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Wong A, Huang Y, Banks MD, Sowa PM, Bauer JD. A Cost-Consequence Analysis of Nutritional Interventions Used in Hospital Settings for Older Adults with or at Risk of Malnutrition. Healthcare (Basel) 2024; 12:1041. [PMID: 38786451 PMCID: PMC11120964 DOI: 10.3390/healthcare12101041] [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: 03/30/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Malnutrition is a significant and prevalent issue in hospital settings, associated with increased morbidity and mortality, longer hospital stays, higher readmission rates, and greater healthcare costs. Despite the potential impact of nutritional interventions on patient outcomes, there is a paucity of research focusing on their economic evaluation in the hospital setting. This study aims to fill this gap by conducting a cost-consequence analysis (CCA) of nutritional interventions targeting malnutrition in the hospital setting. METHODS We performed a CCA using data from recent systematic reviews and meta-analyses, focusing on older adult patients with or at risk of malnutrition in the hospital setting. The analysis included outcomes such as 30-day, 6-month, and 12-month mortality; 30-day and 6-month readmissions; hospital complications; length of stay; and disability-adjusted life years (DALYs). Sensitivity analyses were conducted to evaluate the impact of varying success rates in treating malnutrition and the proportions of malnourished patients seen by dietitians in SingHealth institutions. RESULTS The CCA indicated that 28.15 DALYs were averted across three SingHealth institutions due to the successful treatment or prevention of malnutrition by dietitians from 1 April 2021 to 31 March 2022, for an estimated 45,000 patients. The sensitivity analyses showed that the total DALYs averted ranged from 21.98 (53% success rate) to 40.03 (100% of malnourished patients seen by dietitians). The cost of implementing a complex nutritional intervention was USD 218.72 (USD 104.59, USD 478.40) per patient during hospitalization, with additional costs of USD 814.27 (USD 397.69, USD 1212.74) when the intervention was extended for three months post-discharge and USD 638.77 (USD 602.05, USD 1185.90) for concurrent therapy or exercise interventions. CONCLUSION Nutritional interventions targeting malnutrition in hospital settings can have significant clinical and economic benefits. The CCA provides valuable insights into the costs and outcomes associated with these interventions, helping healthcare providers and policymakers to make informed decisions on resource allocation and intervention prioritization.
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Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, Singapore 529889, Singapore
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Yingxiao Huang
- Department of Dietetics, Changi General Hospital, Singapore 529889, Singapore
| | - Merrilyn D. Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
| | - P. Marcin Sowa
- Centre for the Business and Economics of Health, University of Queensland, St Lucia, QLD 4067, Australia
| | - Judy D. Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3168, Australia;
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Amiri Khosroshahi R, Barkhordar M, Talebi S, Imani H, Sadeghi E, Mousavi SA, Mohammadi H. The impact of malnutrition on mortality and complications of hematopoietic stem cell transplantation in patients with acute leukemia. Clin Nutr 2023; 42:2520-2527. [PMID: 37925779 DOI: 10.1016/j.clnu.2023.10.018] [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: 06/04/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND & AIMS Malnutrition is common in hematopoietic stem cell transplantation (HSCT) patients. However, there are few studies on the association between malnutrition and post-transplant outcomes, with inconsistent results. No standard screening tool has been established for malnutrition in these patients. Previous research suggests the Global Leadership Initiative on Malnutrition (GLIM) criteria is effective in predicting outcomes in other cancers. This study investigates the link between malnutrition based on the GLIM criteria with mortality and complications following allogeneic HSCT. METHODS This single-center, observational, longitudinal, and prospective study of 98 adult leukemia patients at the Hematology Center of Shariati Hospital in Tehran, Iran, monitored patients before transplantation until 100 days after the procedure, focusing on overall survival and mortality as a primary outcome, and secondary endpoints including oral mucositis, acute GVHD, infection during hospitalization, and readmission rates. RESULTS This study involved 98 allogeneic HSCT patients with a median age of 38 years old, 64.3 % with acute myeloid leukemia (AML), and 35.7 % with acute lymphoblastic leukemia (ALL). Among them, 26.5 % were categorized as malnourished based on GLIM criteria. During 100 days of follow-up, 13 patients died, but there was no significant difference in overall survival and mortality between malnourished and well-nourished patients. Malnourished patients demonstrated a noticeable upward trend in the incidence of oral mucositis, hospital readmission, and infection during their hospitalization. It is important to highlight that although this observed trend is discernible, it did not attain statistical significance in statistical analyses (P > 0.05). CONCLUSION The current study determined that, when assessed using the GLIM criteria, malnutrition did not exert a statistically significant influence on survival, mortality, or complications within the specified age range of 18-55 years, underscoring its limited impact on this cohort of younger patients.
