Multi-modal intervention improved oral intake in hospitalized patients. A one year follow-up study

Implementation of nutritional care in hospitals: A qualitative study of barriers and facilitators using implementation theory

BACKGROUND

Disease-related malnutrition is prevalent among hospitalised patients, but not all patients achieve the needed nutritional care. At a Danish University Hospital, focus has been on implementing nutritional practices based on clinical guidelines, but there is continuously variation between the wards regarding the quality of nutritional care.

AIM

The aim of this study was to identify the potential barriers and facilitators for implementation of the clinical guidelines for nutritional practices and to recommend suggestions for development of nutritional practices, using a theoretical implementation strategy.

METHOD

The design was a qualitative interview study of employees at a Danish University Hospital, using a semi-structured interview guide. The participants were nurses, nurse's assistant, nurse nutrition expert, head nurse and dieticians. We recruited 11 employees, representing eight different wards.

FINDINGS

The analysis identified six themes: (1) clear allocation of responsibilities and committed management enhances nutrition practices, (2) leadership support is essential, (3) physical settings and tools affect possibilities for action, (4) selection of equivalent staff is core, (5) teaching promotes the knowledge and skills and (6) a dietitian in the ward facilitates implementation of nutritional care. Barriers and facilitators among the themes were identified and has led to suggestions to strengthen nutritional care, based on implementation theory.

CONCLUSION

Various factors were identified as having impact on the implementation of nutrition practices and different suggestions have emerged to accommodate those factors, as well as to apply an implementation strategy to facilitate change in practice.

Prevalence of the use of oral nutritional supplements among acute inpatients at risk of malnutrition and associated patient characteristics

AIM

To provide a snapshot of the current use of oral nutritional supplements, its association with inpatient characteristics, and with a focus on the role of nursing monitoring of food intake and implementing nutritional interventions for patients with low intake.

DESIGN

Retrospective cohort study.

METHODS

The study collected data from a hospital database regarding oral nutritional supplement initiation and variables of patients hospitalised in internal medicine departments, who did not receive enteral or parenteral nutrition.

RESULTS

Of the 5155 admissions, 1087 fulfilled the inclusion criteria (47% female; mean age, 72.4 ± 14.6 years; mean length of stay, 14.6 ± 11.4 days). Sufficient food intake reporting was noted in 74.6% of the patients; of these 17% had decreased intake. Oral nutritional supplements and non-oral nutritional supplements groups did not differ in terms of sex, age, length of stay, Charlson Comorbidity Index, proportion of nursing reports, and absence of intake monitoring. Oral nutritional supplements were initiated in 31.9% of patients with a Malnutrition Universal Screening Tool score ≥2 and in 34.6% with decreased food intake. On multivariable analysis, hypoalbuminemia (adjusted odds ratio, 3.70), decreased food intake (adjusted odds ratio, 3.38), Malnutrition Universal Screening Tool score ≥2 (adjusted odds ratio, 2.10), and age <70 years (adjusted odds ratio, 1.56) were significantly associated with oral nutritional supplements use.

CONCLUSION

The prevalence of oral nutritional intervention was suboptimal in patients at risk of malnutrition during acute hospitalisation, although decreased food intake and Malnutrition Universal Screening Tool score ≥2 independently increased the probability of oral nutritional supplements initiation.

RELEVANCE IN CLINICAL PRACTICE

Understanding the clinical practice and nursing impact of care management in relation to nutritional intervention can assist in reviewing and improving patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT (ADDRESSING): This study informs clinical management and influences nursing practice standards related to assessing, monitoring, and managing malnutrition risk.

IMPACT

The study impacts the quality of care for patients at risk of malnutrition.

REPORTING METHOD

We adhered to the STROBE Checklist for cohort studies.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

"More2Eat" in patients at nutritional risk during hospital stay lowers the risk of three-month mortality

BACKGROUND & AIMS

Malnutrition is a common problem among hospitalized patients due to increased nutrient requirements and reduced food intake or uptake of nutrients. The aim of this prospective cohort study was to investigate the association of nutritional risk status (at or not at risk by NRS-2002) as well as energy and protein intake, use of oral nutritional supplements (ONS) and snack meals in at risk patients during hospitalization and adverse outcomes (length of stay (LOS), readmissions and mortality) at three-months follow-up.

