Nutrition Support Team Intervention Research Articles

“Nutritional support Team intervention in surgical ICUs and its effect on nutrition delivery and quality in critically ill patients”

“Nutritional support Team intervention in surgical ICUs and its effect on nutrition delivery and quality in critically ill patients”

The effects of nutritional support team intervention on postoperative immune function, nutritional statuses, inflammatory responses, clinical outcomes of elderly patients with gastric cancer

BackgroundTo explore the effects of nutrition support team (NST) intervention on elderly patients with gastric cancer (GC).MethodsThe elderly GC patients (tumor stage I/II/III), admitted to our department from January 2015 to September 2021, were retrospectively analyzed and divided into NST group and traditional nutrition (TN) group according to nutritional management methods. The immune, inflammatory, nutrition-related indices, postoperative recovery and long-term prognosis of two groups were analyzed.ResultsA total of 258 elderly GC patients were included (NST group, n = 125; TN group, n = 133). After propensity score matching (PSM) in ratio of 1:1, 73 pairs of patients were matched. There were statistically significant differences in CD3 and CD4 level postoperative one month and IgG level postoperative one week between NST group and TN group (P < 0.05). There was no significant differences in serum CRP and IL-6 levels preoperative one day, postoperative one week and one month between two groups (P > 0.05). There were significant differences in body mass index (BMI) between the two groups postoperative one month (P < 0.05). The rate of infectious complications in TN group was significantly higher than that in NST group (P < 0.05). There was no statistically significant differences in 3-year relapse-free survival (RFS) or 3-year overall survival (OS) between NST group and TN group (P > 0.05).ConclusionsCompared with TN management, NST intervention might be benefit to the immune function recovery and nutritional status, but there was no evidence that NST could improve the prognosis of elderly GC patients.

Changes in Nutrition-Intake Method and Oral Health through a Multidisciplinary Team Approach in Malnourished Older Patients Admitted to an Acute Care Hospital.

Malnourished older inpatients referred to a nutrition support team (NST) usually receive multidisciplinary oral health management during NST intervention. However, the effects of multidisciplinary oral health management on the nutrition-intake method and oral health in these patients remain unclear. This longitudinal study aimed to investigate the effects of NST-mediated multidisciplinary oral health management on the nutrition-intake methods, oral health, and the systemic and oral factors influencing the changes in the nutrition-intake method. A total of 117 inpatients (66 men, 51 women, mean age, 71.9 ± 12.5 years) who underwent NST-mediated multidisciplinary oral health management between April 2016 and July 2019 were enrolled. Demographic data and Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), and Oral Health Assessment Tool (OHAT) scores at the time of referral to the NST and completion of the NST intervention were evaluated. After multidisciplinary NST intervention, FOIS, DSS, and OHAT scores showed significant improvements (p < 0.001). Even after adjusting the results for systemic parameters, FOIS score improvement correlated positively with the length of NST intervention (p = 0.030) and DSS score improvement (p < 0.001) as well as OHAT score improvement (p = 0.047). NST interventions with multidisciplinary oral health management could improve the nutrition-intake method.

Impact of Nutrition Support Team in Achieving Target Calories in Children Admitted in Pediatric Intensive Care Unit.

To determine the impact of nutrition support team (NST) on achieving an early target caloric goal in mechanically ventilated children admitted in pediatric intensive care unit (PICU). An early enteral nutrition protocol (EENP) was implemented by NST to ensure early and adequate nutrition provision to PICU patients. All children (1 month- 18 years) that were admitted in PICU for >2days and received mechanical ventilation, with no contraindications to enteral feed, were included and data was compared with those of pre-intervention. The adequacy of energy intake was defined as 70% achievement of target energy intake on the third day of admission. Chi-square/t-test was used to determine the difference between different variables pre and post intervention. Total 180 patients (99 and 81 in pre- and post-intervention group, respectively) were included. Overall, 115 (63.9%) received adequate calories (70%) on third day of admission. Of which 69 (85.2%) were from post intervention (P < 0.001; odds ratio [OR] 6.6, 95% confidence interval [CI] 3.195-13.73). Moreover, NST intervention also promoted adequate protein intake in 62 (76.5%) children compared to 37 (37.4%) in pre-intervention group (P < 0.001, OR 5.468, 95% CI 2.838- 10.534). The median (interquartile range) length of PiCU stay in pre-NST group was 6 (4-9) days and in NST supported group was 4 (3-4) days (OR 0.580, CI 0.473-0.712, P < 0.001). Age, severity of illness, multiorgan dysfunction syndrome, sepsis, need of organ support had no effect in achievement of caloric target in both the groups (P > 0.05). Introduction of EENP with NST helped in the achievement of better and quicker target caloric intake.

