutrition. The aim of this exploratory pilot study was to examine whether bioelectrical impedance analysis-derived phase angle (PhA) is a parameter of nutritional status and a marker of mortality in patients with SSc. MethodsConsecutive adult patients with SSc were included in the study. Biochemical analyses, anthropometric data, and bioelectrical impedance analysis assessments were recorded at the time of enrollment. The Malnutrition Universal Screening Tool (MUST) and Global Leadership Initiative on Malnutrition (GLIM) were applied to assess nutritional status. ResultsA total of 104 patients with SSc (88 women; median age: 55 y [interquartile range (IQR), 45.5– 66 y]) were enrolled. In patients with SSc and high malnutrition risk according to MUST, mean values of PhA were significantly lower than those of patients with SSc and low malnutrition risk (4° [IQR, 3.7°–4.4°] vs 4.6° [IQR, 4.2°–5.1°]; P = 0.004). Patients with SSc and malnutrition according to the GLIM criteria showed significantly lower PhA than patients with SSc but without malnutrition (3.8° [IQR, 3.5°–4.3°] vs 4.6° [IQR, 4.2°–5.1°]; P < 0.0001). Kaplan–Meier curves demonstrated that overall survival was significantly shorter (34.57 mo [±13.35] vs 48 mo [±0]; P = 0.001) in patients with SSc and PhA <3.75°. In the multivariate analysis, only PhA was a predictive factor for death (hazard ratio: 0.283; 95% confidence interval, 0.083–0.965; P = 0.044). ConclusionsThe data obtained suggest that lower PhA values in patients with SSc are associated with an increased malnutrition risk with MUST, malnutrition with GLIM, and increased mortality. Additional studies are necessary to confirm these preliminary results.

Accuracy of estimated height from ulnar length using MUST equation

Background &amp; Aim: Height is an important parameter in the assessment of nutritional status. Height is difficult to measure directly in critically ill patients; alternative methods are used to predict the height. One such method used in the Sri Lankan setting is the Malnutrition Universal Screening Tool (MUST) equations using ulnar length. But the accuracy of the estimated height from the ulnar length in local setting is not studied much. The present study is carried out as a pilot study in order to evaluate the equation for estimated height from ulnar length for the Sri Lankan population. Methods: A single-centre cross-sectional study was carried out by using hospital staff in a base hospital in the central province of Sri Lanka during a staff clinic session. Height was measured by a stadiometer (Seca-203) and ulnar length non-stretchable tape. MUST equation was used the calculate the estimated height and it was compared with actual height to check the accuracy. Results: The mean age of the males and females is 39.8 (SD ± 10.2) and 40.7 (SD ± 10.0) years, respectively. The actual height of males was 165.6 cm (SD ± 6.2) and 153.8 cm (SD ± 5.6) in females. The estimated height in males is 175.6 cm (SD ± 4.9) and in females 165.3 cm (SD ± 4.7). The mean difference of estimated height was positive 10.0 cm (SD ± 5.1) in males and in females, it is 11.5 cm (SD ± 4.4). Conclusions: The estimated height from ulnar length in this subgroup differs significantly from the actual height. Therefore, MUST equation should be used cautiously until a further countrywide assessment is done to develop a population-specific equation to predict height using ulnar length.

Improving nutritional assessment in acute medical admissions at a district general hospital.

Malnutrition adversely affects clinical outcomes, necessitating a prompt and accurate assessment of nutritional status on admission. A variety of tools exist to aid nutritional assessment, of which the malnutrition universal screening tool (MUST) is recommended, but remains difficult to implement in practice. The aim of this audit was to improve the utilisation of the malnutrition universal screening tool (MUST) in the Acute Medical Unit (AMU) at Queen Elizabeth Hospital, King's Lynn. Specifically, patients should have a completed and accurate MUST score within 6hours of arrival to AMU and high-risk patients (MUST score ≥2) should be referred to dieticians within 48hours of admission. The first cycle was conducted by March 2019 and the second cycle was completed 1 year later to allow assessment of interventions actioned after the first cycle. We conducted a two-cycle audit evaluating the MUST completion and dietician referral rate of high-risk patients (defined as MUST ≥2) on the Acute Medical Unit in a district general hospital, with the standards of 80% and 100% respectively. A questionnaire was distributed after the first cycle exploring nurses' current experience and competence in using MUST. In the first cycle, MUST scores were calculated correctly in 111/150 patients (74%) and 1/9 (11%) high-risk patients were referred to dieticians. After interventions, MUST scores were calculated correctly in 77/101 patients (76%) and 2/4 high-risk patients (50%) were referred to dieticians. The nurses (n = 19) who took part in the questionnaire felt confident in MUST completion, but the average score in an objective assessment was67%. As per the literature, the first cycle demonstrated the under-utilisation of MUST in clinical practice. In response, we proposed additional face-to-face training for existing staff, the inclusion of an e-learning module within the staff's induction, and provision of ward MUST 'troubleshooting' booklets. MUST utilisation rates improved upon re-auditing, but not to target standards. We will need to consider potential barriers to sustainable change and implement interventions such as identification of nursing champions to overcome them.

