Systematic Nutritional Assessment Research Articles

Knowledge, attitudes and application of nutrition assessments by the veterinary health care team in small animal practice.

To assess the impact of the WSAVA Global Nutrition Committee's work in promoting nutrition as the fifth vital assessment and enhancing knowledge of nutrition. Further objectives were to ascertain use of existing Global Nutrition Committee assessment tools, identify potential new tools and determine which members of the veterinary health care team are responsible for carrying out nutrition assessments, planning and intervention in practice. A 16-question online questionnaire on the awareness, use and frequency of nutritional assessment was completed by 2740 veterinary health care team members. Statistical association was tested between the reported frequency of nutritional assessment in practice and the likely establishment of normal dietary regime, calculation of energy requirements and creation of nutritional plans. Most respondents (95%) currently had responsibility for providing small animal nutrition education, yet only 27% were aware of the WSAVA guidelines. Over half (64%) recognised nutritional evaluation as the fifth vital assessment. Only 4% consistently used WSAVA tools to perform a systematic nutritional assessment. Veterinarians and veterinary nurses/technicians were the most frequent source of nutritional advice in practice, with the consultation recognised as the most important contact point with clients. Awareness of nutritional assessment is apparent, yet implementation in practice is inconsistent. These findings will help the WSAVA Global Nutrition Committee prioritise future activities to support the veterinary health care team and pet owners with nutrition-related knowledge, tools and resources.

Nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea.

To evaluate the nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea. Children <18years diagnosed with HIV between 2009 and 2017 were included. Clinical, immunological and nutritional data were collected. Weight-for-height, weight-for-age and height-for-age Z-scores were calculated using WHO Child Growth Standards. The population was assessed in two equal periods (2009-2013 and 2014-2017) from the time of diagnosis. A total of 213 children were diagnosed with HIV (49.3% males), median age 3.8years (IQR: 1.5-8.2). A total of 121 cases (56.8%) were at WHO clinical stage III, and 53 (24.9%) were at WHO clinical stage IV. CDC immunological stage II was diagnosed in 51/130 (39.2%) and CDC stage III in 44/130 (33.8%). About 56.2% of children were underweight (weight-for-age <-2 SD); 20.1% moderately and 36.1% severely so. About 27.6% of children were wasted (weight-for-height <-2 SD); 11.9% moderately and 15.7% severely so. About 56.3% of children were stunted (height-for-age <-2 SD); 20.7% moderately and 35.6% severely so. The prevalence of wasting was higher in children ≤5years than in children >5years (36.4% vs. 19.1%, P=0.026). In the second period, the prevalence of moderate-severe immunodeficiency decreased (87.2% to 67.0%, P=0.018), without significant differences in the other nutritional or clinical data. Severe underweight was a risk factor for moderate-severe immunodeficiency (aOR: 4 [95% CI: 1.4-11.4], P=0.010). We highlight a high proportion of malnutrition at the time of HIV diagnosis in Guinea´s paediatric population. Early diagnosis of HIV infection is a priority, achievable by training Guinea´s physicians to suspect HIV early, introducing HIV molecular diagnostic techniques and ensuring intensive nutritional treatment.

Sarcopenia associates with increased hospitalization rates and reduced survival in patients with chronic pancreatitis

BackgroundObjectives: Malnutrition is a well-known complication of chronic pancreatitis and alterations in body composition are common in this context. We investigated the prevalence of sarcopenia in patients with chronic pancreatitis, its associated risk factors and health-related outcome. MethodsThis was a prospective cohort study of chronic pancreatitis outpatients. Bioelectric impedance was used to measure body composition, and a handheld dynamometer and the timed-up-and-go test characterized muscle function. Several demographic and disease characteristics, including exocrine pancreatic insufficiency (EPI), were analyzed for their association with sarcopenia. The EORCT QLQ-C30 questionnaire was used to document life quality, and associations between sarcopenia and the number of hospital admissions, the number of in-hospital days and survival over the next 12 months were analyzed. ResultsA total of 182 patients were enrolled in the study. The prevalence of sarcopenia was 17.0% (95% CI; 11.9–23.3) and 74% of sarcopenic patients had a BMI in the normal or overweight range (BMI >18.5 kg/m2). EPI was an independent risk factor for sarcopenia (OR 3.8 95% CI [1.2–12.5]; p = 0.03). Several QLQ-C30 scales and items were associated with sarcopenia including physical functioning (p < 0.001) and global health (p = 0.003). During follow-up, sarcopenia was associated with an increased risk of hospitalization (OR 2.2 95% CI [0.9–5.0]; p = 0.07), increased number of in-hospital days (p < 0.001), and reduced survival (HR 6.7 [95% CI; 1.8–25.0]; p = 0.005). ConclusionSarcopenia is a common complication of chronic pancreatitis and associates with adverse health-related outcomes. As sarcopenia is not recognized by conventional anthropometric parameters in the majority of patients, systematic nutritional assessment should be prioritized.

