Malnutrition in Dutch health care: Prevalence,prevention, treatment,and quality indicators

ObjectiveIn most health care organizations there is still insufficient awareness for recognizing and treating malnourished patients. To gain more insight into nutritional care policies in Dutch health care organizations, this study investigated screening, treatment, and other quality indicators of nutritional care.MethodsIn 2007 a cross-sectional multicenter study was performed that included 20 255 patients (hospitals, n = 6021; nursing homes, n = 11 902; home care, n = 2332). A standardized questionnaire was used to study nutritional screening and treatment at the patient level and quality indicators at institutional and ward levels (e.g., malnutrition guidelines/protocols, nutritional education, and weighing policy).ResultsNutritional screening was performed more often in nursing homes (60.2%) than in hospitals (40.3%) and home care (13.9%, P < 0.001). In general, one in every five patients was malnourished, and nutritional treatment was applied in fewer than 50% of all malnourished patients in nursing homes, hospitals, and home care. At ward level nursing homes focused more on the quality of nutritional care than did hospitals and home care, especially with respect to controlling the use of nutritional guidelines (54.6%, P < 0.03), weighing at admission (82.9%, P < 0.01), and mealtime ambiance (91.8%, P < 0.01).ConclusionThis large-scale study shows that malnutrition is still a considerable problem in one of every five patients in all participating health care settings. It furthermore demonstrates that recognizing and treating malnutrition continues to be problematic. To target the problem of malnutrition adequately, more awareness is needed of the importance of nutritional screening, appropriate treatment, and other nutritional quality indicators.     

Evaluation of the efficacy of nutritional screening tools to predict malnutrition in the elderly at a geriatric care hospital

BACKGROUND/OBJECTIVESMalnutrition in the elderly is a serious problem, prevalent in both hospitals and care homes. Due to the absence of a gold standard for malnutrition, herein we evaluate the efficacy of five nutritional screening tools developed or used for the elderly.SUBJECTS/METHODSElected medical records of 141 elderly patients (86 men and 55 women, aged 73.5 ± 5.2 years) hospitalized at a geriatric care hospital were analyzed. Nutritional screening was performed using the following tools: Mini Nutrition Assessment (MNA), Mini Nutrition Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated as a reference tool. Each patient evaluated as malnourished to any degree or at risk of malnutrition according to at least four out of five of the aforementioned tools was categorized as malnourished in the combined index classification.RESULTSAccording to the combined index, 44.0% of the patients were at risk of malnutrition to some degree. While the nutritional risk and/or malnutrition varied greatly depending on the tool applied, ranging from 36.2% (MUST) to 72.3% (MNA-SF). MUST showed good validity (sensitivity 80.6%, specificity 98.7%) and almost perfect agreement (k = 0.81) with the combined index. In contrast, MNA-SF showed poor validity (sensitivity 100%, specificity 49.4%) and only moderate agreement (k = 0.46) with the combined index.CONCLUSIONSMNA-SF was found to overestimate the nutritional risk in the elderly. MUST appeared to be the most valid and useful screening tool to predict malnutrition in the elderly at a geriatric care hospital.     

Malnutrition and Physical Frailty among Nursing Home Residents: A Cross-Sectional Study in China

Objectives

To assess the association between malnutrition and physical frailty among nursing home older adults in China.

Design and setting

A cross-sectional study in 15 nursing homes in Changsha, China.

Participants

A total of 705 nursing home residents who were aged 60 and older.

Measurements

Physical frailty was identified based on the following five components: slow gait speed, low physical activity, weight loss, exhaustion, and low grip strength. Nutritional status was assessed using the Mini Nutritional Assessment. Multinomial logistic regression models were used to analyze the association between nutritional status and physical frailty.

Results

The mean (SD) age of the participants was 82.5 (8.1) years old (range, 60–106 years), and 226 (32%) was men. Of those participants, 5.1% and 55.6% were malnourished and at risk of malnutrition, respectively; 60.3% and 36.2% were identified as being frail and prefrail, respectively. Compared with participants who were well-nourished, those who were at risk of malnutrition or malnourished were two times more likely to be physically frail (adjusted odds ratio 2.66, 95% confidence interval 1.01 to 7.00), after adjustment for age, education level, cognitive status, depressive symptoms, and disability in activities of daily living. No significant association was observed between malnutrition and physical prefrailty.

