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Visser M, Sealy MJ, Leistra E, Naumann E, De van der Schueren MAE, Jager-Wittenaar H. The Malnutrition Awareness Scale for community-dwelling older adults: Development and psychometric properties. Clin Nutr 2024; 43:446-452. [PMID: 38181522 DOI: 10.1016/j.clnu.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND & AIMS Qualitative studies suggest that malnutrition awareness is poor in older adults. The aim of this study was to develop a questionnaire to quantitatively assess malnutrition awareness in community-dwelling older adults aged 60+ years. METHODS The Malnutrition Awareness Scale (MAS) was developed based on the awareness phase of the Integrated-Change model, and included four domains: knowledge, perceived cues, risk perceptions, and cognizance. Twenty-six scale items were developed using results from mainly qualitative research and the expertise of the authors. Items were piloted in 10 Dutch older adults using the Thinking Aloud method to optimize wording. In a feasibility study, annoyance, difficulty and time to complete the MAS and its comprehensibility were tested. After final revisions, the MAS was applied to a large sample to test its psychometric properties (i.e., inter-item correlations, Cronbach's alpha, score distribution) and relevance of the items was rated on a 5-point scale by 12 experts to determine content validity. RESULTS The feasibility study (n = 42, 55 % women, 19 % 80+ y) showed that the MAS took 12 ± 6 min to complete. Most participants found it not (at all) annoying (81 %) and not (at all) difficult (79 %) to complete the MAS, and found it (very) comprehensible (83 %). Psychometric analyses (n = 216, 63 % women, 28 % 80+ y) showed no redundant items, but two items correlated negatively with other items, and one correlated very low. After removal, the final MAS consists of 23 items with a min-max scoring range from 0 to 22 (with higher scores indicating higher awareness) and an overall Cronbach's alpha of 0.67. The mean MAS score in our sample (n = 216) was 14.8 ± 3.2. The lowest obtained score was 6 (n = 3) and the highest 22 (n = 1), indicating no floor or ceiling effects. Based on the relevance rating, the overall median across all 22 items was 4.0 with IQR 4.0-5.0. CONCLUSION The Malnutrition Awareness Scale is a novel, feasible and reliable tool with good content validity to quantitively assess malnutrition awareness in community-dwelling older adults. The scale is now ready to identify groups with poor malnutrition awareness, as a basis to start interventions to increase malnutrition knowledge and awareness.
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Affiliation(s)
- M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - M J Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands.
| | - E Leistra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - E Naumann
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Postbus 6960, 6503 GL Nijmegen, The Netherlands; Dutch Malnutrition Center of Expertise, The Netherlands.
| | - M A E De van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Postbus 6960, 6503 GL Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
| | - H Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; Department of Gastroenterology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands; Research Unit Experimental Anatomy, Faculty of Physical Education and Physiotherapy, Department of Physiotherapy and Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical Nutrition and Human Rights. An International Position Paper. Nutr Clin Pract 2021; 36:534-544. [PMID: 34013590 DOI: 10.1002/ncp.10667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogota, Colombia
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, Tours, France
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical nutrition and human rights. An international position paper. Clin Nutr 2021; 40:4029-4036. [PMID: 34023070 DOI: 10.1016/j.clnu.2021.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, El Bosque University, Bogotá, Colombia.
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, LA, USA.
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand.
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica Del Country, Bogota, Colombia.
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de La Universidad de Chile, Santiago, Chile.
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, France.