Impact of an interdisciplinary nutrition support team (NST) on the clinical outcome of critically ill patients. A pre/post NST intervention study.

Intensive care unit (ICU) patients are at particular risk for malnutrition with major impact for outcome and prognosis. Nutrition support teams (NST) have been proposed to improve nutrition care in ICU patients. To assess the effectiveness of an interdisciplinary NST on anthropometry and clinical outcome of ICU patients. Before NST implementation, we assessed 120 patients (before NST group; SAPS II score 44±16), afterwards 60 patients (after NST group), of whom 29 received NST guidance (after NST+group; SAPS II 65±19) and 31 not (after NST - group; SAPS II, 54±16). The primary outcome parameter was length of stay in the hospital (hospital-LOS). Severity of disease was assessed by the APACHE II score and the nutritional risk (NUTRIC) score. NST intervention resulted in a more pronounced improvement of disease severity (APACHE II, from 27±8 to 18±6, p<0.001; NUTRIC, from 7±2 to 4±2, p<0.001) compared to no NST intervention (APACHE II from 24±7 to 21±7, p<0.05; NUTRIC from 6±2 to 5±2, p<0.01). The mean hospital-LOS was not reduced, neither in the NST intervention group nor in the control group without NST intervention. NST intervention failed to improve nutritional status or mortality compared to no NST intervention. In our study the NST intervention had a positive effect on disease severity, but failed to improve mortality, hospital-LOS or nutritional status in ICU patients, likely because of a large patient heterogeneity. ClinicalTrials.gov (NCT02200874).

Effect of the Timing of Nutritional Support Team Intervention on Nutritional Status on Patients Receiving Enteral Nutrition.

Many hospitalized patients usually have a high risk of malnutrition, which delays the therapy process and can lead to severe complications. Despite of the potential benefits, the effects of timely intervention by nutrition support team (NST) on the nutritional status of admitted patients are not well established. This study aimed to compare the nutritional status between patients with early and delayed NST supports and to assess the effect of the timing of NST support initiation on the nutritional status of enteral nutrition patients. In a simple comparison between the two groups, the early NST intervention group had shorter hospital stays and fewer tube feeding periods than the delayed NST intervention group. The increase in the amount of energy intake from first to last NST intervention was 182.3 kcal in patients in the early NST intervention group, higher than that in patients in the delayed intervention group (p = 0.042). The extent of reduction in serum albumin and hemoglobin levels between the initial and last NST intervention tended to be lower in the early NST intervention group than in the delayed NST intervention group. The mean odds ratio for the patients who were severely malnourished in the early NST intervention group was 0.142 (95% confidence interval, 0.045–0.450) after adjusting for hospital stay and age. The results of this study indicate that early NST intervention can improve patients' overall nutritional status.

Hyponatremia is a Prognostic Factor in Patients Receiving Nutrition Support

BackgroundHyponatremia, the most common electrolyte disorder, has been reported to be related to increased mortality. However, the association between hyponatremia and prognoses remains unclear in patients with nutrition support team (NST) intervention. This study aimed to determine the prevalence of abnormal serum sodium levels, its relation to patient data, and the impact of hyponatremia on prognosis. MethodsPatients who received nutrition support at Tokushima University Hospital for the first time and whose serum sodium levels were measured at the start of NST intervention were enrolled. Patients were classified into three groups according to their serum Na levels at the start of NST intervention: hyponatremia group, normonatremia group, and hypernatremia group. ResultsIn the hyponatremia group compared to the normonatremia group, body weight and body mass index were significantly lower. C-reactive protein levels and urea nitrogen/creatinine ratios were significantly higher. Meanwhile, there was no significant difference in the estimated glomerular filtration rate among the groups. The prevalence of malnutrition and anemia were the highest in the hyponatremia group. The 3-year survival rate was approximately 45% in the hyponatremia group, which was the lowest of all three groups. The mortality risk ratio of the hyponatremia group to the normonatremia group was 2.29. ConclusionsHyponatremia in NST intervention patients is an independent prognostic predictor. Therefore, adding an assessment of serum sodium at the beginning of NST intervention can identify patients at high risk at an early stage and may improve the quality of NST activity.