Design and rationale of the effect of early nutritional therapy on frailty, functional outcomes and recovery of malnourished medical inpatients trial (EFFORT): a pragmatic, multicenter, randomized-controlled trial

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Malnutrition is highly prevalent and strongly associated with clincial outcomes of medical inpatients. Still, the benefit of nutritional treatment to prevent adverse outcomes in medical inpatients at risk for malnutrition remains unproven. We describe the trial methods of the largest yet nutritional trial in medical inpatients including the rationale for key design decisions regarding the nutritional strategy, eligibility criteria, choice of control arm, and endpoints.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The Effect of early nutritional therapy on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial (EFFORT) is an investigator-initiated, non-commercial, open-label RCT to compare the effects of an intensified nutritional therapy (intervention group) with a control group on medical outcomes. We include adult medical inpatients at risk of malnutrition based on a Nutritional Risk Screening 2002 (NRS) score of ≥3 points with an expected length of stay of ≥5 days. An individualized systematic nutritional assessment by study dieticians is done to define nutritional targets and to establish an implementation plan. Patients in the intervention group receive individualized early nutritional therapy based on a previously published consensus algorithm, while control group patients receive standard hospital nutrition. The study is powered to compare clinical outcomes (composite adverse outcome and mortality) in the 2 study arms as well as to address several mechanistical questions.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; EFFORT aims to close important gaps in the literature regarding the controversy about benefit and possible harm of nutritional therapy in medical inpatients at risk for malnutrition.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Trial Registration: &lt;/strong&gt;ClinicalTrials.gov NCT02517476; registered July 30, 2015.&lt;/p&gt;

État nutritionnel en unité de surveillance continue pédiatrique : évaluation à l’admission, en cours de séjour et à distance

Malnutrition, known as a cause of morbidity, has not been studied in children admitted to pediatric intermediate care units. This study aimed to describe the association between patients' nutritional status and the relative severity of illness that characterizes this population. In this prospective longitudinal study, a dedicated nutrition support team assessed the nutritional status of all children, aged 5 days to 18 years, admitted to our university pediatric intermediate care unit (Hôpital Femme-Mère-Enfants, Lyon, France) over one year (2012-2013). Weight, height, body mass index, weight-for-age ratio, height-for-age ratio, and the analysis of growth curves were collected at admission. We monitored patients' weight, which allowed us to detect malnutrition occurrence during the stay, and its progression up to 3 months after discharge. A total of 459 patients were enrolled. Based on the analysis integrating all nutritional indices and the progression of growth curves, malnutrition at admission was detected in 23.8% of children (20.5% and 6.8% suffered from acute and chronic malnutrition, respectively). Based only on the body mass index, malnutrition was detected in 15.5% of children. Chronic disease appeared as a risk factor for malnutrition at admission (P=0.0001) and young age for acute malnutrition (P=0.04). The incidence of acquired malnutrition during the stay (in children with a length of stay > 5 days) was up to 26%, and dyspnea was the only risk factor identified. This population recovered with a normal nutritional status late (66% after 2 months and 16% after 3 months). The prevalence of malnutrition is high in our pediatric intermediate care unit. The occurrence of acquired malnutrition during the stay is frequent. All children should benefit from systematic nutritional assessment at admission as well as careful monitoring during the stay and after discharge, to adapt early and individualized nutritional support.

A Nursing Survey on Nutritional Care Practices in French-Speaking Pediatric Intensive Care Units: NutriRéa-Ped 2014.