Body impedance analysis to estimate malnutrition in inflammatory bowel disease patients - A cross-sectional study.

Malnutrition is a common clinical problem in patients with inflammatory bowel diseases (IBD). However, a gold standard for the detection of malnutrition in IBD patients is lacking. A cross-sectional study to assess malnutrition in patients with IBD and healthy controls (HCs). Clinical characteristics (Montreal classification, disease activity, previous surgery) and mutations in the NOD2 gene in patients with Crohn's disease (CD) were obtained. We performed a nutritional assessment with screening for nutritional risk and diagnosis for malnutrition (Malnutrition Universal Screening Tool [MUST]) score, NRS-2002, European Society for Clinical Nutrition and Metabolism (ESPEN), and Global Leadership Initiative on Malnutrition (GLIM) criteria and performed body impedance analysis (BIA). 101 IBD patients (57 CD and 44 ulcerative colitis (UC) and 50 HC were included in a single northern German tertiary center. GLIM criteria detected malnutrition significantly more often compared to the ESPEN criteria. Active disease, a long-standing disease course, and previous surgery were associated with reduced muscle mass. IBD patients had a higher fat mass index compared to HC. Mutations in the NOD2 gene had no effect on nutritional status. The GLIM criteria detect malnutrition at a higher rate compared to ESPEN. Specific disease factors might put IBD patients at a higher risk for the development of malnutrition, so these patients might benefit from a frequently performed screening, which might result in a favorable disease course.

Feasibility and impact of a quality improvement initiative to screen for malnutrition in an Inflammatory Bowel Disease clinic

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract that is associated with malnutrition. Malnutrition is associated with poor clinical outcomes in patients with IBD and therefore early identification of those at risk for malnutrition is crucial. We aimed to evaluate how frequently nutrition screening occurs in a large, tertiary care outpatient IBD center and to initiate an intervention to improve malnutrition screening for patients with IBD. We used a traditional plan-do-study-act quality improvement technique to understand our current malnutrition screening practices and institute an intervention to improve screening. To do this, we utilized a modified Malnutrition Universal Screening Tool (mMUST) and integrated this into the electronic health record. We then evaluated the intervention and the impact on IBD related clinical outcomes. Prior to the intervention, few patients with IBD were screened for malnutrition. However, the number of patients screened for malnutrition significantly improved with the study intervention and those who were identified as high-risk had increased nutrition follow up including serum micronutrient evaluations and referral to a dedicated registered dietician. This study demonstrated the feasibility and impact of a malnutrition screening program in ambulatory IBD patients. Those patients identified as high risk for malnutrition who engaged in nutrition care had improved clinical outcomes including reduced hospitalizations and emergency room visits.

The relationship between nutrition screenings and nutritional status determined by malnutrition in hemodialysis patients