Effects of early nutritional intervention by a nutritional support team for patients with head and neck cancer undergoing chemoradiotherapy or radiotherapy

We analyzed the effects of early nutritional intervention by a nutritional support team (NST) in patients with head and neck squamous cell carcinoma (HNSCC) undergoing chemoradiotherapy or radiotherapy. This study investigated whether early nutritional interventions by a multidisciplinary NST improve body weight loss, mucositis, serum albumin level, and hospital length of stay. Sixty-one patients with HNSCC were treated during the study, and 32 patients received NST intervention since admission. The median weight loss rates were 3.3% and 7.3% and grade 3 mucositis was observed in 25.0% and 70.0% of patients in the intervention and nonintervention groups, respectively. In the intervention group, serum albumin level through treatment increased and the hospital length of stay from the end of treatment was shortened. Early nutritional intervention by a multidisciplinary NST improved body weight loss rate, mucositis, albumin level, and hospital length of stay, which might lead to better clinical outcomes.

Association Between Risk Factors and Intensive Nutritional Intervention Outcomes in Elderly Individuals.

BackgroundThe purpose of this study was to identify risk factors for intensive nutritional intervention outcomes in elderly undernourished patients to help reduce the number of patients with prolonged hospital stay or without recuperation of previous activities of daily living and quality of life.MethodsIn total, 230 patients who received interventions from a nutrition support team (NST) between January 2016 and July 2018 were included. Patients were classified into two groups based on NST intervention outcomes: patients with improved nutritional status were included in the successful group, whereas those whose nutritional status did not improve, as defined by progressive illness or death, were classified into the non-successful group. We assessed patient characteristics, laboratory data, and nutrition support methods.ResultsOur multivariate Cox proportional hazard analysis showed that: 1) The presence of peripheral parenteral nutrition (hazard ratio (HR): 1.80; 95% confidence interval (CI): 1.13 - 2.88) was identified as an independent risk factor for NST intervention outcomes; 2) The energy fill rate to total energy expenditure was < 66.0% (HR: 1.61; 95% CI: 0.98 - 2.66); and 3) A geriatric nutritional risk index score < 70.0 (HR: 1.54; 95% CI: 0.92 - 2.56) tended to be negatively associated with NST intervention outcomes.ConclusionsIn addition to the nutrition therapy provided by a traditional NST, patients with the risk factors require nutritional intervention. Elderly individuals should also receive nutrition care because they have been recuperating at their home or in long-term care facilities, to prevent experiencing adverse conditions.

Outcomes and prognoses of nutritionally depleted cases that calorie intake is deficient after nutrition support team intervention

Outcomes and prognoses of nutritionally depleted cases that calorie intake is deficient after nutrition support team intervention

Nutrition Support Team Intervention Improves Activities of Daily Living in Older Patients Undergoing In-Patient Rehabilitation in Japan: A Retrospective Cohort Study

ABSTRACTThe effect of nutrition support on activities of daily living (ADL) in individuals aged ≥75 years requiring rehabilitation is unknown. This study aimed to investigate the effect of nutrition support on ADL improvement in older patients undergoing in-patient rehabilitation in Japan. This retrospective cohort study was performed in 175 patients aged ≥75 years. The nutrition support team (NST) intervened in 85 cases. ADL was evaluated by the functional independence measure (FIM). We analyzed the effects of NST intervention on FIM efficiency. Multiple linear regression analysis revealed that NST intervention (standard partial regression coefficient, β = 0.164; 95% confidence interval [CI] 0.003–0.229; P = 0.044), energy intake at admission (β = 0.179; 95% CI, 0.000–0.016; P = 0.043), body mass index (BMI) at admission (β = 0.227; 95% CI, 0.005–0.046; P = 0.014), and cerebrovascular disease (β = −0.238; 95% CI, −0.298 to −0.063; P = 0.003) were independently associated with FIM efficiency. NST intervention, energy intake, and BMI on admission may affect ADL improvement in older patients undergoing in-patient rehabilitation.

A case of collagenous colitis with watery diarrhea improved by ending lansoprazole administration after nutrition support team intervention

A case of collagenous colitis with watery diarrhea improved by ending lansoprazole administration after nutrition support team intervention

The nutritional intake of elderly patients with dysphagia admitted to the internal medical department of the emergency hospital was analyzed. The Fujishima dysphagia scale after care and treatment by the Nutrition Support Team was assessed.

The Nutrition Support Team (NST) assessed the severity of dysphagia in elderly patients admitted to the internal medical department, and the appropriate nutritional treatment was determined. Patients were treated with either oral nutrition (enteral nutrition, EN) or artificial alimentation (parenteral nutrition, PN). The goal of this study was to analyze whether or not the route of nutrition affected the patient discharge rates. We divided 290 elderly inpatients with dysphagia into 2 groups, the pneumonia group (200 patients) and the non-pneumonia group (90 patients). The NST estimated the swallowing function using the Fujishima dysphagia scale. Monitoring was continued until the NST care and treatment had been finalized. We further divided the pneumonia patients into two subgroups: those with a Fujishima dysphagia scale score ≤3 or ≥4 at the beginning of NST intervention. The changes in the swallowing function were analyzed.The swallowing function in the patients with a score ≥4 was significantly improved compared with that in the patients with a score ≤3. This difference, however, was not observed in the non-pneumonia group. In both the pneumonia and non-pneumonia groups, the ratio of patients discharged on oral nutrition was one-third, and the ratio of death in hospital was one-quarter, the remaining patients required artificial alimentation. Among elderly patients admitted to the internal medical department of the emergency hospital with dysphagia, one-third left the hospital with oral nutritional intake, one-quarter died in hospital, and the remaining required artificial alimentation.

