Nutrition Focused Physical Examination Research Articles

Confidence Levels of Pediatric Registered Dietitian Nutritionists Performing Nutrition-focused Physical Examination

Confidence Levels of Pediatric Registered Dietitian Nutritionists Performing Nutrition-focused Physical Examination

Development of a bronchopulmonary dysplasia nutrition focused physical examination tool: A modified Delphi study.

The objectives of this study were to identify factors impacting nutrition needs in infants and children with bronchopulmonary dysplasia (BPD). A modified Delphi approach to obtain consensus among pediatric registered dietitian nutritionists (RDNs) was used to create a BPD-specific nutrition focused physical examination (NFPE) tool. RDNs, recruited through pediatric nutrition professional associations, completed a survey rating proposed NFPE components on a Likert scale of 1-5 allowing open-ended responses in a two-round Delphi. Responses were analyzed, deidentified, and results were returned to panelists for in-round feedback. Consensus was defined a priori as 75% agreement for usefulness or relevance ± 1 standard deviation. Six domains (anthropometrics, body composition, development, gastrointestinal, respiratory, and physical signs) and 38 components achieved consensus. Components for an evidence-based tool to enhance nutrition assessment in infants and children with BPD were identified with consensus agreement by an expert panel of 19 pediatric RDNs.

Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients.

The assessment of nutrition status, sarcopenia, and frailty holds significant relevance in the context of adult transplantation, as these factors are associated with an unfavorable prognosis; thus, transplant candidates must undergo a full nutrition assessment. Screening tools may be used to prioritize patients, this can be done using the Nutrition Risk Screening 2002 or Royal Free Hospital-Nutritional Prioritizing Tool. Subsequently, a thorough nutrition-focused physical examination should be conducted to evaluate clinical signs of nutrition deficiencies, fat and muscle loss, and fluid overload; dietary history and current intake must also be assessed. Apart from physical examination, specific testing for sarcopenia and frailty are recommended. For sarcopenia assessment, specifically for muscle quantification, the gold standard is the cross-sectional measurement of the muscle at L3 obtained from a computed tomography scan or magnetic resonance imaging; dual-energy x-ray absorptiometry is also a good tool especially when appendicular skeletal muscle index is calculated. Other more readily available options include phase angle from bioelectrical impedance or bioimpedance spectroscopy. In the sarcopenia assessment, muscle function evaluation is required, handgrip strength stands as the primary test for this purpose; this test is also part of the subjective global assessment and is included in some frailty scores. Finally, for frailty assessment, the Short Physical Performance Battery is useful for evaluating physical frailty, and for a multidimensional evaluation, the Fried frailty phenotype can be used. Specifically for liver transplant candidates, the use of Liver Frailty Index is recommended.

Measuring growth in critically ill neonates and children.

Critical illness increases the risk of malnutrition in both infants and children. Malnutrition risk is multifactorial and includes premorbid factors as well as changes in nutrient metabolism and energy demands during critical illness. Inadequate nutrition has been linked to poor health outcomes and prolonged length of stay in the intensive care unit, demonstrating the importance of both recognizing and addressing malnutrition in this population. Assessing growth and identifying malnutrition requires methodical measurement of growth and a collaborative, multimodal approach to nutrition assessment. Among the nutrition assessment and growth evaluation tools, neonatal, preterm, pediatric, and disease-specific growth charts remain an important component of growth assessment and should be used along with a nutrition-focused physical examination. Routine measurement promotes the identification of potential growth delays that may require interventions. Indirect calorimetry adds an additional layer of detail for a complete picture of each infant or child's unique nutrition status and progress. Quality improvement research on a national level is urgently needed to assess the adequacy and availability of resources in neonatal and pediatric critical care units and to further the development of standard clinical outcome measures for nutrition assessment and intervention in the critically ill neonate and child.

Assessment of Nutrition Status of Adults Using the Nutrition-focused Physical Examination

Assessment of Nutrition Status of Adults Using the Nutrition-focused Physical Examination

Identifying and Mapping Canadian Dietetic Students' Interaction(s) with Simulation-Based Education: A Scoping Review.