METHODS

Data were collected at baseline and at three-months follow-up in patients hospitalized at 31 units at a Danish University Hospital. Diet records were performed at baseline by using the nurses' quartile nutrition recording methods. Data about disease and clinical outcomes were collected from electronic medical records at baseline and three-months follow-up.

RESULTS

A total of 318 patients were included. Patients at nutritional risk (n = 149, 47%) had higher risk of longer LOS (≥20 days (OR = 4.24 [1.81;9.95] and ≥30 days OR = 2.50 [1.22;5.14])), having one readmission (OR = 1.86 [1.15;3.01]) and death (OR = 2.56 [1.27;5.20]) compared to patients not at nutritional risk (n = 169, 53%). A longer LOS was associated with patients who achieved ≥75% of energy and protein requirements, consumed snack meals incl. and excl. oral nutritional supplements. Readmissions in patients at nutritional risk during the three-months were not associated with food intake during the index hospitalization. Mortality was observed in 43 of the 318 (13.5%) hospitalized patients. A lower mortality was associated with increased energy and protein intake in patients at nutritional risk.

CONCLUSIONS

The results of this study indicate a longer LOS, higher readmission rate and increased mortality in patients at nutritional risk compared to patients not at risk. Patients at nutritional risk had lower risk of three-month mortality and longer LOS during index hospitalization with increased energy and protein intake. Readmissions in patients at nutritional risk were not affected by food intake. The association of nutritional risk with poorer outcomes indicates that good nutritional care including constant attention to food-intake during hospitalization can be beneficial regarding mortality.

Are nutritional sufficiency of ≥75% energy and protein requirements relevant targets in patients at nutritional risk? - A one month follow-up study

BACKGROUND & AIM

Nutrient intake in patients at nutritional risk was recorded with the aim of reaching at least 75% of estimated requirements for energy and protein. However, the cutoff at 75% has only been sparsely investigated. The aim of this study was to re-evaluate the 75% cutoff of estimated energy and protein requirements among patients at or not at nutritional risk in relation to 30-day mortality and readmissions.

METHODS

A 30-day follow-up study was performed among hospitalized patients in 31 units at a Danish University Hospital. Data was collected using the nurses' quartile nutrition registration method and electronic patient journals. All patients were screened using the NRS-2002 and classified as either at nutritional risk (NRS-2002, score ≥3) or not at nutritional risk (NRS-2002, score <3). Energy and protein requirements were estimated using weighted Harris-Benedict equation and 1.3 g/kg/day, respectively.

RESULTS

In total, 318 patients were included in this study. Patients at nutritional risk were older, lower BMI, male, more comorbidities and a longer primary length of stay compared to patients not at nutritional risk (p < 0.05). After 30-day follow-up, mortality was higher among patients at risk (9.5% vs. 2.0%, p < 0.05). Patients at nutritional risk showed increased risk of mortality if they did not achieve 75% of estimated requirements (energy: OR = 8.08 [1.78; 36.79]; protein: OR = 3.40 [0.74; 15:53]). Furthermore, predicted probability of mortality decreased with increased energy and protein intakes. No significant associations were found for readmissions achieving 75% of estimated energy or protein requirements. A cutoff of 76-81% for energy and 58-62% for protein was equivalent with accepting a 6-8% mortality rate.

CONCLUSION

The results of this study indicate that an energy intake ≥75% of estimated requirement among patients at nutritional risk has a preventative effect regarding mortality within one month, but not for readmissions.