Conclusion

Our findings suggest that poor nutritional status and physical frailty are highly prevalent in nursing home older adults in China, and that poor nutritional status is associated with increased odds of physical frailty.

     

The relationship between malnutrition parameters and pressure ulcers in hospitals and nursing homes

ObjectivesPressure ulcers (PU) remain a major health care problem throughout the world. Although malnutrition is considered to be one of the intrinsic risk factors for PU, more evidence is needed to identify the exact relation between PU and malnutrition. This study aims to identify whether there exists a relationship between PU and malnutrition in hospitals and nursing homes.MethodsA cross-sectional study was performed in April 2007 in hospitals and nursing homes in Germany. PU were assessed using the Braden scale. Malnutrition was assessed by low body mass index (BMI), undesired weight loss, and insufficient nutritional intake.ResultsTwo thousand three hundred ninety-three patients from 29 nursing homes and 4067 patients from 22 hospitals participated in the study. PU in both hospital and nursing home patients were significantly (P < 0.01) related to undesired weight loss (5%–10%). Moreover low nutritional intake and low BMI (<18.5) were also significantly related to PU in hospitals and nursing homes.ConclusionThere is a significant relationship between malnutrition parameters like undesired weight loss, BMI < 18.5, and low nutritional intake and PU.     

Screening for malnutrition among nursing home residents — a comparative analysis of the Mini Nutritional Assessment, the Nutritional Risk Screening, and the Malnutrition Universal Screening Tool

Background

The European Society for Clinical Nutrition and Metabolism (ESPEN) has recommended the Mini Nutritional Assessment (MNA®), the Nutritional Risk Screening 2002 (NRS), and the Malnutrition Universal Screening Tool (MUST) for nutritional screening in various settings and age groups. While in recent years all three tools have been applied to nursing home residents, there is still no consensus on the most appropriate screening tool in this specific setting.

Aim

The present study aims at comparing the MNA, the NRS, and the MUST with regard to applicability, categorization of nutritional status, and predictive value in the nursing home setting.

Method

MNA, NRS, and MUST were performed on 200 residents from two municipal nursing homes in Nuremberg, Germany. Follow-up data on infection, hospitalization, and mortality were collected after six and again after twelve months.

Results

Among 200 residents (mean age 85.5 ±7.8 years) the MNA could be completed in 188 (94.0%) and the NRS and MUST in 198 (99.0%) residents. The prevalence of ‘malnutrition’ according to the MNA was 15.4%. The prevalence of ‘risk of malnutrition’ (NRS) and ‘high risk of malnutrition’ (MUST), respectively, was 8.6% for both tools. The individual categorization of nutritional status showed poor agreement between NRS and MUST on the one hand and MNA on the other. For all tools a significant association between nutritional status and mortality was demonstrated during follow-up as classification in ‘malnourished’, respectively ‘high risk of malnutrition’ or ‘nutritional risk’, was significantly associated with increased hazard ratios. However, the MNA showed the best predictive value for survival among well-nourished residents.

Conclusion

The evaluation of nutritional status in nursing home residents by MNA, NRS, and MUST shows significant differences. This observation may be of clinical relevance as nutritional intervention is usually based on screening results. As the items of the MNA reflect particularities of the nursing home population, this tool currently appears to be the most suitable one in this setting.     

Prevalence of malnutrition and use of nutritional support in Peterborough Primary Care Trust

