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Kahveci FS, Demirkan K, Doganay M, Gomceli I, Gundogan K, Topeli A, Tumer G, Uyar M, Abbasoglu O. Parenteral nutrition consensus report from KEPAN. Nutrition 2024; 123:112424. [PMID: 38593671 DOI: 10.1016/j.nut.2024.112424] [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: 01/25/2024] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Medical nutrition therapy is one of the core components of patient management, although its implication is still limited in Daily practice globally. Clinicians are in need of guidance that will ease the application of medical nutrition therapy. The pre- and post-graduate curriculum for medical nutrition therapy is limited in most regions, worldwide. A report that is short, clear, and having clear-cut recommendations that will guide the primary healthcare professionals in indications, choice, practical application, follow-up, and stopping parenteral nutrition (PN) would facilitate the application and success of medical nutrition therapy. KEPAN is the Clinical Enteral and Parenteral Nutrition Society of Turkey and is an active member of the European Society for Clinical Nutrition and Metabolism (ESPEN). METHOD In this study, we present the KEPAN PN consensus report on optimal PN use in medical nutrition therapy as outlined by the works of academicians experienced in the clinical application of PN (nine working group academicians and 10 expert group academicians). RESULTS This report provides 22 clear-cut recommendations in a question-answer format. CONCLUSIONS We believe that this report could have a significant impact on the optimum use of PN in the context of medical nutrition therapy when clinicians manage everyday patients.
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Affiliation(s)
- Ferda Sohret Kahveci
- Department of Anesthesiology, Division of Critical Care, Uludağ University Faculty of Medicine, Bursa, Turkey.
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Mutlu Doganay
- Department of General Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ismail Gomceli
- Department of General Surgery, Antalya Bilim University, Antalya, Turkey
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Guzin Tumer
- Department of Nutrition and Dietetics, Ondokuz Mayıs University, Samsun, Turkey
| | - Mehmet Uyar
- Department of Anesthesiology and Intensive Care, School of Medicine, Ege University, Izmir, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Doganay M, Akcay K, Cil T, Dag B, Demirag K, Demirkan K, Gundogdu RH, Gunduz HM, Parsak CK, Topcuoglu MA, Turkoglu M, Abbasoglu O. Enteral nutrition consensus report from KEPAN: Indications, choice, practical application, and follow-up. Nutrition 2024; 118:112269. [PMID: 38035451 DOI: 10.1016/j.nut.2023.112269] [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: 08/04/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Clinicians are in need of guidance that will ease the application of medical nutrition therapy. In order to facilitate the application and success of medical nutrition therapy, the Turkish Clinical Enteral & Parenteral Nutrition Society (KEPAN) planned a report that is short, is clear, and has clear-cut recommendations that will guide health care professionals in the indications, choice, practical application, follow-up, and stopping of enteral nutrition. METHODS The enteral nutrition consensus report on enteral nutrition use in medical nutrition therapy was developed by a study group (12 working group academicians and 17 expert group academicians) under the organization of KEPAN. The enteral nutrition consensus report was generated in 5 online and face-to-face phases from December 2019 through October 2022. At the end (Delphi rounds), a total of 24 questions and subjects, recommendations, and comments were sent to the enteral nutrition working group and the expert group via e-mail. They were asked to score the criteria by using the Likert scale. RESULTS The first round of the study resulted in acceptance of all 24 recommendations. None of the criteria was rejected. Only some minor editing for wording was recommended by the panelists during the first and second rounds of the Delphi study. The final report was sent to all 29 panelists and was approved without any revision suggestions. CONCLUSION This report provides 24 clear-cut recommendations in a question-answer format. We believe that this report could have a significant effect on the optimum use of enteral nutrition in the context of medical nutrition therapy when clinicians manage everyday patients.