Can hospitalized patients adequately estimate their own food intake? A cross-sectional pilot study

ABSTRACT Objective To assess and identify factors linked to the accuracy of patients’ food intake estimations through a self-monitoring instrument filled in by the patient. Methods This cross-sectional study approached adult hospital patients subjected to regular or therapeutic diets. The actual food intake percentage was obtained by the ratio between the actual food intake and the amount of food served x 100. Patients had to complete a food chart including 9 circles representing plates of food in percentages (increasing scale of 12.5%) to represent their food intake at lunch and/or dinner. The Bland-Altman method assessed the agreement between the actual and the estimated values. The associations between variables (age, sex, hospitalization day, diet prescription, amount of food served and actual food intake percentage) and the accuracy of the food intake estimation (adequate ±10%, overestimated and underestimated) were evaluated through univariate multinomial logistic regression. Results Ninety-six patients were evaluated (51.0% male; 44.0±15.8 years of age). The Bland-Altman analysis showed good agreement between the actual and the estimated food intake. The actual food intake percentage was the only variable associated with the accuracy of the food intake estimation. Conclusion Most patients (~70%) adequately estimated their food intake using the 9-point food chart tested. Furthermore, the only factor linked to the accuracy of the food intake estimation was the actual food-intake percentage. These findings provide preliminary support for the usefulness of this instrument. However, it must be tested in a representative sample of hospitalized patients.

Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review

This review aims to identify hospital food service strategies to improve food consumption among hospitalized patients. A systematic search that met the inclusion and exclusion criteria was manually conducted through Web of Science and Scopus by an author, and the ambiguities were clarified by two senior authors. The quality assessment was separately conducted by two authors, and the ambiguities were clarified with all the involved authors. Qualitative synthesis was used to analyze and summarized the findings. A total of 2432 articles were identified by searching the databases, and 36 studies were included. The majority of the studies applied menu modifications and meal composition interventions (n = 12, 33.3%), or included the implementation of the new food service system (n = 8, 22.2%), protected mealtimes, mealtime assistance and environmental intervention (n = 7, 19.4%), and attractive meal presentation (n = 3, 8.3%). Previous studies that used multidisciplinary approaches reported a significant improvement in food intake, nutritional status, patient satisfaction and quality of life (n = 6, 16.7%). In conclusion, it is suggested that healthcare institutions consider applying one or more of the listed intervention strategies to enhance their foodservice operation in the future.

Poor performance in nutrition risk screening may have serious consequences for hospitalized patients

BACKGROUND AND AIM

Finding patients at nutrition risk and securing sufficient nutritional intake, is vital to decrease risk of adverse outcomes and all-cause mortality. The aims of this study were therefore to investigate the prevalence of patients being screened for nutrition risk, to determine nutritional coverage in at-risk patients and assess the prevalence of readmissions and mortality within 30 days.

METHODS

A one-day cross-sectional study was performed at Herlev Hospital, Denmark in June 2019. Patients >18 y and hospitalized for ≥4 days were enrolled. Exclusion criteria were admission to the intensive, palliative, acute medical or maternal ward. If a patient was not screened by the ward a clinical dietitian screened the patient. Patients found to be at nutrition-risk underwent a 24-h dietary recall to assess energy and protein intake. Data on length of stay, readmissions, and mortality within 30 days were collected from the hospital patient register.

RESULTS

In total 197 (F:52%) patients were included. Median (IQR) age 74y (65-81). At the audit day n = 76 (39%) had a primary screening, and n = 42 (21%) were screened within 24 h. A NRS-2002-score ≥ 3 was found in 111 patients (63%). At-risk patients were more likely to be readmitted within 30 days (45% vs. 27%, p = 0.024) and had a higher mortality within 30 days after discharge (23% vs. 10%., p = 0.0285). In patients at nutrition risk 23% covered ≥75% of their energy- and protein requirement the last 24 h. More patients covered their energy- and protein-need if they were supplemented with enteral and/or parenteral nutrition fully or partly (63% vs. 15%, p < 0.001 or had been in contact with a clinical dietitian during the admission (33% vs. 15%, p = 0.0337. There were no differences in prevalence of readmissions and mortality between those patients at nutrition risk, who covered their energy and protein need and those who did not.

CONCLUSIONS

The results demonstrate that the current nutritional care process is inadequate and may have serious consequences for hospitalized patients. Further effort is needed on the awareness of screening patients and how to fulfil their requirements during hospitalization. An abstract with part of the results has been accepted as a poster to ESPEN 2020.

Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals

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.

