Nutrition Focused Physical Examination Research Articles

The Nutrition-Focused Physical Examination: Added Value for Patients and Clinicians

The Nutrition-Focused Physical Examination: Added Value for Patients and Clinicians

Frequency and Types of Nutrition Focused Physical Examination Equipment/Techniques used by Registered Dietitians

Frequency and Types of Nutrition Focused Physical Examination Equipment/Techniques used by Registered Dietitians

Assessing the Effectiveness of the Nutrition Focused Physical Examination in the Acute Care Setting

Assessing the Effectiveness of the Nutrition Focused Physical Examination in the Acute Care Setting

Use of a Hybrid Training Program to Teach Nutrition Focused Physical Examination to Dietetic Educators and Dietitians in Malaysia

Use of a Hybrid Training Program to Teach Nutrition Focused Physical Examination to Dietetic Educators and Dietitians in Malaysia

INTEREST GROUP SESSION—NUTRITION: IMPLEMENTATION OF NUTRITION, BODY COMPOSITION, AND FUNCTIONAL ASSESSMENT IN VULNERABLE OLDER ADULTS

This symposium will highlight the implementation of nutrition, body composition and functional assessment in vulnerable older adults. Understanding the barriers and enablers of implementing traditional nutrition screening and assessment tools, nutrition focused physical examination, body composition analysis, functional assessment and biomarkers can aid researchers in the design of pragmatic nutrition studies in vulnerable older adults. DiMaria-Ghalili will provide an introduction to overall nutrition assessment in community-dwelling older adults and present lessons learned in regards to nutrition assessment protocols (Mini-Nutritional Assessment, hand-grip strength, and inflammatory biomarkers) from an ongoing clinical trial. Starr will discuss the issues surrounding nutrition screening and assessment in high-risk older adults undergoing abdominal surgery. A comparison of data on different nutrition screening and assessment tools (NRS-2002; PG-SGA, Nutrition Focused Physical Examination) in older adults undergoing abdominal surgery will be presented. Batsis will discuss the controversies and challenges in body composition assessment focusing on sarcopenic obesity. Data highlighting the different diagnostic criteria of sarcopenic obesity and diagnostic accuracy will be presented. The link between overall nutrition status and physical function on health outcomes is emerging in older adults. Bales will discuss the types of physical function assessment tools used in studies of older adults and discuss her findings on the impact of higher protein intake on functional outcomes. The symposium will conclude with a discussion led by Locher on practical implications of integrating best assessment techniques into clinical practice.

Identifying and Managing Malnourished Hospitalized Patients Utilizing the Malnutrition Quality Improvement Initiative: The UPMC Experience

Registered dietitian nutritionists at University of Pittsburgh Medical Center, a group of 40 academic, community, and specialty hospitals in Pittsburgh, PA, recognized the need to improve the identification and management of malnourished adult patients at their institutions. It was decided to pilot the Malnutrition Quality Improvement Initiative (MQii) at two institutions within their health care system. The MQii is based on the dual-pronged approach of malnutrition-focused electronic clinical quality measures and a quality improvement toolkit (MQii Toolkit), to help identify and manage malnourished adult patients. The quality improvement implementation focused on hospital-wide adoption of the Nutrition Focused Physical Examination (NFPE). The MQii team was guided by the malnutrition electronic clinical quality measures focused on completing a nutrition assessment (the NFPE) within 24 hours of identification of malnutrition risk and ensuring documentation of a malnutrition diagnosis when it was identified. Performance on both measures improved significantly (P<0.01). Performance on appropriate timing of nutrition risk screening improved slightly, and there was almost perfect compliance for completion of nutrition care plans in the presence of malnutrition. Overall, the performance data demonstrated the effectiveness of using the MQii to improve the nutrition processes and the ability to implement NFPE into the process of malnutrition identification. Funding/SupportPublication of this supplement was supported by Abbott. The Academy of Nutrition and Dietetics does not receive funding for the MQii. Avalere Health's work to support the MQii was funded by Abbott.

Nutritional Laboratory Markers in Malnutrition.