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Affiliation(s)
- Mutlu Doganay
- Department of General Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Kezban Akcay
- Nutritional Support Department, Hacettepe University Hospitals, Ankara, Turkey
| | - Timucin Cil
- Division of Medical Oncology, Department of Internal Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Birgul Dag
- Department of Nutrition and Dietetics, Lokman Hekim University, Ankara, Turkey
| | - Kubilay Demirag
- Intensive Care Unit, Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, Izmir, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Riza Haldun Gundogdu
- Department of General Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Hasan Murat Gunduz
- Intensive Care Unit, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Cem Kaan Parsak
- Department of General Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | | | - Melda Turkoglu
- Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Bahat G, Akmansu M, Gungor L, Halil M, Bicakli DH, Koc N, Ozogul Y, Sungurtekin H, Abbasoglu O. Optimal use of oral nutritional supplements (ONS) in medical nutrition therapy: ONS consensus report from KEPAN. Eur J Clin Nutr 2023; 77:705-709. [PMID: 36352101 PMCID: PMC9645761 DOI: 10.1038/s41430-022-01229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
Medical nutrition therapy is one of the core components of the patient management, although its implication is still limited in daily practice globally. Clinicians are in need of guidance that will ease the application of medical nutrition therapy. The first treatment choice in medical nutrition therapy is the use of oral nutritional supplements (ONS) after or concomitant with dietary interventions. The pre and post-graduate curriculum for medical nutrition therapy is limited in most regions, worldwide. A report that is short, clear, and having clear-cut recommendations that will guide the primary healthcare professionals in indications, choice, practical application, follow-up, and stopping ONS would facilitate the application and success of medical nutrition therapy. KEPAN is the Clinical Enteral and Parenteral Nutrition Society of Turkey and is an active member of the European Society for Clinical Nutrition and Metabolism (ESPEN). In this study, we present the KEPAN ONS consensus report on optimal ONS use in medical nutrition therapy as outlined by works of academicians experienced in clinical application of ONS (eight working group academicians and 19 expert group academicians). This report provides 22 clear-cut recommendations in a question-answer format. We believe that this report could have a significant impact in the ideal use of ONS in the context of medical nutrition therapy when clinicians manage everyday patients.
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Affiliation(s)
- Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul University Istanbul Medical School, 34093, Istanbul, Turkey.
| | - Muge Akmansu
- Department of Radiation Oncology, Gazi University Faculty of Medicine, 06500, Ankara, Turkey
| | - Levent Gungor
- Department of Neurology, Ondokuz Mayis University Faculty of Medicine, 55200, Samsun, Turkey
| | - Meltem Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
| | - Derya Hopanci Bicakli
- Department of Medical Oncology, Ege University Faculty of Medicine, 35100, Izmir, Turkey
| | - Nevra Koc
- Department of Nutrition and Dietetics, University of Health Sciences, Gulhane Health Sciences Faculty, 06010, Ankara, Turkey
| | - Yusuf Ozogul
- Department of Gastrointestinal Surgery, Ankara City Hospital, 06800, Ankara, Turkey
| | - Hulya Sungurtekin
- Department of Anesthesiology and Reanimation, Division of Intensive Care Medicine, Pamukkale University Faculty of Medicine, 20070, Denizli, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Hacettepe University Faculty of Medicine, 06230, Ankara, Turkey
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van Zwienen-Pot JI, Reinders I, de Groot LCPGM, Beck AM, Feldblum I, Jobse I, Neelemaat F, de van der Schueren MAE, Shahar DR, Smeets ETHC, Tieland M, Wijnhoven HAH, Volkert D, Visser M. Effects of Nutritional Interventions in Older Adults with Malnutrition or at Risk of Malnutrition on Muscle Strength and Mortality: Results of Pooled Analyses of Individual Participant Data from Nine RCTs. Nutrients 2023; 15:2025. [PMID: 37432139 DOI: 10.3390/nu15092025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 07/12/2023] Open
Abstract
Nutritional intervention studies in older adults with malnutrition aim to improve nutritional status. Although these studies show a significant gain in body weight, there is inconsistent evidence of clinical effectiveness on muscle strength and mortality. This study aimed to examine the effects of nutritional interventions on muscle strength and risk of mortality in older adults (malnourished or at risk) and explore whether these effects are influenced by participant characteristics. Individual participant data were used from nine RCTs (community setting, hospital and long-term care; duration 12-24 weeks and included oral nutritional supplements, dietary counseling, or both). Handgrip strength (HGS) was measured in seven RCTs and six RCTs obtained mortality data. A ≥3 kg increase in HGS was considered clinically relevant. Logistic generalized estimating equations analyses (GEE) were used to test intervention effectiveness. GEE showed no overall treatment effect (OR 1.11, 95% CI 0.78-1.59) on HGS. A greater, but not statistically significant, effect on HGS was observed for older (>80 years) versus younger participants. No significant treatment effect was observed for mortality (OR 0.78, 95% CI 0.42-1.46). The treatment effect on mortality was greater but remained non-significant for women and those with higher baseline energy or protein intake. In conclusion, no effects of nutritional interventions were observed on HGS and mortality in older adults (malnourished or at risk). While the treatment effect was modified by some baseline participant characteristics, the treatment also lacked an effect in most subgroups.
