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Malnutrition-Sarcopenia Syndrome: Is This the Future of Nutrition Screening and Assessment for Older Adults?  [PDF]
Maurits F. J. Vandewoude,Carolyn J. Alish,Abby C. Sauer,Refaat A. Hegazi
Journal of Aging Research , 2012, DOI: 10.1155/2012/651570
Abstract: Malnutrition is common across varying patient populations, particularly older adults, and sarcopenia prevalence increases with advancing age. Both malnutrition and sarcopenia are associated with substantial adverse outcomes affecting both the patient and the healthcare system, including increased morbidity, mortality, rehospitalization rates, and healthcare costs. Healthcare practitioners may assess patients for either malnutrition or sarcopenia; however, many patients clinically present with both conditions, resulting in the syndrome, Malnutrition-Sarcopenia Syndrome, which is the clinical presentation of both malnutrition and accelerated age-associated loss of lean body mass, strength, and/or functionality. Clinicians are urged to screen, assess, and treat these conditions currently so as to adequately address the full spectrum of patients’ nutritional issues. By examining aspects of both conditions, clinicians can more fully assess their patients’ clinical and nutritional status and can tailor targeted therapies to meet their needs and improve outcomes. This proposed syndrome embodies the inherent association of malnutrition and sarcopenia, highlighting their combined impact on clinical outcomes. The objective of this review paper is to characterize Malnutrition-Sarcopenia Syndrome to advance clinical practice, by providing clinicians with the necessary background information to integrate nutritional assessment along with loss of muscle mass and functionality in their everyday clinical practice. 1. Introduction Historically, malnutrition has been defined as a condition of an imbalance of energy, protein, and other nutrients that cause measurable negative effects on body composition, physical function, and clinical outcomes [1]. Typical measures that clinicians use to screen and assess for malnutrition or the risk for malnutrition include dietary or nutrient intake, changes in body weight, and laboratory values [2]. A new definition of malnutrition has recently been proposed by an International Guideline Consensus Committee, integrating the acuity of the associated disease and inflammation [3]. The committee specified three subtypes of malnutrition using an etiology-based terminology to assist clinicians to make a nutrition diagnosis in clinical practice settings: (1) starvation-related without inflammation, (2) chronic disease or conditions that impose sustained mild-to-moderate inflammation (e.g., sarcopenic obesity, organ failure, and pancreatic cancer), and (3) acute disease or injury states, when inflammatory response is marked [3]. One critical
Diagnostic performance of the Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients - a cross-sectional study
Albert Westergren, Erika Norberg, Peter Hagell
BMC Nursing , 2011, DOI: 10.1186/1472-6955-10-24
Abstract: Eighty seven hospital inpatients were assessed for nutritional status with the 18-item MNA (considered as the gold standard), and screened with the NRS 2002 and the MEONF-II.The MEONF-II sensitivity (0.61), specificity (0.79), and accuracy (0.68) were acceptable. The corresponding figures for NRS 2002 were 0.37, 0.82 and 0.55, respectively. MEONF-II and NRS 2002 took five minutes each to complete. Assessors considered MEONF-II instructions and items to be easy to understand and complete (96-99%), and the items to be relevant (87%). For NRS 2002, the corresponding figures were 75-93% and 79%, respectively.The MEONF-II is an easy to use, relatively quick and sensitive screening tool to assess risk of undernutrition among hospital inpatients. With respect to user-friendliness and sensitivity the MEONF-II seems to perform better than the NRS 2002, although larger studies are needed for firm conclusions. The different scoring systems for undernutrition appear to identify overlapping but not identical patient groups. A potential limitation with the study is that the MNA was used as gold standard among patients younger than 65 years.Undernutrition is associated with poorer health, compromised ability to recover from medical conditions and increased mortality [1]. People at risk for or with manifest undernutrition therefore need to be identified in order to initiate prevention or interventions. Low Body Mass Index (BMI) and unintentional weight loss are considered key indicators of undernutrition [2], and together with change in food intake these indicators are associated with changes in function and clinical outcome [3]. This is reflected in commonly used nutritional screening tools such as the Nutritional Risk Screening 2002 (NRS 2002; [4]), the Mini Nutritional Assessment (MNA; [5,6] ), Malnutrition Universal Screening Tool (MUST; [7]) and the recently developed Minimal Eating Observation and Nutrition Form - Version II (MEONF-II; [8,9]).In Sweden, it is recommended that