This scoping review mapped literature available on Canadian dietetics, nutrition, and foods students' and graduates' interaction(s) with simulation-based education (SBE) during undergraduate and/or practicum. One certified Librarian led the preliminary search (Summer, 2021), while three Joanna Briggs Institute-trained reviewers conducted the comprehensive search via MEDLINE (OVID), CINAHL (EBSCO), Academic Search Premier (EBSCO), Embase (Elsevier), Scopus (Elsevier), and Google (February 2022). A data extraction tool designed specifically for the study objectives and research inclusion criteria was used. We recorded 354 results and included 7. Seven types of SBE were recorded: (i) comprehensive care plan (n = 2); (ii) nutritional diagnosis/assessment (n = 2); (iii) body composition assessment (n = 1); (iv) introducing patient to dysphagia care (n = 1); (v) nutrition counselling session (n = 1); (vi) nutrition-focused physical examination (n = 1); and (vii) professional communications via social media (n = 1). Results indicate that Canadian dietitian-led SBE includes the use of simulated patients, nutritional diagnosis/assessment, and the creation of comprehensive care plans, among others. Students have been assessed for performance of trained tasks through exams, self-awareness surveys, and interviews, and SBE activities have been evaluated for effectiveness through questionnaires and interviews with users/students. Canadian literature is limited, and more can be learned by exploring the global context within and outside the profession.

Nutrition-Focused Physical Examination for Detecting Protein Energy Wasting in Children with Chronic Kidney Disease.

There is a need to explore less laborious point-of-care assessment tools to diagnose protein energy wasting (PEW) in children with chronic kidney disease (CKD). This cross-sectional study was undertaken to assess the profile of specific nutrition-focused physical examination (NFPE) and mid-arm muscle area (MAMA) in children with CKD and determine their role in the diagnosis of PEW. PEW criterion was applied to all eligible children and MAMA was derived from mid-arm circumference and triceps skin fold thickness. NFPE signs examined were muscle wasting (MW) and subcutaneous fat loss (FL). One hundred and twenty-six children with CKD (86 in CKD stages 2-4 and 40 on dialysis) were studied. PEW was prevalent in 41.8% children with CKD2-4 and in 72.5% on dialysis. In children with CKD 2-4, low MAMA, MW, and FL were significantly associated with PEW with an odd's ratio of 5.3 (1.55,18.30), 10.6 (3.8,29.8), and 10.5 (3.7,29.2) respectively (P = <0.001). Similarly, in children on dialysis, low MAMA, MW, and FL were more likely to be associated with PEW with an odd's ratio of 17 (2.2,127.7); P = 0.017, 16.6 (3,90.8); P = 0.001 and 19 (2.1,170.3); and P = 0.009, respectively. MW demonstrated high sensitivity and specificity [80.6 and 72%, respectively, with a positive predictive value (PPV) of 67.4%] to diagnose PEW in the CKD 2-4 group and in those on dialysis [86.2 and 72.1%, respectively, with PPV of 89.3%]. Clinical signs based on NFPE are useful in detecting PEW in children with CKD2-4 and in those on dialysis.

Comparison of pre-intestinal transplant and posttransplant sarcopenia and visceral adiposity measurements using computed tomography in the diagnosis of malnutrition during a nutrition-focused physical examination.

Registered dietitian nutritionists subjectively assess muscle loss as part of the nutrition-focused physical examination (NFPE), using guidelines to standardize malnutrition diagnosis. Computed tomography (CT) scans provide an objective measure of skeletal muscle mass and abdominal wall and visceral adipose tissue and can be used to determine skeletal muscle loss. In this retrospective review, our team compared muscle measurements including the psoas, paraspinal muscles, and abdominal wall muscle area at the level of the third lumbar vertebral body (using CT)-as well as visceral and subcutaneous adipose tissue measurements-before and after gut transplant with the malnutrition diagnosis found on the NFPE. We also examined the association between CT measurements and postoperative infection, length of stay, and mortality. Forty-two patients were included in the study. Adipose tissue measurements on CT analysis were significantly lower in the malnutrition group compared with those without malnutrition (P ≤ 0.05) in both the pretransplant and posttransplant groups. Skeletal muscle size measurements were not significantly associated with malnutrition, but when adjusted for patients' height by calculating skeletal muscle index, an association between low skeletal muscle index scores and malnutrition diagnosis was found (P = 0.026). Pretransplant malnutrition diagnosis did not predict infection, length of stay, or mortality. Objective assessment of subcutaneous adipose tissue by CT analysis was significantly correlated with the subjective assessment of malnutrition by NFPE in both pretransplant and posttransplant patients. Skeletal muscle index scores were significantly lower in pretransplant patients who were diagnosed with malnutrition.