Objective: It is aimed to evaluate the relationship of food consumptions, biochemical blood parameters, and some anthropometrics with the screening tests using in the nutritional status of hemodialysis patients with end stage renal failure. Materials and Methods: The survey were conducted with 110 hemodialysis patients who hospitalized at the Nephrology Clinic in Akdeniz University Hospital. The routine biochemical blood parameters of the patients were analyzed and their anthropometric measurements were performed. The food consumptions were recorded by the dietician and Nutritional Risk Screening 2002 (NRS 2002), Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA)has screening tests using were performed. Results: The average age of the patients participating in the study was 55 ± 19 years. In MUST, 42.7% of the patients were at high risk, 18.2% of them at moderate risk by malnutrition. Statistically significant relationship was also negatively determined between body weight, dry weight, BMI, the waist circumference, and MUST and SGA (p&lt;0.05). A negatively significant relationship was statistically found among albumin, creatinine, hemoglobin and calcium readouts by NRS2002, among albumin, BUN, calcium and phosphorus readouts by MUST, among albumin, hemoglobin and calcium readouts by SGA (p&lt;0.05). Conclusion: It was observed that the dialysis patients could not get the advised nutritional quantities, thence malnutrition progressed. It is concluded that anthropometric measurements are more concordant with MUST and the biochemical symptoms with NRS2002, and therefore both must be taken into consideration in the assessment of nutritional status correctly of the end-stage renal patients undergoing hemodialysis.

Analysis of ESPEN and GLIM algorithms reveals specific drivers for the diagnosis of malnutrition in patients with chronic gastrointestinal diseases

ObjectivesDisease-related malnutrition (MN) is common in patients with liver cirrhosis (LC), short bowel syndrome (SBS), and chronic pancreatitis (CP). Different MN risk screening tools and diagnostic criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM) algorithms were analyzed for their diagnostic accuracy and role as specific drivers to diagnose MN in patients with LC, SBS, and CP. MethodsA total of 187 patients with LC, SBS, and CP, as well as control patients were prospectively recruited in a multicenter cross-sectional study. MN risk was screened using Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), and diagnosed using the ESPEN, GLIM, and GLIMCRP+ (GLIM incorporating C-reactive protein [CRP] >5 mg/L) algorithms. For each of the individual diagnostic criteria, relative frequency, sensitivity, specificity, as well as positive and negative predictive values were calculated. ResultsNRS-2002 was only sensitive in conjunction with ESPEN, while MUST was sensitive additionally with the GLIM algorithm. RFH-NPT worked the best for LC. GLIM and GLIMCRP+ diagnosed MN more frequently than the ESPEN algorithm. Diagnostic criteria were detected at remarkably different relative frequencies starting with reduced food intake/malabsorption and chronic disease/inflammation, followed by weight loss, reduced fat-free mass index, low body mass index, and body mass index <18.5 kg/m². Relative frequencies differed between LC, SBS, and CP. Weight loss in LC and CP and reduced fat-free mass index and food intake in SBS had good diagnostic accuracy, suggesting that these criteria act as specific drivers for MN. ConclusionsRFH-NPT and MUST performed better in conjunction with the GLIM algorithm than NRS-2002. MN was diagnosed more frequently by GLIM than the ESPEN algorithm in LC, SBS, and CP. Individual criteria acted as specific drivers in MN in chronic gastrointestinal diseases.

Every fifth patient suffered a high nutritional risk-Results of a prospective patient survey in an oncological outpatient center.

Malnutrition in cancer patients often remains undetected and underestimated in clinical practice despite studies revealing prevalences from 20 to 70%. Therefore, this study aimed to identify patient groups exposed to an increased nutritional risk in a university oncological outpatient center. Between May 2017 and January 2018 we screened oncological patients there using the malnutrition universal screening tool (MUST). Qualitative data were collected by a questionnaire to learn about patients' individual information needs and changes in patients' diets and stressful personal nutrition restrictions. We included 311 patients with various cancers. 20.3% (n = 63) were found to be at high risk of malnutrition, 16.4% (n = 51) at moderate risk despite a mean body mass index (BMI) of 26.5 ± 4.7 kg/m2. The average age was 62.7 (± 11.8) with equal gender distribution (52% women, n = 162). In 94.8% (n = 295) unintended weight loss led to MUST scoring. Patients with gastrointestinal tumors (25%, n = 78) and patients >65 years (22%, n = 68) were at higher risk. Furthermore, there was a significant association between surgery or chemotherapy within six months before survey and a MUST score ≥2 (OR = 3.6). Taste changes, dysphagia, and appetite loss were also particular risk factors (OR = 2.3-3.2). Young, female and normal-weight patients showed most interest in nutrition in cancer. However, only 38% (n = 118) had a nutritional counseling. This study confirms that using the MUST score is a valid screening procedure to identify outpatients at risk of developing malnutrition. Here one in five was at high risk, but only 1% would have been detected by BMI alone. Therefore, an ongoing screening procedure with meaningful parameters should be urgently implemented into the clinical routine of cancer outpatients as recommended in international guidelines.