Malaysian Journal of Pharmaceutical Sciences , 2006,
Abstract: Parenteral nutrition (PN) has been practiced in Hospital Pulau Pinang, Malaysia since 1986. However, there is no published data on the cost, complications and outcome of patients receiving PN in this hospital. A retrospective study was carried out to evaluate the cost, complications and outcome of PN. Data were obtained from patient medical records and analysed using SPSS version 11. From 2003 to 2005, 429 PN cases were evaluated. Of the PN cases, 65% were neonates, 28.2% adults and 6.8% paediatric, where 60.8% of patients were male and 38.5% were female. Malay patients constituted 57.3%, Chinese 30.8% and Indian 11.9%. The reasons for PN were feeding intolerence (86.7%), oral intake restrictions (9.3%), poor oral intake (1.4%) and others (2.6%). The average cost for PN in a neonate was found to be RM185 ± 69, RM 233 ± 126 for a paediatric patient and RM 235 ± 107 for an adult. PN-associated complications were bacterial sepsis (30.4%), metabolic acidosis (13.0%), catheter dislodgment (8.7%), long line swelling (8.7%), hepatic complication (21.8%), long line blockage (4.4%) and catheter-related infection (13.0%). A total of 82.7% of cases tolerated oral nutrition after PN, 7.4% expired, 5.3% developed PN complications and others were discharged, transferred to other ward, transferred to another hospital, or discharged at own risk (0.3%). The study showed a significant difference in the cost of PN in each group of patients (p = 0.002). We concluded that PN services in Hospital Pulau Pinang were associated with low PN-related complications and good outcomes.
Nutritional status of adults and elderly patients admitted in an university hospital Perfil nutricional de pacientes adultos e idosos admitidos em um hospital universitário
Nathálie Crestani,Patrícia Bieger,Raquel Milani El Kik,Raquel da Luz Dias
Ciência & Saúde , 2011,
Abstract: Objective: To identify the nutritional status of adults and elderly patients admitted in an university hospital. Materials and Methods: This is a cross-sectional, retrospective and descriptive study. The nutritional assessment was conducted by using the body mass index (BMI) and the subjective global assessment (SGA), which classifies patients into three categories: well nourished (A), moderately or suspected of being malnourished (B) or severely malnourished (C). All data (SGA, BMI and primary condition) were collected from information present in the evaluation forms filled in the nutritional routine, which are performed within seventy-two hours after admission. The study was approved by the Scientific and Ethics Committee for Research of PUCRS. Results: The study included 32 adults and 36 elderly (n=68). In relation to the SGA, 46,9% of adults were classified as well nourished (A) and 53,1% as moderately (or suspected of being) malnourished (B). Among elderly patients, 25% were classified as well nourished (A) and 75% as moderately (or suspected of being) malnourished (B). The BMI showed 37,5% of adults as eutrophic and 62,5% as overweight or obesity; the elderly were classified as 50% eutrophic, 36,1% overweight and 13,9% underweight. Conclusion: The nutritional status of the studied patients was characterized by the high prevalence of nutritional risk and overweight/obesity in both groups. This reality seems to translate, at the hospital level, the situation of nutritional transition experienced in our country today. In addition, the results point the importance of using more than one method of nutrition screening in patients admitted in hospitals, in order to obtain greater precision in the assessment. Objetivo: Identificar o perfil nutricional de pacientes adultos e idosos admitidos em um hospital universitário. Materiais e Métodos: Trata-se de um estudo transversal, retrospectivo e descritivo. Foram utilizados para avalia o nutricional o índice de Massa Corporal (IMC) e a Avalia o Subjetiva Global (ASG), que classifica o paciente em três categorias: bem nutrido (A), moderadamente ou suspeita de ser desnutrido (B) ou gravemente desnutrido (C). Os dados (ASG, IMC e condi o primária) foram coletados a partir de informa es dos formulários de avalia o nutricional preenchidos na rotina assistencial, aplicados em até setenta e duas horas após a intera o do paciente. Esse estudo foi aprovado pela Comiss o Científica e pelo Comitê de ética em Pesquisa da PUCRS. Resultados: O estudo incluiu 32 adultos e 36 idosos (n=68). Em rela o à ASG, 46,9% dos a
Nutrition Therapy in the Transition between Hospital and Home: An Investigation of Barriers  [PDF]