Background: Recent NICE guidance recommends that people in care homes should be screened with a validated tool such as the Malnutrition Universal Screening Tool [MUST (Elia, 2003)] on admission and where there is clinical concern (NICE, 2006). Nutrition support should be used for those who are either malnourished or at risk of malnutrition (NICE 2006; Stratton & Elia, 2007). Before implementation of MUST in care homes within the Peterborough PCT area, a cross sectional survey was undertaken with the aim of determining documentation of nutrition information, current screening practices, prevalence of malnutrition risk and use of nutrition support. Methods: A cross sectional study of nutritional care in 703 care home residents [mean age 84 (27–104) years] across 19 care homes (54% residential; 46% nursing) in Peterborough PCT was carried out for 4 months in 2007. The survey of care home notes collected information on; equipment, documentation of nutritional information (e.g. weight, height, weight loss), use of screening tools, and use of nutritional support including food fortification, dietary advice, use of supplements, and seeing a dietitian. To establish the prevalence of malnutrition risk, available nutritional information (n = 566) from the notes was used to classify residents risk using the MUST criteria. Results: All care homes (n = 19) had weighing scales with 74% having sitting and/or hoist scales, and 21% having standing scales only. Stadiometers were unavailable in all homes. Most (91%) of the residents had a recent weight documented and 58% had a documented height. Eighty‐one per cent of residents had been screened, mostly monthly, but nine different tools were used across the care homes. Using available data to calculate MUST indicated that 32% of residents were at risk of malnutrition (13% medium; 19% high) with a higher prevalence in nursing compared to residential homes (38% versus 25%; P = 0.001 Chi squared). The majority (64%) of residents at high risk of malnutrition using MUST were not receiving any form of nutritional support; in contrast 9% at low risk of malnutrition were receiving support including food fortification, oral nutritional supplements, and dietetic care. Discussion: This survey suggests that using MUST more than a quarter of residents in care homes are at risk of malnutrition. However, inconsistency in screening practices (frequency, types of tools and equipment available) can impair the identification of at risk residents preventing the appropriate use of nutrition support. Conclusions: There is a need to improve the identification and treatment of malnutrition and reduce inappropriate use of nutritional support in care homes. Therefore a programme is planned to implement routine screening with MUST, use of evidence based care plans, followed by an audit to evaluate its effects on the nutritional care of residents. References National Institute for Health and Clinical Excellence (NICE). (2006) Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. Clinical Guideline 32. Stratton, R.J. & Elia, M. (2007) A review of reviews: A new look at the evidence for oral nutritional supplements in clinical practice. Clin. Nutr. (Suppl. 2), 5–23. Elia, M. ed. The “MUST” report (2003). Nutritional Screening for Adults: A Multidisciplinary Responsibility. Vol. 2. Suppl. 1. Redditch, UK: BAPEN.     

Factors associated with deterioration of mini nutritional assessment-short form status of nursing home residents during a 2-year period

Objective

A number of other studies have been conducted to verify the Mini Nutritional Assessment (MNA) or the MNA short form (MNA-SF) as a nutritional assessment/screening tool in various clinical settings or communities. However, there are few longitudinal studies using these tools to analyze which factors affect the incidence of deteriorating nutritional status. We tried to identify the factors associated with deterioration of MNA-SF status of nursing home residents during a 2-year period.

Methods

Participants were 392 people with a mean age of 84.3 in 12 nursing homes in Japan. The factors associated with deterioration in MNA-SF categories during the study period compared to stable/improved MNA-SF categories were identified.

Results

At baseline, 19.9% of the participants were malnourished and 60.2% were at risk of malnutrition, according to the MNA-SF classification. After 2 years, 66.3% participants maintained and 6.1% participants improved their nutritional status according to the MNA-SF classification, while 27.6% showed deterioration in MNA-SF status. Stepwise logistic-regression procedure indicated that basic ADL impairment and hospitalization during the follow-up period were associated with declining MNA-SF status.

Conclusions

Poor basic ADL status and hospitalization during the follow-up period were associated with malnutrition and risk of malnutrition as assessed by MNA-SF of nursing homes residents during a 2-year period.     

Screening for malnutrition in nursing home residents: Comparison of different risk markers and their association to functional impairment

Objectives

To identify nursing home residents with malnutrition or at risk of malnutrition by using different markers, determine if the Mini Nutritional Assessment (MNA®) is able to identify all residents at risk according to single risk markers and explore the relation between risk markers and functional impairment.

Design

Cross-sectional study.

Setting

Six German nursing homes.

Participants

286 residents (86±7y, 89% female).