How to use the Malnutrition Universal Screening Tool

A five-step resource to identify issues and develop care plans for patients with malnutrition

S930 Identifying Risk Factors and Predictors of Malnutrition in Patients With Inflammatory Bowel Disease at a Tertiary Care Center

Introduction: Malnutrition is highly prevalent in patients with inflammatory bowel disease (IBD). Nutritional assessment tools have been created to identify malnourished individuals and facilitate prompt nutritional intervention. The Malnutrition Universal Screening Tool (MUST) is a validated tool recommended for patients across all healthcare settings. In the present study, we implemented the MUST among patients with IBD at outpatient clinics in an academic health system. The aim of this study was to examine the relationship between patient and clinical characteristics, and laboratory markers of nutrition with the MUST nutritional risk score in patients with IBD. Methods: This was a multi-center retrospective study conducted in outpatient clinics throughout the MedStar Healthcare System. 199 patients with IBD were screened using the MUST between February 10, 2022, and May 31, 2022. Low, medium, and high nutritional risk scores were defined as a score of 0, 1, or ≥ 2, respectively. We examined the association between the MUST scores and patient demographic data, markers of nutrition, and markers of disease activity. Univariate and multivariate logistic regression was used to examine associations between independent risk factors with nutritional risk score. Results: Among the 199 patients screened, 87% were classified as low risk for malnutrition, 9% as moderate risk, and 4% as high risk. There was no statistically significant association between nutritional risk score and sex, IBD diagnosis, or age. In univariate analysis, IBD-related hospitalizations within one year of screening (p = 0.022), recent steroid use (p < .001), and elevated C-reactive protein (CRP) (p = 0.027) were associated with moderate-to-high risk of malnutrition as compared to low risk (Table). Decreased albumin (OR: 0.10; 95% CI: 0.02-0.57) and decreased hemoglobin (OR: 0.58; 95% CI: 0.40-0.84) were also significant predictors of malnutrition. In multivariate analysis, recent steroid use remained an independent risk factor for malnutrition. Conclusion: In this study, we demonstrate that MUST screening correlates to markers of disease activity, inflammation, and nutrition in patients with IBD. Univariate analysis identified IBD-related hospitalizations, recent steroid use, elevated CRP, decreased albumin, and decreased hemoglobin as risk factors. Only recent steroid use was identified as an independent risk factor. Further study on nutritional risk screening and disease markers in larger populations is warranted. Table 1. - Univariate analysis of risk factors associated with moderate-high risk nutritional risk score Characteristic Odds Ratio 95% Confidence Interval P-Value Lower Limit Upper Limit Steroid Use 7.314 2.346 22.805 < .001 IBD-related Hospitalization 4.632 1.247 17.213 0.022 CRP (mg/L) 1.129 1.014 1.257 0.027 Fecal Calprotectin (mcg/gm) 1.001 1.000 1.002 0.062 Albumin (gm/dL) 0.101 0.018 0.570 0.009 Hemoglobin (gm/dL) 0.580 0.403 0.835 0.003

The Role of Diet and Nutrition on Fracture Healing: A Systematic Review

Category: Other Introduction/Purpose: Not only is poor nutritional status common amongst the elderly, but its incidence is also high amongst orthopedic trauma patients as injuries, and fractures more specifically, cause hypermetabolic states. The purpose of this review was to perform the most comprehensive analysis of literature published within the last decade to determine the effect of nutritional status on fracture healing, as well as outlining the effects of specific herbal supplements, vitamins and minerals. Methods: Following PRISMA guidelines, PubMed, Embase and Web of Science databases were searched using variations of the terms nutrition and malnutrition along with vitamins, minerals and proteins as well as fractures and fracture healing. Two independent reviewers screened articles, graded evidence quality, and extracted data. A total of 31 studies were related to nutritional status - 22 human studies and 9 animal studies - and 45 studies were related to specific herbs or food products - 2 human studies, 36 animal studies, and 7 review articles. Results: There is substantial variability in the definitions of nutritional status, with some quantitative measures including serum albumin and lymphocyte count being the most popular, and questionnaires like the Mini Nutritional Assessment (MNA) and the Malnutrition Universal Screening Tool (MUST). Published human studies predominately studied the effects of nutrition on traumatic fractures in the elderly or bone healing after spinal surgery. Consistently, hypoalbuminemia was found to be an independent risk factor of post-operative complications and longer hospital stays. Few studies reported on nutritional supplementation, but those that did found supplementation to be associated with lower rates of postoperative complications and wound infection, as well as shorter hospital stays. Although there is much evidence published on herbal supplements and food products in animals, there is a dearth of evidence of their benefits to humans with only two RCTs included in this analysis (demonstrating the benefits of Momiai and lactobacillus casei Shirota). Conclusion: Nutrition remains an easily targetable factor that can significantly improve fracture healing, especially amongst elderly populations. Although proper adherence to supplementation is rare, when attained its benefits are profound. To demonstrate that the beneficial effects of herbal supplements and food products on fracture healing seen in animal models persist in humans, future placebo-controlled trials are needed.