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Affiliation(s)
- Judith I van Zwienen-Pot
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, 3015 EK Rotterdam, The Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Lisette C P G M de Groot
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Herlev and Gentofte Hospital, DK-2730 Herlev, Denmark
| | - Ilana Feldblum
- The Daniel Abraham International Center for Health Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 84105, Israel
| | - Inken Jobse
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Floor Neelemaat
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Marian A E de van der Schueren
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands
| | - Danit R Shahar
- The Daniel Abraham International Center for Health Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 84105, Israel
| | - Ellen T H C Smeets
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Amsterdam University of Applied Science, 1067 SM Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
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Towards developing a Core Outcome Set for malnutrition intervention studies in older adults: a scoping review to identify frequently used research outcomes. Eur Geriatr Med 2022; 13:867-879. [PMID: 35278200 PMCID: PMC9378339 DOI: 10.1007/s41999-022-00617-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Purpose
To conduct a scoping review to provide a systematic overview of outcomes used in nutritional intervention studies focused on the treatment of protein-energy malnutrition in older adults.
Methods
A systematic search of four electronic databases (Medline, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) was performed to retrieve randomized controlled trials (RCTs), published until March 9, 2020, that evaluated the effect of nutritional interventions to treat protein-energy malnutrition in older adults and those at risk for malnutrition. Two authors screened titles, abstracts and full texts independently. One author extracted data that were cross-checked by another author.
Results
Sixty-three articles reporting 60 RCTs were identified. Most frequently used outcomes included body weight/body mass index (75.0% of RCTs), dietary intake (61.7%), functional limitations (48.3%), handgrip strength (46.7%), and body circumference (40.0%). The frequencies differed by setting (community, hospital and long-term care). For some outcomes there was a preferred assessment method (e.g., Barthel index for functional limitations), while for other outcomes (e.g., functional performance) a much greater variation was observed.
Conclusion
A large variation in outcomes, not only across but also within settings, was identified in nutritional intervention studies in malnourished older adults and those at risk. Furthermore, for many outcomes there was a large variation in the used assessment method. These results highlight the need for developing a Core Outcome Set for malnutrition intervention studies in older adults to facilitate future meta-analyses that may enhance our understanding on the effectiveness of treatment.