Measurements

Screening for malnutrition or its risk included low BMI (≤22 kg/m²), recent weight loss (WL), low food intake (LI) as single risk markers and MNA (<24 points, p.) as composite marker. Prevalence of single nutritional risk markers in different MNA categories was compared by cross-tables. Mental (cognition, mood) and physical function (mobility) were assessed by interviewing nursing staff and association of impaired status to nutritional risk markers determined by Chi² test.

Results

32.9% of residents had a low BMI, 11.9% WL and 21.3% LI. 60.2% were categorized malnourished (18.2%) or at risk of malnutrition (42.0%) by MNA. 64% presented at least one of these nutritional risk markers. Of those classified malnourished by MNA, 96.2% also showed low BMI, WL or LI. In contrast, eleven residents (9.6%) considered well-nourished by MNA presented single risk markers (9 low BMI, 2 WL). Cognitive impairment, depressive symptoms and immobility was present in 59.0%, 20.8% and 25.5%, respectively. Functional impairment, and in particular severe impairment, was to a higher proportion present in residents at nutritional risk independent of the chosen marker (MNA<24 p., low BMI, WL, LI).

Conclusion

The high prevalence of nutritional risk highlights the importance of regular screening of nursing home residents. The MNA identified nearly all residents with low BMI, WL and LI. The close association between nutritional risk and functional impairment requires increased awareness for nutritional problems especially in functionally impaired residents, to early initiate nutritional measures and thus, prevent further nutritional and functional deterioration.     

Nationwide “Pediatric Nutrition Day” survey on the nutritional status of hospitalized children in South Korea

BACKGROUND/OBJECTIVESTo evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea.SUBJECTS/METHODSThis first cross-sectional nationwide “Pediatric Nutrition Day (pNday)” survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests.RESULTSAt admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively. During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization.CONCLUSIONSMalnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.     

Malnutrition in Turkish nursing homes: A correlate of short term mortality

Objective

Elderly nursing home residents are under high risk of malnutrition. Early interventions to prevent malnutrition may play a critical role in malnutrition-mortality correlation. This study aimed to obtain insight into the prevalence of malnutrition in nursing homes in the capital city of Turkey and the role of malnutrition in predicting the risk for short-term mortality.

Design

This study was conducted in seven different residential care facilities in Ankara.

Measurements

Nutritional status was evaluated by Mini Nutritional Assessment-Short Form.

Results

The mean age of the 534 participants was 79.46±7.22 years. Nutritional assessment revealed that 15.9% of all older adults suffered from malnutrition and another 53.6% were at risk of malnutrition. The mortality rate for all subjects was 118 (22.1%) over 18 months, which was significantly higher in participants with malnutrition.

Conclusions

We noted a high prevalence of malnutrition and a strong correlation of increased mortality with malnutrition in nursing home residents. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy in nursing homes.     

Institutional Factors Associated with Residents’ Malnutrition in Nursing Homes: A Cross-Sectional Study

ObjectivesMalnutrition is frequent in older adults, associated with increased morbidity, mortality, and higher costs. Nursing home residents are especially affected, and evidence on institutional factors associated with malnutrition is limited. We calculated the prevalence of malnutrition in Swiss nursing home residents and investigated which structure and process indicators of nursing homes are associated with residents’ malnutrition.DesignSubanalysis of the Swiss Nursing Homes Human Resources Project 2018, a multicenter, cross-sectional study conducted from 2018 to 2019 in Switzerland.Setting and ParticipantsThis study included 76 nursing homes with a total of 5047 residents.MethodsMalnutrition was defined as a loss of bodyweight of ≥5% in the last 30 days or ≥10% in the last 180 days. Binomial generalized estimating equations (GEE) were applied to examine the association between malnutrition and structural (staffing ratio, grade mix, presence of a dietician, malnutrition guideline, support during mealtimes) and process indicators (awareness of malnutrition, food administration process). GEE models were adjusted for institutional (profit status, facility size) and specific resident characteristics.ResultsThe prevalence of residents with malnutrition was 5%. A higher percentage of units per nursing home having a guideline on prevention and treatment of malnutrition was significantly associated with more residents with weight loss (OR 2.47, 95% CI 1.31-4.66, P = .005). Not having a dietician in a nursing home was significantly associated with a higher rate of residents with weight loss (OR 1.60, 95% CI 1.09-2.35, P = .016).Conclusions and ImplicationsHaving a dietician as part of a multidisciplinary team in a nursing home is an important step to address the problem of residents’ malnutrition. Further research is needed to clarify the role of a guideline on prevention and treatment of malnutrition to improve the quality of care in nursing homes.     