Functional and Clinical Characteristics of Individuals Attending Pulmonary Rehabilitation After Severe COVID-19.

A proportion of patients with COVID-19 need hospitalization due to severe respiratory symptoms. We sought to analyze characteristics of survivors of severe COVID-19 subsequently admitted to in-patient pulmonary rehabilitation and identify their rehabilitation needs. From the COVID-19 Registry of Fondazione Don Gnocchi, we extracted 203 subjects admitted for in-patient pulmonary rehabilitation after severe COVID-19 from April 2020-September 2021. Specific information on acute-hospital stay and clinical and functional characteristics on admission to rehabilitation units were collected. During the acute phase of disease, 168 subjects received mechanical ventilation for 26 d; 85 experienced delirium during their stay in ICU. On admission to rehabilitation units, 20 subjects were still on mechanical ventilation; 57 had tracheostomy; 142 were on oxygen therapy; 49 were diagnosed critical illness neuropathy; 162 showed modified Barthel Index < 75; only 51 were able to perform a 6-min walk test; 32 of 90 scored abnormal at Montreal Cognitive Assessment; 43 of 88 scored abnormal at Hospital Anxiety and Depression Scale; 65 scored ≥ 2 at Malnutrition Universal Screening Tool, and 95 showed dysphagia needing logopedic treatment. Our analysis shows that subjects admitted for in-patient pulmonary rehabilitation after severe COVID-19 represent an extraordinarily multifaceted and clinically complex patient population who need customized, comprehensive rehabilitation programs carried out by teams with different professional skills. The need for step-down facilities, such as sub-intensive rehabilitation units, is also highlighted.

A modified nutrition risk screening 2002 predicts the risk of death among hospitalized patients with COVID-19.

ObjectivesThe aim of this study was to evaluate the ability of a modified Nutrition Risk Screening 2002 (modified NRS) compared with other nutrition screening tools such as NRS 2002, Mini Nutrition Assessment Short Form (MNA-SF), and Malnutrition Universal Screening Tool (MUST) on predicting the risk of death in patients with coronavirus disease 2019 (COVID-19).MethodsWe retrospectively collected data of patients who were admitted to the West campus of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 25th, 2020 to April 24th, 2020. The nutritional status of the patients was assessed by modified NRS, NRS 2002, MNA-SF, and MUST. According to the score of modified NRS, patients were divided into malnutrition risk group (score ≥3) and normal nutrition group (score < 3). Clinical characteristics were compared between the two groups. Kaplan meier survival curve was used to analyze the difference of compositing survival rate between the two groups. The predictive efficacy of different nutritional scales on the outcome of death was detected by Receiver operating characteristic (ROC) analysis.ResultsThe modified NRS, NRS 2002, MNA-SF, and MUST identified malnutrition risk in 71.4%, 57.9%, 73.9%, and 43.4% of the patients, respectively. The patients were divided into malnutrition risk group and normal nutrition group by modified NRS score. Patients in the malnutrition risk group were older (65y vs. 56y) and with more severe and critical cases (42.30% vs. 5.20%) and diabetes cases (21.50% vs. 9.80%), worse prognosis (death of 13.80% vs. 0.50%), longer hospital stay (29days vs. 23days), lower albumin (31.85g/L vs. 38.55g/L) and prealbumin (201.95mg/L vs. 280.25mg/L) compared with the normal nutrition group (P were <0.001, respectively). There were more patients with chronic respiratory disease in malnutrition risk group (9.70 vs. 2.10%, P=0.001). BMI was lower in malnutrition risk group (23.45 kg/m2vs. 24.15 kg/m2, P=0.017). Kaplan meier survival curve demonstrated that the survival of malnutrition risk group was significantly lower than normal nutrition group (P<0.001). The area under the ROC curve (AUC) of the modified NRS scale (0.895) outperformed NRS 2002 (0.758), MNA-SF (0.688), and MUST (0.485). The former three scales could predict the risk of death (P were<0.001), while MUST could not (P =0.690).ConclusionsPatients with COVID-19 at risk of malnutrition have a worse prognosis than those with normal nutrition. The modified NRS scale could effectively predict the risk of death among patients with COVID-19.