Serum visceral proteins such as albumin and prealbumin have traditionally been used as markers of the nutritional status of patients. Prealbumin is nowadays often preferred over albumin due to its shorter half live, reflecting more rapid changes of the nutritional state. However, recent focus has been on an appropriate nutrition-focused physical examination and on the patient’s history for diagnosing malnutrition, and the role of inflammation as a risk factor for malnutrition has been more and more recognized. Inflammatory signals are potent inhibitors of visceral protein synthesis, and the use of these proteins as biomarkers of the nutritional status has been debated since they are strongly influenced by inflammation and less so by protein energy stores. The current consensus is that laboratory markers could be used as a complement to a thorough physical examination. Other markers of the nutritional status such as urinary creatinine or 3-methylhistidine as indicators of muscle protein breakdown have not found widespread use. Serum IGF-1 is less influenced by inflammation and falls during malnutrition. However, its concentration changes are not sufficiently specific to be useful clinically as a marker of malnutrition, and serum IGF-1 has less been used in clinical trials. Nevertheless, biomarkers of malnutrition such as prealbumin may be of interest as easily measurable predictors of the prognosis for surgical outcomes and of mortality in severe illnesses.

Nutrition-Focused Physical Examination Practices of Registered Dietitian Nutritionists Who Have Completed an In-Person NFPE Course

This study explored nutrition-focused physical examination (NFPE) practices of registered dietitian nutritionists (RDNs) who completed an in-person NFPE course. Relationships between NFPE conduct and professional characteristics of respondents were also investigated using a mixed-mode survey. Ninety-six respondents met the inclusion criteria. Examination of muscle, fat loss, hair/nails, weight, peripheral edema, skin, and height was the most frequently reported independent task. Time and workload were limitations to NFPE. Respondents with additional NFPE training conducted significantly more NFPE components independently (P = .002) than those without more training. Further research is needed with a larger sample of registered dietitian nutritionists who completed NFPE training.

Malnutrition Identified by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Consensus Criteria and Other Bedside Tools Is Highly Prevalent in a Sample of Individuals Undergoing Treatment for Head and Neck Cancer.

Using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (Academy/ASPEN) Consensus malnutrition definition, we estimated malnutrition prevalence in a sample of individuals with head and neck cancer (HNC) and compared it with the Patient-Generated Subjective Global Assessment (PG-SGA). We also investigated the utility of the 50-kHz phase angle (PA) and 200-kHz/5-kHz impedance ratio (IR) to identify malnutrition. Nineteen individuals (18 males, 1 female) scheduled to undergo chemoradiotherapy were seen at 5 time points during and up to 3 months after treatment completion. Multiple-frequency bioelectrical impedance analysis, PG-SGA, nutrition-focused physical examination, anthropometry, dietary intake, and handgrip strength data were collected. Using the Consensus, 67% were found to be malnourished before treatment initiation; these criteria diagnosed malnutrition with overall good sensitivity (94%) and moderate specificity (43%) compared with PG-SGA. Over all pooled observations, "malnourished" (by Consensus but not PG-SGA category) had a lower mean PA (5.2 vs 5.9; P = .03) and higher IR (0.82 vs 0.79; P = .03) than "well-nourished" categorizations, although the clinical relevance of these findings is unclear. PA and IR were correlated with higher PG-SGA score (r = -0.35, r = 0.36; P < .01) and handgrip strength (r = 0.48, r = -0.47; P < .01). The Academy/ASPEN Consensus and the PG-SGA were in good agreement. It is unclear whether PA and IR can be used as surrogate markers of nutrition status or muscle loss.

Use of a Computer-Assisted Instruction Module to Teach Nutrition Focused Physical Examination to Pre-Professional Dietetic Students

The primary objective of this study was to examine the use of a CAI module on NFPE as a method of education for pre-professional dietetic students.

Use of Computer-Assisted Instruction for Teaching Nutrition-Focused Physical Examination to Dietetics Students

The purpose of this study was to assess changes in knowledge scores of dietetic students enrolled in a computer-assisted instruction (CAI) module about nutrition focused physical examination (NFPE). The module included live virtual classroom sessions, multi-media presentations, online discussion forums, and case studies. Students completed multiple-choice pre/postassessments and course evaluations. All 21 participants had significant increases in knowledge scores from a mean of 29.2 (SD = 4.47) at pretest to a mean of 39.4 (SD = 2.91) at posttest (p &lt; .001). Student evaluations were positive. These findings support future larger controlled trials to assess use of CAI for NFPE training with dietetic students.

Nutritional status and weakness following pediatric hematopoietic cell transplantation.