Unintended weight loss in hematology outpatients - Work to do

BACKGROUND

Malnutrition frequently occurs in hematology diseases and may threaten the course of treatment and patient outcomes. While screening for nutritional risk is often done in hospitalized patients, it is rarely described in the outpatient setting. Hematology patients are often followed in outpatient settings before hospitalization and for a longer time after.

AIMS

The primary aim of this study was to investigate the prevalence of nutritional risk measured by unintended weight loss within three months and reduced food intake within one week among patients in a hematology outpatient clinic. The second purpose was to investigate the two variables as a quick initial screening tool.

METHODS

All patients visiting the outpatient clinic within one week were invited to participate in this study, designed as a questionnaire-based cross-sectional study, consisting of nine questions. Descriptive statistical analyses, chi² test and simple logistic regression analyses were performed.

RESULTS

Of the 219 included patients, 23.7% had an unintended weight loss of mean 13.7% of body weight within the last three months and 13.2% had eaten less than usual within the past week. Patients who had significantly increased odds for unintended weight loss were >80 years of age [CI95%: 1274; 6084], patients visiting for examinations [CI95%: 1.105; 7.227], patients visiting for treatment [CI95%: 1.383; 6598] and patients visiting as part of a course of investigations [CI95%: 1.112; 34.184] as well as patients who had eaten less [CI95%: 2.731; 14.224]. Patients visiting the outpatient clinic for examination had significantly increased odds of having eaten less [CI95%: 1.783; 14.629].

CONCLUSIONS

Based on the statistical analyses, almost one fourth of the patients had a significant unintended weight loss, about 15% had reduced food intake and only 7.8% had both unintended weight loss and reduced food intake. These results indicate that unintended weight loss can be used as a quick screening tool to identify and detect patients at risk of malnutrition and that guidelines should be drawn up for managing patients at nutritional risk in hematology outpatient clinics.

Protein and energy intake improved by in-between meals: An intervention study in hospitalized patients

BACKGROUND/AIM

Disease related malnutrition is a major problem in hospitals. Malnutrition in hospitalized patients is caused by many factors. Among these factors are decreased appetite and early satiety, and reaching nutritional requirements in nutritional risk patients is a challenge when using ordinary energy and protein dense food. The aim of this study was to examine if total protein and energy intake in medical and surgical patients at nutritional risk could be improved by protein fortified and energy rich in-between meals.

METHODS

An assortment of fortified in-between meals including 10 g of protein was developed based on patient preferences and served in the Departments of Lung Medicine and Abdominal Surgery for a period of three months. Nutrition intake was recorded before and after intervention.

RESULTS

Food intake records were collected from a total of 92 patients, (46 before and 46 after intervention). The total amount of protein intake per in-between meal was increased from 2,6 g to 10,3 g. Total daily protein intake increased from 49% to 88% (p < 0.00) and total energy intake from 74% to 109% (p < 0.00) of requirements.

CONCLUSION

Protein and energy intake for surgical and medical patients at in-between meals as well as total daily intake increased significantly. Recommended average level for individually measured requirements was reached.

Improving the nutritional intake of hospital patients: how far have we come? A re-audit

BACKGROUND

Malnutrition affects up to 33.6% of hospitalised patients, with consequences that are detrimental for both patients and healthcare providers. In 2015, an audit demonstrated inadequate nutritional provision and consumption by hospitalised patients, comprising a major risk factor for malnutrition. This re-audit evaluates whether patients are meeting recommended energy and protein standards and estimated individual requirements, subsequent to food service improvements since 2015.

METHODS

Patients (n = 111) were included from a South West hospital, and Malnutrition Universal Screening Tool scores (MUST) categorised patients as 'nutritionally well' (MUST 0) or 'nutritionally vulnerable' (MUST ≥ 1). Individual energy and protein requirements were estimated using weight-based equations. Nutritional intakes were assessed via 24-h dietary recall and compared against the British Dietetic Association's Nutrition and Hydration Digest standards, as well as estimated individual requirements.