Results of High-Protein,High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational,Multicenter, Prospective,Pragmatic Study (PROT-e-GER)

ObjectivesTo assess if the impact of oral nutritional supplements (ONS) on nutritional and functional status in malnourished older persons living in nursing homes shown by clinical trials are also found outside a trial setting.DesignObservational, multicenter, prospective, pragmatic study.Setting and ParticipantsThis study was carried out in 38 nursing homes throughout Spain. Nursing home physicians recruited consecutive residents, older than 65 years, with a diagnosis of malnutrition, when a clinical decision to start ONS had been taken after unsuccessful initial management with dietary interventions.InterventionThe participants received daily 2 bottles of an energy-rich, high-protein commercial ONS for 3 months.MeasuresPrimary outcomes were changes in nutritional status [body weight, body mass index (BMI), and Mini Nutritional Assessment-Short Form (MNA-SF)]; secondary outcomes were functional changes [Functional Ambulation Classification, Barthel index, handgrip strength, and Short Physical Performance Battery (SPPB)], as well as safety and adherence after 12 weeks of follow-up.ResultsA total of 282 residents (median age 86 years, 67% women) were included, and 244 (86.5%) completed the follow-up. At baseline, 77.3% of the participants were malnourished (BMI 19.7 kg/m², interquartile range 18.3–21.8). After 12 weeks of follow-up, participants experienced significant increases in body weight (2.6 ± 3.1 kg, 5.2 ± 5.9%), BMI (1.0 ± 1.2 kg/m²) and MNA-SF (4.0 ± 2.5 points). There were also significant improvements in functional status measured by the Barthel index, handgrip strength, SPPB, and gait speed. Good adherence was registered in 94.6% of the participants. No relevant side effects were found.Conclusions and ImplicationsImprovements in nutritional and functional status can be found when using a high-protein, high-calorie ONS in older undernourished people living in nursing homes.     

Malnutrition prevalence in The Netherlands: results of the annual dutch national prevalence measurement of care problems

The objective of this study was to provide data on malnutrition prevalence in hospitals, nursing homes and home-care organisations in The Netherlands in a nationally representative sample, and to assess the factors such as age, sex, time since admission, ward type and disease for identifying patients at high risk of malnutrition. A cross-sectional, multi-centre design with a standardised questionnaire was used to measure the prevalence of malnutrition. Nutritional status was assessed by BMI, undesired weight loss and nutritional intake. In this study, 12 883 patients were included. The prevalence of malnutrition was the highest in hospitals (23.8 %), followed by home-care organisations (21.7 %) and nursing homes (19.2 %). Logistic regression analysis revealed no association with age, time since admission and ward type. Being female was associated with malnutrition only in nursing homes. Blood diseases, gastrointestinal tract diseases, infection, chronic obstructive pulmonary disease, dementia and cancer were the factors associated with malnutrition in hospitals. Dementia was associated with malnutrition in nursing homes, while gastrointestinal tract diseases, diabetes mellitus and cancer were the associated factors in home care. This study shows that malnutrition is still a substantial problem in hospitals, nursing homes and home care in The Netherlands. Malnutrition is a problem for more than one in five patients. Despite growing attention to the problem, more continued alertness is required.     

Screening older people at risk of malnutrition or malnourished using the Simplified Nutritional Appetite Questionnaire (SNAQ): a comparison with the Mini-Nutritional Assessment (MNA) tool