Specific nutrition evaluation of patients with advanced chronic liver disease: Development and validation.

Malnutrition is frequently identified in patients with advanced chronic liver disease (ACLD), and its early identification is necessary for effective nutrition treatment. The aim of this study was to develop and validate a tool for specific nutrition evaluation of patients with ACLD (SNE-ACLD). SNE-ACLD was developed by consensus among experts using Delphi technique. The initial proposal for the SNE-ACLD had six domains (history of weight loss, changes in food intake, gastrointestinal symptoms, changes in functional capacity, presence of complications of liver disease, and a nutrition-focused physical examination) and 11 items. Fifteen experts participated in content validation. In a cross-sectional study design, the new tool was applied to 129 inpatients and outpatients from a gastrohepatology unit. Nutrition status was evaluated with SNE-ACLD and subjective global assessment by one researcher. Content validation and semantic analysis were obtained by content validity index. To verify accuracy of SNE-ACLD, the sensitivity, specificity, Youden index, and area under the receiver operating characteristic curve (AUC) were calculated. After five evaluative sequences conducted by experts, experts excluded the domain for history of weight loss and its respective item. The final version of SNE-ACLD consists of five domains and 10 items. The new instrument showed good accuracy in identifying any level of malnutrition (AUC = 0.83; 95% CI, 0.76-0.91) and severe malnutrition (AUC = 0.90; 95% CI, 0.79-1.00). SNE-ACLD can be used in nutrition assessment of patients with liver disease. Future works should investigate its agreement with other methods and its predictive value.

Nutrition-Focused Physical Examination Knowledge and Practice Changes in Clinical Dietitians and Dietetic Educators Who Completed a 12-Month Hybrid Training Program in Malaysia

This pilot study explored nutrition-focused physical examination (NFPE) knowledge and practice changes in clinical dietitians and dietetics educators who completed a hybrid training program in Malaysia. Integration of NFPE into dietetics curricula was also assessed. Mean knowledge scores increased significantly from baseline to posttests immediately posttraining and at 6 and 12 months (P ≤ .001) posttraining. Dietitians were significantly more likely to report they perform versus not perform all NFPE tasks (P &lt; .001). Educators included all NFPE tasks in their curricula 12 months posttraining. Participants demonstrated increased NFPE knowledge and curricular and clinical practices. The hybrid approach to teaching NFPE was feasible.

Role of the nutrition-focused physical examination in identifying malnutrition and its effectiveness.

It has long been recognized that malnutrition changes physical appearance, as evidenced by muscle wasting, losses of fat stores, signs of vitamin and mineral deficiencies, and reduced physical activity. Malnutrition is associated with poor clinical outcomes and quality of life. Various nutrition assessment parameters have been used to determine the presence and degree of malnutrition, including use of anthropometric measurements and laboratory values. In the mid-1980s, the Subjective Global Assessment (SGA) tool was developed in acknowledgement of the physical features of malnutrition; an evaluation of muscle mass, fat stores, edema, and functional capacity was a major component of the SGA. SGA became a gold standard for nutrition assessment. Since then, nutrition assessment evolved from anthropometric tools and laboratory values to one based on the nutrition-focused physical examination (NFPE). NFPE uses a head-to-toe approach to evaluate muscle mass, fat stores, fluid retention, micronutrient deficiencies, and functional capacity. In 2012, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (AND/ASPEN) developed a standardized definition for malnutrition diagnoses for coding and reimbursement; the AND/ASPEN malnutrition diagnosis is derived from the SGA. A few studies demonstrated good agreement between SGA and AND/ASPEN malnutrition criteria in diagnosing malnutrition, and some studies have shown malnutrition, as diagnosed by AND/ASPEN criteria, is associated with poor clinical outcomes. More research is needed to validate the AND/ASPEN malnutrition diagnosis criteria.

Content and Face Validation of a Novel, Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) to Evaluate Registered Dietitians' Competence: A Delphi Consensus from the United States.