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
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Keller HH, Laur C, Dhaliwal R, Allard JP, Clermont-Dejean N, Duerksen DR, Elias E, Gramlich L, Lakananurak N, Laporte M. Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals. JPEN J Parenter Enteral Nutr 2020; 45:670-684. [PMID: 33236411 DOI: 10.1002/jpen.2047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 01/04/2023]
Abstract
Hospital malnutrition is a longstanding problem that continues to be underrecognized and undertreated. The aim of this narrative review is to summarize novel, solution-focused, recent research or commentary to update providers on the prevention of iatrogenic malnutrition as well as the detection and treatment of hospital malnutrition. A narrative review was completed using the top 11 clinically relevant nutrition journals. Of the 13,850 articles and editorials published in these journals between 2013 and 2019, 511 were related to hospital malnutrition. A duplicate review was used to select (n = 108) and extract key findings from articles and editorials. Key criteria for selection were population of interest (adult hospital patients, no specific diagnostic group), solution-focused, and novel perspectives. Articles were categorized (6 classified in >1 category) as Screening and Assessment (n = 17), Standard (n = 25), Advanced (n = 12) and Specialized Nutrition Care (n = 8), Transitions (n = 15), Multicomponent (n = 21), Education and Empowerment (n = 9), Economic Impact (n = 3), and Guidelines (n = 4) for summarizing. Research advances in screening implementation, standard nutrition care, transitions, and multicomponent interventions provide new strategies to consider for malnutrition prevention (iatrogenic), detection, and care. However, several areas requiring further research were identified. Specifically, larger and more rigorous studies that examine health outcomes and economic analyses are urgently needed.
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Affiliation(s)
- Heather H Keller
- Schlegel-University of Waterloo Research institute for Aging, Waterloo, Ontario, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Rupinder Dhaliwal
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, Ontario, Canada
| | - Johane P Allard
- Department of Medicine, University of Toronto, Toronto General Hospital, University Health Network Toronto, Toronto, Ontario, Canada
| | - Nayima Clermont-Dejean
- Clinical Nutrition, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald R Duerksen
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Evan Elias
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Narisorn Lakananurak
- Department of Medicine, University of Alberta, Edmonton, Canada.,Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Manon Laporte
- Department of Clinical Nutrition, Réseau de santé Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada
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Jager‐Wittenaar H, de Bats HF, Welink‐Lamberts BJ, Gort‐van Dijk D, van der Laan BFAM, Ottery FD, Roodenburg JLN. Self-Completion of the Patient-Generated Subjective Global Assessment Short Form Is Feasible and Is Associated With Increased Awareness on Malnutrition Risk in Patients With Head and Neck Cancer. Nutr Clin Pract 2020; 35:353-362. [PMID: 31134665 PMCID: PMC7078954 DOI: 10.1002/ncp.10313] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We aimed to assess feasibility of self-completion of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) by head and neck cancer patients, and to assess self-reported increased awareness regarding malnutrition risk after self-completion. METHODS Participants were randomized to complete the PG-SGA SF by paper or app. Feasibility was assessed by time needed to complete the PG-SGA SF, perceived difficulty, and help needed during completion. Participants were asked if they knew what malnutrition was (yes/no) and if they could define "malnutrition." They were also asked 9 questions on whether they perceived increased awareness of malnutrition risk after having completed the PG-SGA SF and 2 on their intention to change lifestyle habits. RESULTS Of all participants (n = 59; 65.9 ± 12.6 years; 73% male), 55% completed the PG-SGA SF paper version and 46% the Pt-Global app. Median time needed for self-completion of the PG-SGA SF was 2 minutes 41 seconds (interquartile range: 1 minute 49 seconds-3 minutes 50 seconds). Forty-eight percent needed help with completion, indicating acceptable feasibility. Participants who completed the Pt-Global app needed help significantly more often (66%; 21/32) than those who completed the PG-SGA SF paper version (26%; 7/27) (P = 0.005). All difficulty scores were excellent. For 7/9 questions on malnutrition risk awareness, >50% of the participants answered positively. CONCLUSION The results of this study show that self-completion of the PG-SGA SF by head and neck cancer patients is feasible and that awareness regarding malnutrition risk may increase after completing the PG-SGA SF.
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Affiliation(s)
- Harriët Jager‐Wittenaar
- Department of Maxillofacial SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
- Research Group Healthy AgeingAllied Health Care and NursingHanze University of Applied SciencesGroningenthe Netherlands
| | - Hester F. de Bats
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Bertine J. Welink‐Lamberts
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Dorienke Gort‐van Dijk
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Bernard F. A. M. van der Laan
- Department of Otorhinolaryngology/Head & Neck SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Faith D. Ottery
- Research Group Healthy AgeingAllied Health Care and NursingHanze University of Applied SciencesGroningenthe Netherlands
- Ottery & AssociatesLLCOncology Care ConsultantsDeerfieldIllinoisUSA
| | - Jan L. N. Roodenburg
- Department of Maxillofacial SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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