TO STUDY OF THE PROPORTION AND PATTERN OF SELECTIVE MICRONUTRIENT AND MACRONUTRIENT DEFICIENCY IN TRAUMATIC BRAIN INJURY PATIENT ADMITTED IN NEUROSURGERY ICU

Aim: To study the proportion of selective micronutrient and macronutrient deciency in traumatic brain injury. Material And Methods: A prospective observational Study performed at department of neurosurgery, SMS medical college, Jaipur.200 traumatic head injury patient of age 15 to 80 years admitted at neurosurgery trauma ICU with post resuscitation Glasgow coma scale (GCS) score of 3 to 8 (severe traumatic brain injury) were included in the study.“Malnutrition Universal Screening Tool” (MUST) was used to assess the nutritional status of all subjects and it was classied as: no risk, moderate risk and high risk of malnutrition when MUST score was 0, 1 and ≥ 2respectively. Severity of TBI was classied into mild, moderate, and severe based on Glasgow Coma Scale (GCS) when it ≥13, 9 -12 and ≤ 8 respectively. Serum electrolytes were measured at time of admission in emergency before starting intravenous uid and repeated at 24 hours after resuscitation and Serum electrolytes (serum sodium, potassium) were repeated at 24 hours after resuscitation and along with calcium, phosphate, B12. Results: Mild, moderate and severe TBI was revealed in 26%, 30.5% and 43.5% of the subjects respectively. All the nutrients intake viz. energy (kcal/d), protein (gm/d), CHO (gm/d) and fat (gm/d) was found to be signicantly less among the TBI subjects. Macronutrients inadequacy viz. energy (kcal/d), protein (gm/d), CHO (gm/d) and ber (gm/d) inadequacy was reported among 93.5%, 69%, 4.5% and 71.5% of the subjects respectively. Conclusion: Nutrition assessment upon admission of TBI patients could be a vital factor in identifying patients with malnutrition, and prevention from nutrition-related complications.

Validation of GLIM criteria on malnutrition in older Chinese inpatients.

ObjectiveMalnutrition is a nutritional disorder and common syndrome that has a high incidence and is easily ignored in hospitalized older patients. It can lead to multiple poor prognoses, such as frailty. Early identification and correct evaluation of possible malnutrition and frailty are essential to improve clinical outcomes in older patients. Therefore, our objective was to explore the applicability and effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) criteria for identifying malnutrition in older patients.MethodsIn total, 223 participants aged ≥60 years were involved. Nutrition was evaluated using the Mini Nutritional Assessment-Full Form (MNA-FF) and GLIM criteria, which adopt a two-step procedure. The first step was to use three different methods for the screening of nutritional risk: the Nutrition Risk Screening 2002, the Mini Nutritional Assessment Short Form (MNA-SF), and the Malnutrition Universal Screening Tool. The second step was to link a combination of at least one phenotypical criterion and one etiological criterion to diagnose malnutrition. The Clinical Frailty Scale was used to assess frailty. Sensitivity, specificity, Youden index, kappa values, and positive and negative predictive values were used to evaluate the validity of the GLIM criteria. Logistic regression models were used to assess whether there was a correlation between malnutrition, as defined by the GLIM criteria, and frailty.ResultsWe found that 32.3–49.8% of our patient sample were at risk of malnutrition based on the GLIM diagnosis and using the three different screening tools; 19.3–27.8% of the patients were malnourished. GLIM criteria with MNA-SF as a diagnostic validation and MNA-FF as a reference showed high consistency (K = 0.629; p < 0.001), sensitivity (90.5%), and specificity (86.4%). Logistic regression analysis showed that malnutrition, using MNA-SF with the GLIM criteria, was relevant for a higher likelihood of frailty (OR = 1.887; 95% CI 1.184–2.589).ConclusionsThe incidence of GLIM-defined malnutrition was 19.3–27.8% using different screening tools. The consistency between the GLIM criteria using the MNA-SF and the MNA methods was high. Malnutrition, as diagnosed by the GLIM criteria with MNA-SF, was significantly correlated with frailty. GLIM criteria with MNA-SF may be a more reliable malnutrition assessment process in older inpatients.