RESULTS

In total, the Digest standards for energy and protein were met by 35% and 63% of patients respectively, which is an increase of 19% and 36% since 2015. 'Nutritionally well' patients were more likely to meet nutrient standards for protein (62%) than estimated individual requirements (30%) (P ≤ 0.001). 'Nutritionally vulnerable' patients were more likely to meet estimated individual requirements for energy (60%) than the Digest standards (30%) (P = 0.047).

CONCLUSIONS

The proportion of patients meeting the Digest standards has increased considerably following numerous food service changes. Nutritional training for housekeepers, energy/protein-dense snacks and drinks, and fortified dietary items may further increase nutritional intakes. Additionally, as a result of discrepancies between the Digest standards and individual estimated requirements, more research is required to identify the most appropriate auditing standards that reflect best practice.

Improving the standard of nutrition care in hospital: Mealtime barriers reduced with implementation of the Integrated Nutrition Pathway for Acute Care

BACKGROUND

Poor food intake is common in hospital patients and is associated with adverse patient and healthcare outcomes; diverse mealtime barriers to intake often undermine clinical nutrition care.

AIM

This study determines whether implementation of locally adaptable nutrition care activities as part of uptake of the Integrated Nutrition Pathway for Acute Care (INPAC) reduced mealtime barriers and improved other patient outcomes (e.g. length of stay; LOS) when considering other covariates.

METHODS

1250 medical patients from 5 Canadian hospitals were recruited for this before-after time series design. Mealtime barriers were tallied with the Mealtime Audit Tool after a meal, while proportion of the meal consumed was assessed with the My Meal Intake Tool. Implementation of new standard care activities occurred over 12 months and three periods (pre-, early, and late) of implementation were compared. Regression analyses determined the effect of time period while adjusting for key covariates.

RESULTS

Mealtime barriers were reduced over time periods (Period 1 = 2.5 S.D. 2.1; Period 3 = 1.8 S.D. 1.7) and site differences were noted. This decrease was statistically significant in regression analyses (-0.28 per time period; 95% CI -0.44, -0.11). Within and across site changes were also observed over time in meal intake and LOS; however, after adjusting for covariates, time period of implementation was not significantly associated with these outcomes.

DISCUSSION

Mealtime barriers can be reduced and sustained by implementing improved standard care procedures for patients. The More-2-Eat study provides an example of how to implement changes in practice to support the prevention and treatment of malnutrition.

TRIAL REGISTRATION

Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.

Long-term effects of a computer-based nutritional training program for inpatient hospital care

RATIONALE

A previous short-term study showed that a computer-based training in eating and nutrition increased the probability for hospital inpatients at undernutrition (UN) risk to receive nutritional treatment and care without increasing overtreatment (providing nutritional treatment to those not at UN risk). The aim of this study was to investigate if a computer-based training in eating and nutrition influences the precision in nutritional treatment and care in a longer-term perspective.

METHOD

A preintervention and postintervention study was conducted with a cross-sectional design at each time points (baseline and 7 months postintervention). Hospital inpatients >18 years old at baseline (2013; n = 201) and follow-up (2014; n = 209) were included. A computer-based training was implemented during a period of 3 months with 297 (84%) participating registered nurses and nurse assistants. Undernutrition risk was screened for using the minimal eating observation and nutrition form-version II. Nutritional treatment and care was recorded using a standardized protocol.

RESULTS

The share of patients at UN risk that received energy-dense food (+25.2%) and dietician consultations (+22.3%) increased between baseline and follow-up, while fewer received oral nutritional supplements (-18.9%). "Overtreatment" (providing nutritional treatment to those not at UN risk) did not change between baseline and follow-up.

CONCLUSION

The computer-based training increased the provision of energy-dense food and dietician consultations to patients at UN risk without increasing overtreatment of patients without UN risk.

Short-term effects of a computer-based nutritional nursing training program for inpatient hospital care

RATIONALE

This study aimed to explore whether a computer-based training in eating and nutrition for hospital nursing staff can influence the precision in nutritional treatment and care.