Malnutrition in critically ill children contributes to morbidity and mortality. The French-speaking pediatric intensive care nutrition group (NutriSIP) aims to promote optimal nutrition through education and research. The NutriSIP-designed NutriRéa-Ped study included a cross-sectional survey. This 62-item survey was sent to the nursing teams of all of the French-speaking pediatric intensive care units (PICUs) to evaluate nurses' nutrition knowledge and practices. One nurse per PICU was asked to answer and describe the practices of their team. Of 44 PICUs, 40 responded in Algeria, Belgium, Canada, France, Lebanon, Luxemburg, and Switzerland. The majority considered nutrition as a priority care but only 12 of the 40 (30%) had a nutrition support team, 26 of the 40 (65%) had written nutrition protocols, and 19 of 39 (49%) nursing teams felt confident with the nutrition goals. Nursing staff generally did not know how to determine nutritional requirements or to interpret malnutrition indices. They were also unaware of reduced preoperative fasting times and fast-track concepts. In 17 of 35 (49%) PICUs, the target start time for enteral feeding was within the first 24 hours; however, frequent interruptions occurred because of neuromuscular blockade, fasting for extubation or surgery, and high gastric residual volumes. Combined pediatric neonatal intensive care units were less likely to perform systematic nutritional assessment and to start enteral nutrition rapidly. We found a large variation in nursing practices around nutrition, exacerbated by the lack of nutritional guidelines but also because of the inadequate nursing knowledge around nutritional factors. These findings encourage the NutriSIP to improve nutrition through focused education programs and research.

Outcomes of Systematic Nutritional Assessment and Medical Nutrition Therapy in Pancreatic Cancer

We investigated the nutritional and survival outcomes of medical nutrition therapy by a registered dietitian, along with support from a dedicated nutrition and metabolic support team in pancreatic cancer patients requiring enteral or parenteral nutrition. Subjective global assessment (SGA) was used to assess nutritional status in 304 pancreatic cancer patients. Using baseline and last SGA, patients were categorized into 3 groups: improved SGA, deteriorated SGA, and unchanged SGA. Kaplan-Meier and Cox regression were used to calculate survival after controlling for relevant confounders. One-hundred twenty-five (41.1%) patients had their SGA unchanged, 87 (28.6%) patients had "improved SGA," whereas 92 (30.3%) patients had "deteriorated SGA." On univariate survival analysis, the median survival was 7.8, 11.2, and 12.6 months for deteriorated, unchanged, and improved SGA groups, respectively. On multivariate analysis, change in SGA was independently predictive of survival. Patients with deteriorated SGA had 1.5 times (95% confidence interval, 1.1-2.1) greater risk of mortality compared to those with improved SGA. The majority of pancreatic cancer patients (70%) in our study either maintained or improved their nutritional status during cancer treatment. Improvement in SGA correlated with a significantly decreased risk of mortality independent of sex, previous treatment history, and evidence of biological anticancer activity.

Improving standards of nutritional care on a cancer ward: the development and evaluation of a nutritional care assistant role

Improving standards of nutritional care on a cancer ward: the development and evaluation of a nutritional care assistant role Mary Wells1, Fiona Ross2, Jackie Davie3, Thilo Kroll11School of Nursing and Midwifery, University of Dundee, Dundee, Scotland, UK; 2Department of Nutrition and Dietetics, Torbay Hospital, Torquay, UK; 3Tayside Cancer Centre, Ninewells Hospital and Medical School, Dundee, Scotland, UKPurpose: Patients with cancer are particularly at risk of malnutrition and suffer a range of nutritional problems as a consequence of their disease and its treatment. Clinical outcomes may be adversely affected and the normal, pleasurable, and social aspects of eating and drinking are often lost within a busy hospital ward environment. This project aimed at developing and evaluating a role for a nutritional care assistant (NCA) over 22 months to improve standards of nutritional care on a cancer ward, through systematic nutritional assessment, attention to the physical and social factors that promote good nutrition, and the provision of healthy and nutritious snacks.Patients and methods: Evaluation measures included snapshot audits of nutritional screening, patient questionnaires to assess views of eating and drinking, process audit of the contribution made by the NCA, and staff knowledge and attitude questionnaires. 277 cancer patients were seen by the NCA.Results: Feedback from patients and staff showed that the project had a positive impact on the provision of food and drink and the experience of patients on the ward. Nutritional screening and documentation also improved.Conclusion: The findings of this audit demonstrate that simple and innovative changes at ward level can make a tangible difference to standards of nutritional care, and to patients&rsquo; experiences of eating and drinking, even in the context of cancer.Keywords: malnutrition, hospital, environment, nutritional assessment