Complementarity of nutritional screening tools to GLIM criteria on malnutrition diagnosis in hospitalised patients: A secondary analysis of a longitudinal study

The Global Leadership Initiative on Malnutrition (GLIM) proposed a two-step approach for the malnutrition diagnosis: screening to identify "at risk" patients by any validated nutritional screening tool (NST), followed by a detailed nutritional assessment for diagnosis and grading the severity of malnutrition. Since there are several validated NST, this study aimed to evaluate the complementarity of five NST to GLIM criteria for malnutrition diagnosis in a sample of hospitalized patients. A secondary analysis of a longitudinal study. Data collection occurred within 48h of hospital admission and included clinical, sociodemographic and nutritional data. We applied five tools for nutritional risk (NR) screening: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Nutritional Risk in Emergency-2017 (NRE-2017), Nutritional Risk Screening - 2002 (NRS-2002), and Short Nutritional Assessment Questionnaire (SNAQ). GLIM criteria were applied to malnutrition diagnosis considering all five criteria. Patients were followed up until discharge to assess hospital length of stay (LOS) and in-hospital mortality and contacted six months post-discharge to assess hospital readmission and death. We calculated the sensitivity, specificity, predictive positive and negative values (PPV and NPV), and kappa. We grouped patients according to NR and malnutrition status in four categories [i.e. NR(+)/GLIM(+)] and investigated their associations with the clinical outcomes in regression models adjusted to the Charlson Comorbidity Index. Among the 601 patients included (55.8±14.8 years, 51.4% males), 41.6% were malnourished by GLIM criteria. The frequency of NR ranged from 24.0% (NRE-2017) to 35.8% (NRS-2002). MUST had the highest sensitivity (73.6%), NPV (83.6%) and PPV (93.4%). All NST presented specificity higher than 90%, except NRS-2002. The accuracy of NST ranged from 76.3% (SNAQ) to 86.8% (MUST). NR (+)/GLIM (+) by NRE-2017, MST, and MUST increased the risk of in-hospital mortality (HR ranged from 5.34 to 10.10). NR (+)/GLIM (+) increased the odds of LOS ≥10 days (RR between 2.11 and 3.01), readmission (RR between 1.51 and 1.80), and mortality six months after discharge (RR between 3.91 and 5.12), regardless of the NST applied. MUST presented the highest metrics of accuracy in comparison to GLIM criteria and was an independent predictor of worse clinical outcomes when nutritional risk was combined to malnutrition diagnosis. So, risk screening by MUST is suggested as the first step of the GLIM approach.

350 Nutritional Management of Emergency and Elective Surgical Patients – Are We Doing Enough?

Abstract Aim Malnourished patients make poor surgical candidates, with an increased risk of post-operative complications. We assessed the peri-operative nutritional status of patients undergoing elective and emergency general surgical operations. Method Data was collected from 1 September 2021 to 1 November 2021. The inclusion criteria included: underwent surgery for gastro-intestinal pathology, length of stay ≥5 days, and high risk of malnutrition as per the Malnutrition Universal Screening Tool (MUST). Results 50 emergency patients were identified. In the pre-operative to post-operative period, these patients had a mean albumin decrease from 30.5 to 23.7, against a decrease in CRP of 146 to 105.5, suggesting worsening nutrition rather than worsening inflammation. 48% of these patients had dietician referrals in-place with 54% of these on oral supplementation. Post-surgical complications increased in these patients without a dietician referral, with wound infection the most common cause (n=4). 50 elective patients were identified. 40% of these patients had dietician referrals in-place with 70% of these on oral supplementation. Post-surgical complications increased in these patients without a dietician referral with the most common complication being acute kidney injury followed by wound infection. Conclusions Optimal nutrition is key to optimal recovery. Most patients with dietician referrals had a plan of oral supplementation. This intervention can be commenced by the immediate surgical team. 56% of patients meeting the MUST tool criteria for high risk of malnutrition had no dietician referral. This can be addressed through early consideration for dietician referral, teaching sessions and educational posters distributed across surgical wards.