METHOD

A pre-intervention and post-intervention study was conducted with a cross-sectional design at each time point. The settings were one intervention (IH) and two control hospitals (CH1 and CH2). Hospital inpatients >18 years old at baseline (2012; n = 409) and follow-up (2014; n = 456) were included. The computer-based training was implemented during a period of 3 months in the IH with 297 (84%) participating registered nurses and nurse assistants. Nutritional risk was screened for using the Minimal Eating Observation and Nutrition Form. Nutritional treatment and care was recorded using a standardized protocol

RESULTS

In the IH, there was an increase in the share of patients at UN risk that received energy-dense food (+16.7%) and dietician consultations (+17.3%) between baseline and follow-up, while fewer received feeding assistance (-16.2%). There was an increase in the share of patients at UN risk that received energy-dense food (+19.5%), a decrease in oral nutritional supplements (-30.5%) and food-registrations (-30.6%) in CH1, whereas there were no changes in CH2. 'Overtreatment' (providing nutritional treatment to those not at UN risk) was significantly higher in CH2 (52.7%) than in CH1 (14.3%) and in the IH (25.2%) at follow-up.

CONCLUSION

The computer-based training seemed to increase the probability for patients at UN risk in the IH to receive nutritional treatment without increasing overtreatment.

ESPEN guidelines on definitions and terminology of clinical nutrition

BACKGROUND

A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.

OBJECTIVE

This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.

METHODS

The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.

RESULTS

Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.

CONCLUSION

An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.

Optimizing protein and energy intake in hospitals by improving individualized meal serving, hosting and the eating environment

OBJECTIVE

Optimizing protein and energy intake by food in nutritional risk patients is difficult. The aim of this study was to improve the ≥75% of energy and protein requirements. We would like to see nurses take on the role of hosting the nutritional-risk patients, including focusing on bringing nutrition to the forefront in the collaboration between nurses and patients.

METHODS

This was an interventional study that included patients admitted to the Departments of Infectious Diseases, Hematology, and Heart-Lung Surgery in a baseline and follow-up investigation. It included 24-h food intake registrations (FRs) for 3 d consecutively, a questionnaire, and a semistructured patient interview. The interventions included in this study helped to improve the eating environment and serving, integrated nutrition into the nurse-patient welcome interview, and targeted individual preferences and challenges for eating.

RESULTS

The study comprised 76 24-h FRs at baseline and 108 FRs at follow-up. The total group had improved food intake; 75% of individual energy requirements were met by (67.6% vs. 40%; P = 0.036) and the Heart-Lung Surgery group (85.7 vs. 38.5; P = 0.036). This was not reflected for protein (NS). Energy intake improved for the entire group, albeit not significantly (P = 0.862). Patients reported being happy with the interventions regarding individualized food serving, nurse communication, and improved meal environments.

CONCLUSION

Only insignificant improvements to overall energy intake were seen in two of the three departments and in the overall group, and no statistical or clinically significant improvements to protein intake were observed. The relative risk of meeting 75% of energy requirements was improved in the overall group and in patients in the Department of Heart-Lung Surgery. This did not include the meeting of protein requirements. Improvements were welcomed by patients and staff. Focus on individualized nutrition from the nursing staff also improved.

Protein and energy intake improved by breakfast intervention in hospital

BACKGROUND/AIM

Undernutrition affects about 40% of patients in hospitals. Ordinary food is recommended as the first choice to prevent and correct undernutrition. Meanwhile, sufficient intake, especially regarding protein, is difficult to reach, in patients at nutritional risk. The aim of this study was to improve protein intake at breakfast to at least 20% of total daily requirement or at least 20 g.

METHODS

A protein rich breakfast including 20 g of protein was served in the departments of heart and lung surgery and vascular surgery for three months. Nutrition intake was registered before and after intervention.

RESULTS

Food intake records were collected from 32 and 30 patients respectively, mean age 69 (SD 8) years. At breakfast, protein intake was improved from 14% of individual requirements to 22% (p<0.001) and energy intake was improved from 18% to 25% (p=0.01). Total amount of protein intake for breakfast was increased from 14 g to 20 g (p<0.002). Total daily protein intake increased from 64% to 77% (p=0.05) and total energy intake from 76% to 99% (p<0.01) of requirements.

CONCLUSION

Protein and energy intake for surgical patients at breakfast as well as total daily intake was significantly increased to meet recommended average level for minimum individually measured requirements.