Impact of malnutrition on surgical outcome of patients with ovarian cancer: Results of a prospective study

e16564 Background: The purpose of this study was to examine an influence of poor nutritional status on surgical outcome in patients with ovarian cancer. Methods: Data from 152 consecutive patients with histologically confirmed ovarian cancer were prospectively analyzed. Overall 79 suffered from primary and 73 from recurrent disease. All patients received a systematic nutritional assessment prior to cytoreductive surgery and postoperative all complications were analyzed in detail. The Nutritional Risk Score (NRS-2002) was used to identify patients at high nutritional risk (NRS≥3). Intraoperatively, a standardized documentation script (IMO) was applied including tumor localization, surgical interventions, and postoperative residual tumor mass. Results: 29 patients (19%) were classified as malnourished, including 19 (24%) with primary and 10 (14%) with recurrent disease. These patients showed a significantly poorer performance status preoperatively compared to patients with NRS&lt;3 (p &lt; 0.05), which was assessed according to the American Society of Anesthesiologists (ASA). Also an intra-operatively documented tumor spread was significantly more extended in group with NRS≥3 than among patients with NRS&lt;3 (p &lt; 0.05). In malnourished patients complete resection rate was significantly decreased (31% vs. 69%, p &lt; 0.001) and they required more often a colo- or ileostoma (17% vs. 6%, p = 0.041). Malnourished patients suffered more often from post-operative complications (62% vs. 37%, p &lt; 0.05), especially infectious like pneumonia or sepsis. All postoperative mortality events (3 cases) occurred in the malnourished group. Conclusions: Malnourished ovarian cancer patients have significantly more often post-operative complications. They suffer from more extended tumor spread and were less frequently postoperatively tumor-free. Based on our results further prospective trials of preoperative nutritional therapy to improve surgical outcome are warranted. No significant financial relationships to disclose.

Promoting Growth Interpretation and Lifestyle Counseling in Primary Care

To pilot a practice-directed intervention to promote growth interpretation and lifestyle counseling during child health supervision visits. The intervention at 4 diverse primary care practices included education, facilitation by a practice-change leadership team, tools, and guidance from the study team. Preintervention and postintervention evaluations used were clinician interviews, in-office surveys of parents, 1-month post-visit telephone survey, visit observations, and medical record reviews. Outcomes evaluated growth interpretation documentation, clinician recognition of overweight, topic discussed at health supervision visit, and parental visit content recall and health behavior changes. The intervention was well accepted, and tools provided were deemed helpful. Documentation of growth interpretation was higher after intervention (pre versus post: 32% vs 87%; P< .001). Parent reports of topics discussed were similar between evaluation periods (pre versus post: growth 96% vs 99%; diet 90% vs 93%; physical activity 81% vs 85%). Observed topics at health supervision visits were similarly high and were unchanged between periods. Parental recall of topics at 1 month was also high and similar between periods. Parental report of adoption of a healthier behavior for themselves or their child at 1 month did not significantly change. The Systematic Nutritional Assessment in Pediatric Practice intervention provides a promising model to increase interpretation and documentation of growth.