Survivorship after pediatric HCT has increased over the past decade. Focus on long-term care and well-being remains critical due to risk of poor dietary habits and exaggerated sedentary behavior, which can lead to muscle weakness, increased risk for obesity, and cardiometabolic disorders. Nutrition and physical activity are key factors in survivorship; however, data are limited. Comprehensive nutritional assessments, including nutrition-focused physical examination, grip strength, and food/activity surveys, were completed in 36 pediatric HCT survivors (aged 2-25years). Patients were divided into undernutrition, normal-nutrition, and overnutrition categories. Fifty percent of participants were classified as normal nutrition, 22% undernutrition, and 28% overnutrition. Few patients met the U.S. Dietary Guidelines recommended intake for vegetables, fiber, saturated fat, and So FAS. Patients in the undernutrition group demonstrated significantly lower grip strength than those in the normal- and overnutrition groups. When grip strength was normalized to body mass, patients in the overnutrition group had the highest prevalence of weakness. Using NHANES reference data, maximum grip strength and NGS cutoffs were identified that could significantly distinguish the nutrition groups. Comprehensive nutritional assessments and grip strength measurements are feasible, non-invasive, easy to perform, and inform both under- and overnutrition in pediatric HCT survivors.

Nutrition Focused Physical Examination Practices of Registered Dietitian Nutritionists That Have Completed an In-Person Nutrition Focused Physical Examination Course

Nutrition Focused Physical Examination Practices of Registered Dietitian Nutritionists That Have Completed an In-Person Nutrition Focused Physical Examination Course

The Use of Computer Assisted Instruction to Teach Nutrition Focused Physical Examination to Students Enrolled In An Online Nutrition Assessment Course

The Use of Computer Assisted Instruction to Teach Nutrition Focused Physical Examination to Students Enrolled In An Online Nutrition Assessment Course

Malnutrition Assessment: In-Depth Training Improves Dietetic Interns’ Confidence and Use of Nutrition-Focused Physical Examination

Participants will be able to describe the effectiveness of training dietetics interns regarding adult malnutrition assessment and nutrition-focused physical examination using The Academy and ASPEN’s Consensus Statement.

Nutrition-focused physical examination in pediatric patients.

A complete nutrition assessment includes several components: medical record review, anthropometric measurements, diet/nutrition intake, interview, and physical examination. The nutrition-focused physical examination (NFPE) can identify or confirm muscle wasting, subcutaneous fat loss, and edema and clarify information gathered during the medical record review. The physical examination component of the nutrition assessment is more critical in pediatric patients because pediatric patients can become malnourished more quickly than adults and because prolonged malnutrition can negatively affect growth and development. In addition, case studies of micronutrient deficiencies, essential fatty acid deficiency, and protein-calorie malnutrition with skin manifestations have been reported in developed countries. The etiologies of the deficiencies are chronic disease, long-term tube feedings, or long-term parenteral nutrition. An NFPE involves an in-depth examination of the patient from head to toe by a trained nutrition professional. Nutrition professionals recognize the importance and value of an NFPE, yet it is seldom completed, particularly in pediatrics, most likely due to lack of training and lack of pediatric-specific information or training opportunities. Although there are similarities between NFPE in pediatric and adult patients such as the techniques used (inspection, palpation, percussion, and auscultation), there are important differences related to growth and development. This review provides an overview of nutrition assessment with focus on the NFPE and aspects unique to the pediatric patient.

Nutrient Deficiencies Associated With Nutrition‐Focused Physical Findings of the Oral Cavity

Conducting nutrition-focused physical examinations and reporting the findings from the perspective of nutrition status strengthen the practitioner's assessments, interventions, and monitoring. The nutrition-focused physical examination of the oral cavity is particularly useful to identify nutrient deficiencies early and with accuracy as the tissues in the oral mucosa have a turnover rate of <1 week. As biomarkers may not always be reliable for identifying micronutrient deficiencies, these physical examinations are important for providing comprehensive nutrition care. The purpose of this article is to discuss the methods of conducting a nutrition-focused oral screening examination and compile and document the evidence regarding the effects of micronutrient deficiencies on the oral mucosa. The information is formatted into a table that can be used as a tool when conducting an oral screening by identifying possible deficiencies based on the observations and other relevant findings. The tool will also guide the practitioner in confirming the physical findings, suggesting interventions to treat the deficiency and how to monitor the outcomes.

Nutrition Focused Physical Examination Practices of RD Members of the Renal Practice Group and/or the Council on Renal Nutrition

Nutrition Focused Physical Examination Practices of RD Members of the Renal Practice Group and/or the Council on Renal Nutrition

Nutrition Focused Physical Examination Practices of Registered Dietitians

Nutrition Focused Physical Examination Practices of Registered Dietitians

Nutrition Focused Physical Examination Practices of RD Members of the Oncology Nutrition Dietetic Practice Group and Board Certified Specialists in Oncology Nutrition

Nutrition Focused Physical Examination Practices of RD Members of the Oncology Nutrition Dietetic Practice Group and Board Certified Specialists in Oncology Nutrition