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Oral nutritional supplement use is weakly associated with increased subjective health-related quality of life in malnourished older adults: a multicentre randomised controlled trial. Br J Nutr 2021; 127:103-111. [PMID: 33678201 DOI: 10.1017/s0007114521000805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malnutrition is common among older adults in health-care settings and is associated with decreased quality of life (QoL). The present study aimed to investigate the effect on health-related QoL (HRQoL) among older adults after 6 months of treatment with individual dietary advice (DA) and/or oral nutritional supplements (ONS), utilising 409 patients included in a multicentre randomised controlled trial of patients ≥ 65 years old, stratified according to nutrition status (malnourished/at risk of malnutrition), admitted to hospital in Sweden 2010-2014. Patients were randomised into four arms: DA, ONS, DA + ONS or routine care (control). The intervention started at discharge from hospital, with HRQoL measured using European QoL five-dimension, three-level (EQ-5D-3L) and European QoL-visual analogue scale (EQ-VAS) at baseline and at 6-month, 1-year and 3-year follow-ups. Data were analysed using the Kruskal-Wallis test and multiple linear regression. Overall, HRQoL increased from baseline to follow-ups, although the magnitude of change in EQ-5D-3L did not differ significantly between the four arms in any of the nutrition groups. However, a significant difference was observed for change in EQ-VAS from baseline to 6-month follow-up in the malnourished group, with mean changes of 22·4 and -3·4 points for the ONS and control groups, respectively (P = 0·009). In the multiple linear regression analyses, participants in the ONS arm had 27·5, 34·4 and 38·8 points larger increases in EQ-VAS from baseline to the 6-month (P = 0·011), 1-year (P = 0·007) and 3-year (P = 0·032), respectively, follow-ups than the control group. The use of ONS improved subjectively assessed HRQoL in these malnourished older adults.
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Söderström L, Rosenblad A, Bergkvist L, Frid H, Thors Adolfsson E. Dietary advice and oral nutritional supplements do not increase survival in older malnourished adults: a multicentre randomised controlled trial. Ups J Med Sci 2020; 125:240-249. [PMID: 32362168 PMCID: PMC7721033 DOI: 10.1080/03009734.2020.1751752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 10/25/2022] Open
Abstract
Objectives: The study aimed to investigate the effect on survival after 6 months of treatment involving individual dietary advice and oral nutritional supplements in older malnourished adults after discharge from hospital.Methods: This multicentre randomised controlled trial included 671 patients aged 65 years who were malnourished or at risk of malnutrition when admitted to hospital between 2010 and 2014, and followed up after 8.2 years (median 4.1 years). Patients were randomised to receive dietary advice or oral nutritional supplements, separate or in combination, or routine care. The intervention started at discharge from the hospital and continued for 6 months, with survival being the main outcome measure.Results: During the follow-up period 398 (59.3%) participants died. At follow-up, the survival rates were 36.9% for dietary advice, 42.4% for oral nutritional supplements, 40.2% for dietary advice combined with oral nutritional supplements, and 43.3% for the control group (log-rank test p = 0.762). After stratifying the participants according to nutritional status, survival still did not differ significantly between the treatment arms (log-rank test p = 0.480 and p = 0.298 for the 506 participants at risk of malnutrition and the 165 malnourished participants, respectively).Conclusions: Oral nutritional supplements with or without dietary advice, or dietary advice alone, do not improve the survival of malnourished older adults. These results do not support the routine use of supplements in older malnourished adults, provided that survival is the aim of the treatment.Trial registration: ClinicalTrials.gov with ID: NCT01057914.