The nutrition-focused physical examination (NFPE) is an integral component of nutrition assessment performed by registered dietitian nutritionists (RDNs) to determine signs of malnutrition and other nutrition-related complications. Increased use of this essential skill among RDNs and the transformation of dietetics education to a competency-based model in the near future calls for appropriately validated tools to measure RDNs’ NFPE competence. To fill the need for a validated competency tool, this study developed an Interactive Nutrition-Specific Physical Exam Competency Tool (INSPECT) utilizing the initial 70 items identified in the first phase of the study. The second phase of this study aimed to test the preliminary version of the INSPECT for content and face validity. An expert panel of 17 members provided consensus recommendations through the Delphi process. Internal consistency of the consensus was measured with Cronbach’s alpha (α) and α of ≥0.70 was defined as acceptable a priori. Inter-rater agreement among the expert panel was determined using the intraclass correlation coefficient (ICC) and an a priori ICC of 0.75 to 0.9 was established as good and >0.9 as excellent agreement. The results showed acceptable face validity (α = 0.71) and excellent content validity for the INSPECT, with an internal consistency of α = 0.97 in the first round and α = 0.96 in the second round. The inter-rater agreement was also excellent with ICC = 0.95 for each of the Delphi rounds. A total of 52 items were retained from the preliminary version of the INSPECT. Open feedback from the experts allowed for the consolidation of 11 similar items for better scoring and evaluation and thus, a total of 41 items were included in the final version of the INSPECT. The final version of the INSPECT is currently being studied in real-life, multi-site clinical settings among practicing RDNs to examine construct validity, reliability, and item-level psychometric properties. Ultimately, the validated INSPECT will be available for the competency evaluation of RDNs practicing in clinical settings.

Change in Knowledge Scores Among Registered Dietitian Nutritionist Preceptors Following an In-Person or Virtual One-Day Nutrition-Focused Physical Examination Training

Describe how to increase Registered Dietitian Nutritionist preceptors' knowledge in nutrition-focused physical examination Nutrition-focused physical examination (NFPE) is an essential component of the nutrition care process. Dietetics and nutrition students training to become Registered Dietitian Nutritionists (RDN) need mentoring in the conduct of NFPE in the clinical setting by RDN preceptors. This study explored RDN preceptors’ changes in knowledge following a one-day NFPE workshop and differences in knowledge based on training platform (in-person versus virtual) and between those who had/had no prior NFPE training. RDN preceptors for a future education model graduate degree program completed a one-day NFPE workshop; a 50-item multiple-choice test was administered pre- and post-training. NFPE knowledge change from pre- to post-test was analyzed using Wilcoxon signed-rank test. Differences in knowledge changes between in-person and virtual training platforms and those with or without prior NFPE training were analyzed by independent samples t-tests. Pre- and post-tests were completed by (n=111) RDN preceptors. Sixty-three percent (n = 70) of the preceptors were trained in-person; 68% (n=73) reported prior NFPE training. A statistically significant 8-point median increase in knowledge scores from pre-(median score=36.0) to post-test (median score=44.0) (p < 0.001) was found. There were no significant differences in mean score changes based on training platform (p=0.451) or prior NFPE training (p=0.816). RDN preceptors’ NFPE knowledge scores significantly increased after a one-day NFPE workshop independent of prior NFPE training or training platform used. Training preceptors in NFPE is necessary to assist with mentoring students to conduct NFPE in the clinical setting.

Dietitians' Change in Practice

Dietetics has recently begun implementing the nutrition-focused physical examination, based on a physical examination of oral health. This qualitative study, interviewing 18 dietitians, examined how dietitians experience and cope with this change. Inductive thematic analysis revealed that dietitians experienced the change as either a threat or a challenge, as well as stemming from within or outside the profession. Dietitians' preferred coping strategies that derive from their personal experiences. Managers are recommended to develop coaching programs for dietitians to help them perceive the change as a challenge, focus on the opportunity for mastery, and gain skills to lead the interdisciplinary team.

Changes in Nutrition Focused Physical Exam Knowledge and Curriculum Integration of Dietetic Educators in Malaysia Who Have Completed an NFPE Hybrid Training Program