ObjectivesThe Mini-Nutritional Assessment (MNA) is recommended to assess malnutrition in older people. However, its implementation is challenging in large elderly population, nursing home, or community or large clinical research programs. The Simplified Nutritional Appetite Questionnaire (SNAQ), a self-assessment nutritional screening tool that predicts weight loss, could be used to screen older people at risk of malnutrition or malnourishment. Our objective was to assess whether the SNAQ is related to the MNA and can screen older people at risk of malnutrition or malnourishment.Design/Setting/ParticipantsCross-sectional study conducted of 175 persons aged 65 or older who were community dwelling, hospitalized, and nursing home residents.MeasurementsThe SNAQ and the MNA score were performed. Correlation between the scores was studied. The most discriminating SNAQ value, which separated the participant at risk of malnutrition or malnourishment from the participant with a normal nutrition status (defined by MNA), was calculated.ResultsThe SNAQ and the MNA score were significantly correlated (Spearman test r = 0.48, P < .001). The distribution of the population using the SNAQ or the MNA was significantly different (MacNemar P < .01). The area under the receiver operator characteristic curve, which assesses the ability of the SNAQ score to predict an abnormal MNA score, was 0.767 (95% confidence interval, 0.69–0.85). An SNAQ score under 14 was the best clinical indicator of older people at risk of malnutrition or malnourishment (sensitivity = 71%, specificity = 74%). Using this cut-off, 26.8% of the population (n = 47) were misclassified. Most of them (n = 33; 18.8%) had an abnormal SNAQ with a normal MNA.ConclusionThe SNAQ is a poor screening tool to predict older people with an abnormal MNA score. However, an abnormal SNAQ might identify those who will lose weight earlier than will the MNA.     

Identifying Geriatric Patients at Risk for Malnutrition: A Quality Improvement Project

Abstract

Malnourishment leads to poor outcomes in the geriatric surgical population and national guidelines recommend preoperative nutrition screening. However, care practices do not reflect current recommendations. As a quality-improvement project, a validated nutritional screening tool, the Mini Nutritional Assessment-Short Form (MNA-SF), was implemented in the preoperative clinic of a large academic health center to identify patients at-risk for malnutrition prior to elective surgery. Patients were screened during the nursing intake process and categorized as no nutritional risk; at-risk for malnourishment; or severely malnourished. During the four-week screening period, 413 patients met inclusion criteria with 67.8% (n?=?280) screened. No nutritional risk was identified in 77.5% (n?=?215) of patients, 18.2% (n?=?51) were at-risk, and 4.3% (n?=?12) were malnourished. This project will inform and guide a prehabilitation plan for nutrition optimization to improve healthcare quality, outcomes, and costs in the geriatric surgical population.     

Comparison between Nutritional Risk Tools and Parameters Derived from Bioelectrical Impedance Analysis with Subjective Global Assessment

BackgroundNutritional risk and malnutrition are highly prevalent among hospitalized patients. As a result, several methods have been developed to produce an adequate nutritional diagnosis.ObjectiveWe aimed to assess the relationship between nutritional risk tools and parameters derived from bioelectrical impedance analysis with a Subjective Global Assessment (SGA).DesignA cross-sectional study was conducted from April to September 2010.Participants/settingThe study included 124 patients admitted to the Surgical Clinic I, University Hospital, Federal University of Santa Catarina, Florianópolis, Brazil, to undergo elective surgery.Main outcome measuresWe utilized SGA and Nutritional Risk Screening 2002 (NRS 2002), Nutritional Risk Index (NRI), Fat-Free Mass Index (FFMI), Fat Mass Index (FMI), body cell mass as a percentage of the total weight (%BCM), and standardized phase angle (SPA).Statistical analysis performedThe agreement was tested by κ coefficient, while bivariate associations were tested by Mann-Whitney U test.ResultsPrevalence of nutritional risk by NRS 2002 and NRI or malnutrition by SGA, FFMI, FMI, %BCM, and SPA was 19.3%, 69.5%, 35.5%, 12.9%, 8.1%, 46.8%, and 4.8%, respectively. The best agreement was between SGA and NRS 2002 (κ=.490), possibly because they constitute similar instruments. Patients identified as malnourished by SGA (B+C) showed considerably lower values of FFMI, FMI, BCM, and SPA.ConclusionsThe results suggest that the NRS 2002 and parameters derived from bioelectrical impedance analysis identify patients with impaired nutritional status.     