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Affiliation(s)
- Lisa Söderström
- Centre for Clinical Research, Region Västmanland, Uppsala University, Västerås, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Andreas Rosenblad
- Department of Statistics, Stockholm University, Stockholm, Sweden
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Leif Bergkvist
- Centre for Clinical Research, Region Västmanland, Uppsala University, Västerås, Sweden
| | - Hanna Frid
- Department of Child and Adolescence Psychiatry, Västmanland Hospital, Västerås, Sweden
| | - Eva Thors Adolfsson
- Centre for Clinical Research, Region Västmanland, Uppsala University, Västerås, Sweden
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A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care. Clin Nutr 2020; 39:654-663. [DOI: 10.1016/j.clnu.2019.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 02/03/2023]
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Volkert D, Visser M, Corish CA, Geisler C, de Groot L, Cruz-Jentoft AJ, Lohrmann C, O'Connor EM, Schindler K, de van der Schueren MAE. Joint action malnutrition in the elderly (MaNuEL) knowledge hub: summary of project findings. Eur Geriatr Med 2019; 11:169-177. [PMID: 32297234 DOI: 10.1007/s41999-019-00264-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub was established to extend scientific knowledge, strengthen evidence-based practice, build a sustainable, transnational network of experts and harmonize research and clinical practice in the field of protein-energy malnutrition in older persons. This paper aims to summarize the main scientific results achieved during the 2-year project and to outline the recommendations derived. METHODS 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand) worked together on 6 relevant domains of malnutrition-i.e. prevalence, screening, determinants, treatment, policy measures and education for health care professionals-making use of existing datasets, evidence and expert knowledge. RESULTS Four systematic reviews, six secondary data analyses of existing cohort and intervention studies, two web-based surveys and one Delphi study were performed. In addition, a scoring system to rate malnutrition screening tools and a theoretical framework on the aetiology of malnutrition in older persons were developed. Based on these activities and taking existing evidence into consideration, 13 clinical practice, 9 research and 4 policy recommendations were developed. The MaNuEL Toolbox was created and made available to effectively distribute and disseminate the MaNuEL results and recommendations. CONCLUSIONS The MaNuEL Knowledge Hub successfully achieved its aims. Results and recommendations will support researchers, healthcare professionals, policy-makers as well as educational institutes to advance their efforts in tackling the increasing problem of protein-energy malnutrition in the older population.
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Affiliation(s)
- D Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany.
| | - M Visser
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C A Corish
- University College Dublin, Dublin, Ireland
| | - C Geisler
- Christian-Albrechts-Universitat, Kiel, Germany
| | - L de Groot
- Wageningen University, Wageningen, The Netherlands
| | | | - C Lohrmann
- Medical University of Graz, Graz, Austria
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10
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Association between separate items of the Mini Nutritional Assessment instrument and mortality among older adults: A prospective cohort study introducing a trimmed MNA version. Clin Nutr 2019; 39:2255-2264. [PMID: 31703950 DOI: 10.1016/j.clnu.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 08/26/2019] [Accepted: 10/07/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS The predictive ability of the separate items of the full Mini Nutritional Assessment (MNA-F) instrument in relation to all-cause mortality (ACM) in older adults is unclear. The present study aimed to examine the magnitudes of the independent associations between separate MNA-F items and ACM among people aged ≥65 years old admitted to hospital. A secondary aim was to construct a trimmed MNA instrument (MNA-T) consisting of MNA-F items that contributed independently to predicting ACM, and compare its predictive ability with that of MNA-F and MNA short forms (MNA-SF). METHODS This prospective cohort study included 1768 individuals aged ≥65 years old admitted to a Swedish hospital who answered MNA-F in 2008. They were followed-up for ACM after two years using national registers. Associations with ACM were calculated using Cox regression analysis. Predictive abilities for ACM were calculated using an R2-type measure. RESULTS After a mean follow-up time of 1.7 years (3006 person-years), 455 (25.7%) participants had died. In adjusted analyses, nine MNA-F items contributed independently to predicting ACM (P < 0.20) and were included in MNA-T. Five items (food intake, independent living, > 3 prescription drugs, fluid intake, self-assessed health status) had significant contributions (P < 0.05). MNA-T had a better predictive ability for ACM than MNA-F and MNA-SF. CONCLUSIONS MNA-F could possibly benefit from excluding less important and more time-consuming items when used for predicting the ultimate consequence of malnutrition, an early death. MNA-T should be a more reliable instrument to use for this purpose.