ObjectivesThere is limited research on the integration of Nutrition Focused Physical Examination (NFPE) into dietetic educators’ curricula practices globally. The primary objectives of this study were to assess changes in dietetic educators’ NFPE knowledge and curricula practices over 12-months after completing a hybrid training program in NFPE. MethodsThis was a secondary analysis of data from the study A Two-phase International Approach to Teaching Nutrition Focused Physical Examination, a prospective cohort pilot study. Dietetic educators in Malaysia completed an NFPE hybrid training program consisting of in-person training and follow-up computer-assisted instruction over 12 months. Participants reported the extent to which they integrated 32 NFPE tasks into their curricula at 3 timepoints (baseline, 6- and 12-months post-training) and completed a 50-item multiple-choice knowledge test at 4 timepoints (baseline and immediately, 6- and 12-months post-training). Descriptive statistics were used for curricula data; one-way repeated measures ANOVA test was used to analyze the change in knowledge scores over time. ResultsData were analyzed from those who completed knowledge tests (n = 14) and NFPE curricula data collection forms (n = 13) at all timepoints. Mean knowledge scores out of 50 possible points) increased significantly from baseline to immediately post-training and 6- and 12-months post-training (P < 0.001 for all) from 34.1 ± 5.4 at baseline to 43.7 ± 3.1 immediately post-training, 43.5 ± 2.9 at 6-months post-training, and 43.1 ± 3.0 at 12-months post-training. Changes in knowledge test scores were maintained from immediately post-training to 6- and 12-months post-training. At baseline, all of the participants reported that they “teach student NFPE tasks,” for three of the 32 NFPE tasks (examination of orbital fat pads, gastrocnemius muscle, and clavicle). At 12-months post-training,100% of the participants reported teaching all 32 NFPE tasks. ConclusionsDietetic educators in Malaysia who participated in the study significantly increased their NFPE knowledge and the integration of NFPE tasks in their nutrition and dietetics curricula from baseline to 12-months post-training. An NFPE hybrid training program is feasible to train dietetic educators in Malaysia. Funding SourcesRutgers Global Grant

The Use of Different Muscle Assessment Techniques to Assess Validity of Global Leadership Initiative on Malnutrition (GLIM)

ObjectivesTo assess which combination of indicators in the Global Leadership Initiative on Malnutrition (GLIM) diagnostic tool better predicts malnutrition. Additionally, to compare the validity of GLIM upon the use of different muscle assessment techniques for the assessment of muscle loss. MethodsNutritional screening was performed through the Nutrition Risk Screening-2002 (NRS-2002) or the Mini-Nutrition Assessment-Full Form (MNA-FF). Nutritionally at-risk patients were assessed for malnutrition using the GLIM criterion. Fat free muscle index (FFMI), nutrition focused physical examination (NFPE) and handgrip strength (HG) were used to identify muscle loss. Sensitivity, specificity, positive and negative predictive values were calculated for GLIM with each of the three muscle assessment tools. Results579 patients were screened for malnutrition and 121(20.90%) patients were considered nutritionally at risk. GLIM criterion showed close percentages of malnourished patients: 117(20.21%), 110(19.0%) and 110 (19.0%) when using NFPE, FFMI, and HG respectively. With three different muscle assessment techniques, 10 different combinations of indicators in GLIM were retrieved. The combination of muscle loss, assessed through NFPE, with either one of the two etiologic criteria yielded the highest numbers of malnourished patients among all three techniques [NFPE + reduced food intake/assimilation: 113(19.52%) and NFPE + Inflammation: 117(20.21%)], while the use of FFMI resulted in the lowest [FFMI + reduced food intake/assimilation: 37(6.39%) and FFMI + Inflammation: 40(6.91%)]. All three tools, GLIM + NFPE, GLIM + FFMI, and GLIM + HG reported high specificity [98.9% (97.45–99.64), 99.1% (97.76–99.76) and 99.1% (97.78–99.76) respectively]. However, results revealed moderate sensitivity for GLIM + FFMI [89.8% (82.91–94.63)]and GLIM + HG [89.1% (82.04–94.05)] yet a high sensitivity for GLIM + NFPE [93.3% (87.29–97.08)]. ConclusionsThe combination of NFPE with either of the etiologic criteria identified more malnourished patients than the combinations including FFMI or HG. A high degree of validity was reported for all three muscle assessment tools in GLIM criterion. Funding SourcesNone.