Mini Nutritional Assessment in elderly subjects receiving home nursing care

Background: Old age and disease are risk factors for malnutrition. We assessed the nutritional status in elderly receiving home nursing care. Methods: Eighty people (86% women) over the ages of 70 years (mean±SD 84±6) were investigated. One-third had lung and/or cardiovascular disease, 10% had diabetes mellitus and the remainder had miscellaneous disorders. The Mini Nutritional Assessment (MNA) scale (0–30 points), consisting of 18 point-weighted questions, including anthropometry, e.g. body mass index (BMI, kg m^?2), was used. Results: Fifty patients (62%) were assessed as having suspected malnutrition (MNA 17–23.5 points), while two were assessed as being malnourished (MNA < 17 points). The mean BMI was 22.7±5. One third of the subjects had BMI values <20 and 64% had BMI ≤ 23. Patients with cardiac failure and/or lung disease had the lowest MNA values (20.9±3.3 points) and 85% of these patients were assessed as being at risk for malnourishment. More than half drank ≤1 L of fluid per day. Over half of those who were malnourished or were suspected to be malnourished did not have meal support, whereas almost half of the well-nourished patients had meal support. Conclusion: Two-thirds of the patients receiving home nursing care were assessed as having suspected or confirmed malnutrition, or were underweight. Nutritional routines may need more focus within home nursing care services.     

Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea

ObjectiveAlthough malnutrition is common in cancer patients in Korea, little attention is paid to its risks and consequences. This study was carried out to investigate the prevalence and risk factors of malnutrition in hospitalized cancer patients according to tumor location and stage.MethodsOf 14 972 cancer patients admitted to the National Cancer Center, screening examinations were carried out for 12 112 patients and nutritional status was assessed in 8895 patients. Information on age, sex, length of hospital stay, and tumor location and stage were collected from the electronic medical records system. The nutritional status of each subject was assessed using body mass index, serum albumin, total lymphocyte count, and diet and classified into three groups: high risk, moderate risk, and low risk of malnutrition.ResultsAbout 61% of hospitalized patients were malnourished and the prevalence of malnutrition was higher in male patients with longer hospital stays (60.2%, P = 0.0101) and readmitted patients (66.6%, P < 0.0001). Patients with liver and lung cancer (86.6% and 60.5%, respectively) and patients with advanced cancer stage (60.5%, III or IV) had a higher prevalence of malnutrition than other patients (P < 0.0001). Logistic regression analysis showed that patients with advanced cancer stage and longer hospital stay and readmitted patients were at a higher risk for malnutrition.ConclusionThe prevalence of malnutrition in hospitalized cancer patients was high and varied across tumor location and stage. Early identification of malnutrition status is required for proper nutritional intervention during hospitalization.     

Evolution of Nutritional Status after Early Nutritional Management in COVID-19 Hospitalized Patients

Background & Aims: SARS-CoV2 infection is associated with an increased risk of malnutrition. Although there are numerous screening and nutritional management protocols for malnutrition, only few studies have reported nutritional evolution after COVID-19. The objectives of this study were to describe the evolution of nutritional parameters between admission and 30 days after hospital discharge, and to determine predictive factors of poor nutritional outcome after recovery in adult COVID-19 patients. Methods: In this observational longitudinal study, we report findings after discharge in 91 out of 114 patients initially admitted for COVID-19 who received early nutritional management. Nutritional status was defined using GLIM criteria and compared between admission and day 30 after discharge. Baseline predictors of nutritional status at day 30 were assessed using logistic regression. Results: Thirty days after discharge, 28.6% of patients hospitalized for COVID-19 were malnourished, compared to 42.3% at admission. Half of malnourished patients (53%) at admission recovered a normal nutritional status after discharge. Weight trajectories were heterogeneous and differed if patients had been transferred to an intensive care unit (ICU) during hospitalization (p = 0.025). High oxygen requirement during hospitalization (invasive ventilation p = 0.016 (OR 8.3 [1.6–61.2]) and/or oxygen therapy over 5 L/min p = 0.021 (OR 3.2 [1.2–8.9]) were strong predictors of malnutrition one month after discharge. Conclusions: With early nutritional management, most patients hospitalized for COVID-19 improved nutritional parameters after discharge. These findings emphasize the importance of nutritional care in COVID-19 patients hospitalized in medicine departments, especially in those transferred from ICU.