Mette Holst,Henrik H?jgaard Rasmussen
Journal of Nutrition and Metabolism , 2013, DOI: 10.1155/2013/463751
Abstract: Aims and Objectives. This study aimed to investigate barriers for nutrition therapy in the transition between hospital and home and hereby to identify areas for potential improvements. Background. Though the focus on nutritional risk is improving in hospital, there seems to be less effort to maintain or even improve nutritional status after discharge and during the rehabilitation period. Design. Qualitative focus group interviews. Methods. Semistructured focus group interviews with experienced multiprofessional staff from hospital, home care, nursing homes, and general practise. The study was done in the county of Aalborg with about 280.000 inhabitants regarding homecare and general practise as well as Aalborg University Hospital, Denmark. Results. Interviews were generated with 41 professionals from hospital, general practise, and home care. Barriers identified between settings included the following aspects: economic, organisation, and education. The impression of professionals was that few patients are discharged with nutrition therapy, compared to who could benefit from nutrition therapy after discharge. Most often, reasons were a short in-hospital stay and lack of knowledge and interest. Moreover, lack of clinical guidelines throughout all settings, time consumption, lack of transparency regarding economy and workflows, and lack of assistance from experts regarding complicated nutritional problems were identified. Conclusions. Many barriers were found in hospital as well as in the community and general practise. These were most often practical as well as organizational. Improvements of clinical guidelines and instructions and improvement of knowledge and communication at all levels are needed. Relevance to Clinical Practise. This study emphasizes that responsibility needs to be taken for patients whom are still at nutritional risk at discharge, and even before hospitalization. Nurses and doctors in and outside hospital are in need of improved knowledge, standard care plans, and instructions. 1. Introduction Nutritional risk has been described as prevalent as 20 to 80% among hospitalized patients depending on population, setting, and screening tool [1], and [2, pages 473–481]. Nutritional risk is associated with poorer outcome in many terms, including function, life quality, and mortality [3, pages 321–325], [4, pages 386–395], [5, pages 923–932], and [6, pages M741–746]. Nutritional health tends to deteriorate during hospital stay. Deterioration of nutritional status during hospital stay indicates the necessity for introducing a good nutrition plan
Development of a nutrition knowledge questionnaire for obese adults
Anne Feren,Liv E Torheim,Inger T L Lillegaard
Food & Nutrition Research , 2011, DOI: 10.3402/fnr.v55i0.7271
Abstract: The aim of this study was to develop a questionnaire for assessing nutritional knowledge among overweight adults. The questionnaire should reveal knowledge about current dietary recommendations, sources of nutrients, everyday food choices, and conditions related to overweight.The first draft of the nutrition knowledge questionnaire (113 items) was based on literature review. To ensure content validity and expert-assessed face validity, an expert panel examined the questionnaire. Thereafter, the questionnaire was tested for user friendliness and ambiguity by five students. The questionnaire was pilot tested in a group of obese adults, similar to the target group. The results were analyzed for item difficulty and internal consistency and comments made by respondents were taken into account. Two student groups, differing in nutritional expertise, answered the questionnaire on two occasions to test construct validity and test–retest reliability. After the retest, a total overview of the questionnaire was made by the expert panel. The final questionnaire consisted of 91 items.The pilot study was conducted in obese adults waiting for a gastric bypass operation (n=33). Construct validity (n=34) and test–retest reliability (n=27) was tested in two student groups: public health nutrition students and construction students.Results from the pilot study showed that internal consistency of the three first sections together was 0.84, measured by Cronbach's α. Test of construct validity showed that public health nutrition students scored significantly better than construction students (p<0.001 for all sections), and test–retest reliability for all sections together was 0.82 (Pearson's r).The knowledge questionnaire had reasonable content-, face-, and construct validities and overall good reliability. The questionnaire can be a useful tool for measuring nutrition knowledge among obese adults.