Changes in Nutrition Focused Physical Examination Knowledge and Practices of Dietitians Who Completed an In-Person Workshop With 1-Year Online Follow-Up in Malaysia

Abstract Objectives Nutrition-focused physical examination (NFPE) is a component of nutrition assessment performed by dietitians. There is limited research globally on NFPE practices of dietitians. This study explored changes in NFPE knowledge and practices over 1-year among clinical dietitians in Malaysia who completed a hybrid NFPE training program. Methods This was a secondary analysis of data from a pilot study. Participants attended a 2-day in-person workshop in Malaysia with quarterly online follow-up over 1-year. A 50-item multiple-choice knowledge test was completed by participants before and immediately, 6- and 12-months post-training. They completed data collection forms with self-reported performance of 43 NFPE practice tasks conducted during patient assessments before and 6- and 12-months post-training. Descriptive statistics, one-way repeated-measures ANOVA for knowledge assessment scores and Chi-square tests for changes in frequencies of NFPE performance were used for analyses; statistical significance was P ≤ 0.05. Results Of the 16 clinical dietitian participants who enrolled, 81.3% (n = 13) completed the study. Participants had a mean of 9.3 ± 6.4 years ofclinical practice; 81.3% (n = 13) had no prior NFPE training. Mean NFPE knowledge scores increased significantly from before (33.8 ± 3.9) to immediately post-training (44.0 ± 3.2; P &amp;lt; 0.001); this increase was sustained to 12-months post-training (43.3 ± 2.9; P &amp;lt; 0.001). Performance of all 43 NFPE practice tasks increased significantly from before to 12-months post-training (P &amp;lt; 0.001). Conclusions Clinical dietitian participants in this study increased their knowledge and practice of NFPE from before to 12-months post-training. In-person NFPE training with 1-year online follow-up is feasible for training clinical dietitians in Malaysia. Future research should explore using a control group to examine the effectiveness of a hybrid NFPE training program in this population. Funding Sources Rutgers Global Grant.

Item Generation in the Development of an Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT): A Qualitative Study Utilizing Technology-Based Focus Groups in the United States.

An alarming 30% to 50% prevalence rate of disease-related malnutrition among hospitalized patients compels the need for early diagnosis and treatment of malnutrition. Registered Dietitian Nutritionists (RDNs) can utilize the nutrition-focused physical examination (NFPE) as one of the nutrition assessment criteria to accurately diagnose malnutrition. Although RDNs are striving to employ NFPE in practice, a lack of experience and adequate training impedes full utilization of this technique. This results in wide skill variations requiring continuous evaluation of RDNs’ NFPE competency. However, a standardized, validated competency tool is not widely available and hence this study aims to develop a standardized, interactive nutrition-specific physical exam competency tool (INSPECT). As a first step in the development of INSPECT, a qualitative, technology-based focus group approach with 7 content and practice experts was utilized to generate appropriate tool items. A total of 70 NFPE items under 9 areas including 12 items for muscle loss, 4 items for subcutaneous fat loss, 31 items for micronutrient deficiencies, 1 item for fluid status, 2 items for handgrip strength, 5 items for initial preparation, 4 items for bedside manner, 8 items for swallowing, and 3 items for abdominal evaluation were generated. This study successfully utilized technology-based focus groups to generate appropriate NFPE items for the competency tool development. Using the items, an initial version of INSPECT has been developed, which is presently being investigated for content and face validity. The final version will undergo field tests and will be examined for reliability, validity, and item-level psychometric properties.

Pediatric reference ranges for various laboratory markers as children's nutritional needs change

Background: Historically, serum visceral proteins like albumin and prealbumin have been used as indicators of patients' nutritional condition. Prealbumin is generally used over albumin since it has a shorter half-life, which means it reflects more fast changes in nutritional status. Recently, there has been increasing attention given to the need of doing a nutrition-focused physical examination and reviewing the patient's medical history in order to diagnose malnutrition. Additionally, there is a growing recognition of the role that inflammation plays as a risk factor for malnutrition. Inflammatory signals have a considerable inhibitory effect on the synthesis of visceral proteins. Aim of Work: The use of these proteins as indicators for nutritional status has been a subject of discussion since they are significantly impacted by inflammation and less affected by protein energy storage. Methods: Currently, it is widely agreed upon that laboratory markers may be used as a supplementary tool to a comprehensive physical examination. Additional indications of nutritional status, such as urine creatinine or 3-methylhistidine, have not been widely used to measure muscle protein breakdown. Serum IGF-1 is hardly affected by inflammation and decreases with starvation.

A nutrition-focused physical examination workshop improves skills and knowledge of registered dietitians in the diagnosis of malnutrition

A nutrition-focused physical examination workshop improves skills and knowledge of registered dietitians in the diagnosis of malnutrition