Assessment of the nutritional status among residents in a Danish nursing home – health effects of a formulated food and meal policy

To gain information about the effects of implementation of a written food and meal policy and to evaluate to what extent systematic nutritional assessment and intervention would result in weight stability among the residents. Studies have shown that aged residents living in institutions suffer from malnutrition or are at risk of malnutrition. Health policies have pointed out that more attention should be given to individualised nutritional care. Several techniques are available to identify malnourished nursing home residents, but very few studies have reported findings of studies based on systematic nutritional assessment. A quasi-experimental study based on a time series design used the residents as their own controls. The study included all 20 residents who resided at the nursing home at baseline in September 2004. Five residents died during the study period (mean age 84.4 years, range 62-91 years). Altogether 15 residents (75%) were assessed all five times during the study period. The proportion of weight-stable residents increased significantly over the study from 52.6% (CI 99%: 23.1-80.2) at baseline to 87.7% (p < 0.01) at the end of the study. The proportion of weight losers significantly decreased from 42% (CI 99%: 23.1-80.8) to 13.3% (p < 0.01). The weight ranges indicate substantial weight changes, but over time the weight ranges became narrower, indicating a tendency towards weight stability. Although the nursing home had a formulated food and meal policy, this study shows the importance of a regular nutritional assessment combined with an individualised care planning. Relevance to clinical practice. Regular weighing combined with individualised care planning results in weight stability in nursing home residents. Individualised approach for nutritional care led by a qualified nurse is just as important in nursing homes as it is in hospitals.

Aproximación al estado nutricional de una población en atención domiciliaria

Objective to evaluate the risk of malnutrition in patients included in a home care program in a health center and its association with sociodemographic, clinical, and functional variables. Material and methods we performed a cross-sectional descriptive study. Stratified systematic sampling was performed and data on sociodemographic characteristics, chronic diseases, functional and cognitive status, and symptoms of depression and/or anxiety were gathered. Nutritional assessment included anthropometric evaluation, complete blood analysis (iron, ferritin, folic acid, vitamin B 12, total proteins and albumin) and risk of malnutrition (mini-nutritional assessment [MNA] questionnaire). Results of an initial sample of 96 patients (95% confidence interval [CI], precision = 0.08), data collection was complete in 91 (94.8%); 75.8% were women, and the mean age ± standard deviation was 80.4 ± 7.4 years. More than two chronic diseases were found in 70.5% and the mean number of drugs was 5.4 ± 2.8. Depressive symptoms were present in 47.3%, with moderate-severe cognitive impairment in 45.9% and symptoms of anxiety in 38.6%. A total of 89.9% required help for instrumental activities and 82.2% for basic activities. Risk of malnutrition was found in 35.2% (95% CI = 25.4-45.0) and malnutrition was found in 23.1% (95% CI = 14.5-31.7). Levels were below normal for serum folic acid (41.4%), total serum proteins (40.3%), haemoglobin (38.8%) and albumin (33.8%). Malnutrition or malnutrition risk was associated with low weight, smaller brachial and calf circumference, greater age, and lower Lawton and Barthel scores (p < 0.05). The only statistically significant association in the multivariate analysis was between lower Barthel scores and greater age. Conclusions systematic nutritional assessment should be performed periodically in elderly patients in home care programs. Prevention and intervention measures should be established, especially in patients with worse functional capacity and greater age.

Outcome of older patients requiring ventilatory support in intensive care: impact of nutritional status.

To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after discharge; to assess the lifestyles of survivors 6 months after discharge. Prospective cohort study of patients screened upon admission and 6 months after discharge from the ICU. The ICU of a university hospital. One hundred sixteen consecutive patients age 70 and older admitted to the ICU and treated by mechanical ventilation for at least 24 hours. A comprehensive medical, functional, nutritional, and social assessment was undertaken for each patient upon admission to the ICU. Functional status and residence were recorded for patients still living 6 months after discharge from the ICU. Mortality in the ICU and 6 months after discharge was 31% and 52%, respectively. The predictors of in-ICU mortality on multivariate analysis were a high omega score per day in the ICU and a high simplified acute physiologic score corrected for points related to age (SAPS IIc). The predictors of mortality at 6 months were a high omega score per day in the ICU, a high SAPS IIc, and a mid-arm circumference (MAC) under the 10th percentile for the older French population in good health. Six months after discharge from the ICU, 91% of the surviving patients had the same residential status and 89% had a similar or improved functional status compared with pre-admission status. Although severity of illness remains an important predictor of in-ICU mortality and mortality at 6 months after release from ICU, we found that impaired nutritional status upon admission was related to 6-month mortality. These results emphasize the need for a systematic nutritional assessment in older patients admitted to the ICU and treated by mechanical ventilation.