Health and Lifestyle of Patients with Mesothelioma: Protocol for the Help-Meso Study

Patients with mesothelioma (PwM) have a poor prognosis and are at risk of adverse health outcomes and poor health-related quality of life. Sarcopenia and malnutrition are important prognostic factors for cancer patients and can be partially reversed with adequate nutrition and physical activity/exercise. There is a limited evidence base about the nutritional status of PwM, the understanding of which might potentially influence interventions in PwM. The primary aim of the Help-Meso (Health and Lifestyle of PwM) study is to describe the nutrition, appetite, physical activity and attitude towards lifestyle interventions of PwM. Patients, informal carers and health professionals will be invited to participate in semi-structured interviews and thematic analysis will be performed. The secondary aim of Help-Meso is to assess the feasibility of nutritional screening of PwM via a validated quantitative tool (Malnutrition Universal Screening Tool). The findings from this study will provide an understanding of the health and lifestyle of PwM and the corresponding attitudes of their informal carers and healthcare providers. This information will inform the design of future targeted interventions to improve the nutrition, quality of life of PwM and outcomes. The study has Research Ethics Committee (REC) and Health Research Authority approvals obtained from Wales REC7 (Integrated Research Application System (IRAS) project ID 287193).

Malnutrition risk screening: New insights in a new era

Twenty years ago, ESPEN published its "Guidelines for nutritional screening 2002", with the note that these guidelines were based on the evidence available until 2002, and that they needed to be updated and adapted to current state of knowledge in the future. Twenty years have passed, and tremendous progress has been made in the field of malnutrition risk screening. Many screening tools have been developed and validated for different patient groups and different health care settings. Some countries even have introduced mandatory screening for malnutrition at admission to hospital. Yet, changes in society and healthcare require a reflection on current practice and policies regarding malnutrition risk screening. In this opinion paper, we share our perspectives on malnutrition risk screening in the twenty-twenties, addressing the changing and varying profile of the malnourished individual, the goals of screening and screening tools (i.e., preventive or reactive), the construct of malnutrition risk (i.e., screening for risk factors or screening for existing malnutrition), and screening alongside a patient's journey.

Nutritional Status in a Sample of Patients With β-Thalassemia Major.

Background: Patients suffering from thalassemia have decreased levels of lean body mass and an increased nutritional risk. To assess the body composition and vitamin D levels of thalassemic patients in relation to nutritional risk.Methods: A total of 67 consecutive adult patients who were diagnosed with thalassemia major and followed a regular blood transfusion scheme were included in this study. Demographic and clinical data were collected for each participant. Blood samples were collected to assess 25-hydroxy-vitamin D (25-OH-D) levels. The assessment of patients’ nutritional risk was based on the Malnutrition Universal Screening Tool. Body composition assessment was based on bioelectrical impedance analysis (BIA).Results: Eleven patients (16.4%) and five patients (7.5%) were at moderate and high risk for malnutrition, respectively. Moreover, 86.6% of patients had a low fat-free mass index (FFMI) and 74.6% of patients had a high-fat mass (FM) index. The prevalence of sarcopenic obesity and 25-OH-D deficiency was 64.2% and 92.2%, respectively. Medium and high-risk patients had significantly lower BMI (18.81 ± 1.29 vs 23.90 ± 2.65 kg/m2, p<0.001), lower FFM index (12.80 ± 1.38 vs 14.19 ± 1.89 kg/m2, p=0.009) and lower FM index (5.97 ± 1.86 vs 9.70 ± 2.70 kg/m2, p<0.001) than their low-risk counterparts.Conclusions: Adult patients with β-thalassemia major had low levels of vitamin D and altered body composition, presenting with increased adiposity, low levels of lean body mass, and high rates of sarcopenic obesity. Timely detection of patients at risk could lead to the prioritization of patients who could benefit from nutritional interventions.