Effects of a nutrition support team on clinical outcomes, metabolic complications and electrolyte abnormalities in patients receiving parenteral nutrition.

The effectiveness of the Nutrition Support Team (NST) at Hospital Sungai Buloh, a large public hospital in Kuala Lumpur, Malaysia, in optimising parenteral nutrition (PN) has not been evaluated. To evaluate the effects of this NST in optimising patient outcomes, treatment outcomes, and adherence to biochemical monitoring guidelines, two groups of patients, those given PN before (n = 106) NST intervention and those given PN after (n=106) NST intervention, were retrospectively compared. Intervention by the NST significantly reduced metabolic abnormalities, reducing sodium abnormalities from 67% to 44% (p<0.01); potassium abnormalities from 42% to 15% (p<0.01); magnesium abnormalities from 13% to 3% (p<0.05) and phosphate abnormalities from 21% to 9% (p=0.01). Intervention by the NST also significantly reduced the incidence of hypertriglyceridemia from 68% to 45% (p=0.002) and significantly improved adherence to biochemical monitoring guidelines from 46% to 72% (p<0.01). However, the length of hospital stay, patient mortality, and duration of PN were similar in both groups. This study failed to demonstrate that the establishment of a NST gave better outcomes in terms of the common measures of effectiveness. In conclusion, although management by an NST significantly reduced metabolic abnormalities and improved adherence to biochemical monitoring guidelines, the NST did not improve patient mortality rates and length of hospital stay.

90歳以上の超高齢大腿骨近位部骨折患者に対する栄養サポートチーム介入―Functional Independence Measureを用いた効果検証―

Malnutrition is common in the hospitalized elderly with hip fractures and has been linked to poorer recovery and increased complications. Hence, the aim of this study is to investigate whether nutrition support team (NST) intervention has a beneficial effect on rehabilitation outcome in the elderly, especially in the oldest-old patients with hip fracture using the Functional Independence Measure (FIM). Patients were classified into two groups before and after NST intervention, and we evaluated FIM gain, FIM efficacy, and discharge outcomes. Every item was compared in low-ADL patients with an FIM of 54 or less on admission. The numbers of patients were 18 in the non-NST and 22 in the NST group. Although nutritional indicators on admission showed no significant difference in the groups, FIM gain and FIM efficacy were significantly higher (p<0.01) and walking ability at discharge was better in the NST group (p<0.05). In low-ADL patients, the same results were confirmed. Although the malnourished patients often have a poor prognosis, there was a significant improvement in rehabilitation effect and discharge outcome in the NST group. Thus, these results suggest the effectiveness of multidisciplinary NST intervention. Moreover, even in elderly patients with low ADL on admission, significant effect of rehabilitation can be expected by appropriate nutritional management.

Multidisciplinary nutritional support for autologous hematopoietic stem cell transplantation: A cost–benefit analysis

ObjectiveThe objective of the present study was to evaluate the economic and clinical efficacy of a multidisciplinary nutritional support team (NST) for autologous stem cell transplantation. MethodsWe performed a retrospective cost–benefit analysis of autologous stem cell transplantation (ASCT) in patients with and without NST intervention at a single institute. Patients (n = 120) had undergone 169 ASCTs, 67 before the commencement of NST intervention in September 2005 and 102 after September 2005. The conditioning regimens, prophylactic antibiotics, and supportive care were unchanged from 2001 through 2008. The duration of hospitalization, cost, and laboratory data were analyzed. ResultsWith NST intervention, the duration of total parenteral nutrition, absence of oral food intake, hospitalization, and therapeutic antibiotic usage were significantly shortened by 11.4, 9.7, 8.1, and 4.5 d, respectively. With NST intervention, the incidence of hepatic adverse events and hyperglycemia was low, and the total cost of hospitalization was significantly decreased by 403 600 yen (US $4484.40). Two cases of therapy-related death were recorded before September 2005. No therapy-related mortality was observed after commencement of NST intervention; however, the difference was not significant. ConclusionMultidisciplinary NST intervention has a positive effect on cost decrease, and it may decrease the incidence of adverse events associated with ASCT and total parenteral nutrition.