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11
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Volkert D, Beck AM, Cederholm T, Cereda E, Cruz-Jentoft A, Goisser S, de Groot L, Großhauser F, Kiesswetter E, Norman K, Pourhassan M, Reinders I, Roberts HC, Rolland Y, Schneider SM, Sieber CC, Thiem U, Visser M, Wijnhoven HAH, Wirth R. Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions. J Clin Med 2019; 8:E974. [PMID: 31277488 PMCID: PMC6678789 DOI: 10.3390/jcm8070974] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023] Open
Abstract
Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany.
| | - Anne Marie Beck
- Department Nutrition and Health, University College Copenhagen, 2200 Copenhagen, Denmark
- Herlev and Gentofte University Hospital, 2703 Herlev, Denmark
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, 701 05 Uppsala, Sweden
- Theme Ageing, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Sabine Goisser
- Heidelberg University Centre for Geriatric Medicine and Network Aging Research (NAR), University of Heidelberg, 69126 Heidelberg, Germany
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, 6708 WE Wageningen, The Netherlands
| | - Franz Großhauser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Kristina Norman
- German Institute for Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, 14558 Nuthetal, Germany
- Research Group on Geriatrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Maryam Pourhassan
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Helen C Roberts
- Southampton NIHR Biomedical Research Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Yves Rolland
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse, France
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06200 Nice, France
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, 8401 Winterthur, Switzerland
| | - Ulrich Thiem
- Centre of Geriatrics and Gerontology, Albertinen-Haus, Hamburg, and Chair of Geriatrics and Gerontology, University Medical Centre Eppendorf, 20246 Hamburg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Rainer Wirth
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
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Correa-Pérez A, Abraha I, Cherubini A, Collinson A, Dardevet D, de Groot LCPGM, de van der Schueren MAE, Hebestreit A, Hickson M, Jaramillo-Hidalgo J, Lozano-Montoya I, O'Mahony D, Soiza RL, Visser M, Volkert D, Wolters M, Cruz Jentoft AJ. Efficacy of non-pharmacological interventions to treat malnutrition in older persons: A systematic review and meta-analysis. The SENATOR project ONTOP series and MaNuEL knowledge hub project. Ageing Res Rev 2019; 49:27-48. [PMID: 30391755 DOI: 10.1016/j.arr.2018.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We aimed to perform a review of SRs of non-pharmacological interventions in older patients with well-defined malnutrition using relevant outcomes agreed by a broad panel of experts. METHODS PubMed, Cochrane, EMBASE, and CINHAL databases were searched for SRs. Primary studies from those SRs were included. Quality assessment was undertaken using Cochrane and GRADE criteria. RESULTS Eighteen primary studies from seventeen SRs were included. Eleven RCTs compared oral nutritional supplementation (ONS) with usual care. No beneficial effects of ONS treatment, after performing two meta-analysis in body weight changes (six studies), mean difference: 0.59 (95%CI -0.08, 1.96) kg, and in body mass index changes (two studies), mean difference: 0.31 (95%CI -0.17, 0.79) kg/m2 were found. Neither in MNA scores, muscle strength, activities of daily living, timed Up&Go, quality of life and mortality. Results of other intervention studies (dietary counselling and ONS, ONS combined with exercise, nutrition delivery systems) were inconsistent. The overall quality of the evidence was very low due to risk of bias and small sample size. CONCLUSIONS This review has highlighted the lack of high quality evidence to indicate which interventions are effective in treating malnutrition in older people. High quality research studies are urgently needed in this area.
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Affiliation(s)
- Andrea Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
| | - Iosef Abraha
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, Italian National Research Center on Aging (IRCCS- INRCA), Ancona, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, Italian National Research Center on Aging (IRCCS- INRCA), Ancona, Italy
| | - Avril Collinson
- Institute of Health and Community, University of Plymouth, United Kingdom
| | - Dominique Dardevet
- Université Clermont Auvergne, INRA, UNH, Centre de Recherche en Nutrition Humaine (CRNH), Clermont-Ferrand, France
| | | | - Marian A E de van der Schueren
- Department of Nutrition and health, HAN University of Applied Sciences, Nijmegen, Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS. Bremen, Germany
| | - Mary Hickson
- Institute of Health and Community, University of Plymouth, United Kingdom
| | | | | | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Roy L Soiza
- Department of Medicine for the Elderly, NHS Grampian, Aberdeen, United Kingdom
| | - Marjolein Visser
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Nederlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS. Bremen, Germany
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