Nutritional screening tools application in a general hospital: a comparative study Aplica o de instrumentos de triagem nutricional em hospital geral: um estudo comparativo  [cached]
Janaína Damasceno Bezerra,Maria Amélia Marques Dantas,Sancha Helena Lima Vale,Márcia Marília Gomes Dantas
Ciência & Saúde , 2012,
Abstract: Introduction: There are many nutritional screening tools and it becomes difficult to choose which one is the best to be used in clinical nutrition practice. Objective: To compare five nutritional screening tools (MST, NRS-2002, MUST, MNA and MNA-SF) in adults and elderly hospitalized. Materials and Methods: A cross-sectional study, with the application of nutritional screening tools in adult and elderly patients in the first 48 hours of hospitalization was performed. Nutritional risk occurrence between adult and elderly patients was compared. Statistical analyses were performed using descriptive data and a non-parametric test (Man Whitney). Results: We evaluated 77 patients, 51 (66.2%) adults and 26 (33.8%) elderly, aged 53.6 (standard deviation of 17.9) years, with female predominance (53.2%). The main reasons for hospitalization were neoplasia and nephrolithotripsy. Overall, one quarter of patients was at nutritional risk. Nutritional risk in adults was detected with similarity by MUST and MST. However it was underestimated by NRS-2002. The MNA and MNA-SF, exclusively for the elderly, also had similar result to detect nutritional risk. In relation to the time of application, the MNA was the instrument with longer application time. Conclusion: Considering the higher detection of patients with nutritional risk, the easiness and the lower application time, we suggest, respectively, MUST and MNA-SF to be used in adult and elderly patients admitted in this hospital. Introdu o: Com inúmeros instrumentos de triagem nutricional existentes, é difícil eleger o mais adequado para os protocolos de nutri o hospitalar. Objetivo: Comparar cinco instrumentos de triagem nutricional (MST, NRS-2002, MUST, MNA e MNA-SF) em adultos e idosos hospitalizados. Materiais e Métodos: Nesse estudo transversal, cinco instrumentos de triagem nutricional foram aplicados aos pacientes nas primeiras 48 horas de interna o hospitalar. A ocorrência de risco nutricional entre adultos e idosos foi comparada. Para análise estatística, os dados foram descritos e o teste n o paramétrico de Man Whitney foi aplicado. Resultados: Foram avaliados 77 pacientes, sendo 51 (66,2%) adultos e 26 (33,8%) idosos, com média de idade de 53,6 (desvio padr o de 17,9) anos e predominancia do gênero feminino (53,2%). Os principais motivos de interna o foram neoplasia e nefrolitotripsia. De forma geral, um quarto dos pacientes estava em risco nutricional. O risco nutricional em pacientes adultos foi mais detectado pelo MUST e MST, com resultados semelhantes. Porém, esse parametro foi pouco detectado pelo NR
Natalija Stojanovic,Svetlana Pavlovic,Maja Nikolic,Jelenka Nikolic
Acta Facultatis Medicae Naissensis , 2007,
Abstract: The aim of this study was to confirm the significance of introducing perioperative nutrition screening for patients who have undergone radical cystectomy so as to motivate them to have proper nutrition protocol introduced in future. This pilot research involved 14 patients with urinary bladder cancer treated at the Urology Clinic in Nis, from September 1, 2005 to March 1, 2007. All the patients had undergone a surgical procedure of radical cystectomy with urinary diversion. Postoperatively, all the patients were treated with total parenteral and enteral nutrition, while indication for starting a liquid diet was the point when peristalsis occurred. Nutrition parameters were measured preoperatively and on the first, third and fifth day following the surgery. Nutrition parameters included body mass index, lymphocyte count, protein and albumin values. The data were analyzed by means of quantitative analysis methods. For the analysis of the research results we used the statistic package SPSS 10.0.Only 1/3 of the patients in our research was malnourished. There were 71.43% of the patients with a depleted number of lymphocytes preoperatively, while there were 42.86% with lower than normal value of protein. Preoperatively, hypoalbuminemia was present in all the patients, whereas albumin level was very low in almost 1/3 of the patients, less than 35 g/l. The later the nasogastric tube was removed and the later a liquid diet was introduced, the greater frequency of postoperative complications appeared in these patients.Nutrition screening should encompass anthropometric and biochemical parameters as they complement each other. Earlier beginning of per os nutrition decreases the frequency of postoperative complications.
Do the malnutrition universal screening tool (MUST) and Birmingham nutrition risk (BNR) score predict mortality in older hospitalised patients?
Sarah Henderson, Nicola Moore, Emma Lee, Miles D Witham
BMC Geriatrics , 2008, DOI: 10.1186/1471-2318-8-26
Abstract: Consecutive admissions to Medicine for the Elderly assessment wards in Dundee were assessed between mid-October 2003 and mid-January 2004. Body Mass Index (BMI), MUST and BNR scores were prospectively collected. Time to death was obtained from the Scottish Death Register and compared across strata of risk.115 patients were analysed, mean age 82.1 years. 39/115 (34%) were male. 20 patients were identified as high risk by both methods of screening. A further 10 were categorised high risk only with the Birmingham classification and 12 only with MUST.80/115 (67%) patients had died at the time of accessing death records. MUST category significantly predicted death (log rank test, p = 0.022). Neither BMI (log rank p = 0.37) or Birmingham nutrition score (log rank p = 0.35) predicted death.The MUST score, but not the BNR, is able to predict increased mortality in older hospitalised patients.Undernutrition is known to be prevalent in hospitalized patients, with 40% of all patients admitted found to be undernourished[1]. Of those who are undernourished on admission, further deterioration often occurs during their inpatient stay[2]. Routine screening of nutritional state is therefore recommended in all patients admitted to hospital to allow early intervention.Several different tools have been developed to screen for undernutrition. Two commonly used tools are the Birmingham Nutrition Risk Score (BNR) and the newer Malnutrition Universal Screening Tool (MUST). The former, the Birmingham Nutrition Risk Score was developed in the mid 1990's at the Birmingham Heartlands Hospital[3]. Initial validation studies showed that the score correlated well with other previously described scores, correlated well with a dietician's clinical impression and was reproducible between dieticians and nursing staff[4].The more recent MUST score was developed by the Malnutrition Advisory Group of the British Association of Parenteral and Enteral Nutrition (BAPEN) for use in all health care settings.
The Art of Capturing Opportunities —Screening Arab Social Entrepreneurs  [PDF]
Mohamed Buheji
American Journal of Industrial and Business Management (AJIBM) , 2018, DOI: 10.4236/ajibm.2018.84055
Abstract: This paper investigates how opportunities are captured by those that bring in unique contributions to their communities. More than fifty Arab initiatives were studied to see how they started by social change entrepreneurs through capturing opportunities that came due to community needs, gaps, challenges, crisis. The study shows that even hidden opportunities can be exploited through utilising the alertness psychology of the entrepreneurs along with problem solving techniques and optimising their social capital that each opportunity brings. The originality of this work is that it shows that capturing opportunities can occur when people are more driven by values, or vision, or self-purposefulness. It is very important to all Social Change Agents and especially in developing countries/regions as the Arab World. The limitation to data screened in this study doesn’t undermine the possibility for generalising it further in different areas in the world as it carries a great development potential for our socio-economies and even to the world abundance thinking.
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