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Affiliation(s)
- Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Barkhordar
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sadeghi
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Asadollah Mousavi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Global, Regional, and National Burden of Protein–Energy Malnutrition: A Systematic Analysis for the Global Burden of Disease Study. Nutrients 2022; 14:nu14132592. [PMID: 35807772 PMCID: PMC9268010 DOI: 10.3390/nu14132592] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Statistical data on the prevalence, mortality, and disability-adjusted life years (DALYs) of protein–energy malnutrition are valuable for health resource planning and policy-making. We aimed to estimate protein–energy malnutrition burdens worldwide according to gender, age, and sociodemographic index (SDI) between 1990 and 2019. Methods: Detailed data on protein–energy malnutrition from 1990 to 2019 was extracted from the Global Burden of Disease (GBD) database. The global prevalence, deaths, and DALYs attributable to protein–energy malnutrition and the corresponding age-standardized rates (ASRs) were analyzed. Results: In 2019, the global prevalence of protein–energy malnutrition increased to 14,767,275 cases. The age-standardized prevalence rate (ASPR) showed an increasing trend between 1990 and 2019, while the age-standardized deaths rate (ASDR) and age-standardized DALYs rate presented a significantly decreasing trend in the same period. Meanwhile, there was a clearly ASPR, ASDR, and age-standardized DALYs rate downtrend of the prediction curve when the SDI went up. Conclusions: PEM still has a relatively serious disease burden in the world, especially in children and the elderly. At the same time, this phenomenon will be more obvious due to the aging of the world’s population. Effective prevention measures should be strengthened to continuously improve public health conditions.
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Asemota IR, Shaka H, Akuna E, Edigin E, Adeoti O. Effect of Malnutrition on Outcomes of Patients Hospitalized for Implantable Cardioverter-Defibrillator Implantation. Heart Rhythm 2022; 19:858-859. [PMID: 35017114 DOI: 10.1016/j.hrthm.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Iriagbonse Rotimi Asemota
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, 1950 West Polk Street, Chicago IL, USA 60612
| | - Hafeez Shaka
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, 1950 West Polk Street, Chicago IL, USA 60612
| | - Emmanuel Akuna
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, 1950 West Polk Street, Chicago IL, USA 60612
| | - Ehizogie Edigin
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, 1950 West Polk Street, Chicago IL, USA 60612
| | - Oluwatomi Adeoti
- Department of Medicine, Boston Medical Center, 72 East Concord Street, Evans 124, Boston MA, USA 02118; Boston University School of Medicine, 72 East Concord Street, Evans 124, Boston MA, USA 02118
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Inciong JFB, Chaudhary A, Hsu HS, Joshi R, Seo JM, Trung LV, Ungpinitpong W, Usman N, Pradelli L, Omaralsaleh AJ. Economic burden of hospital malnutrition: A cost-of-illness model. Clin Nutr ESPEN 2022; 48:342-350. [DOI: 10.1016/j.clnesp.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
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Ruiz-García I, Contreras-Bolívar V, Sánchez-Torralvo FJ, Ulloa-Díaz O, Ruiz-Vico M, Abuín-Fernández J, Barrios-García M, Alba-Conejo E, Olveira G. The economic cost of not coding disease-related malnutrition: A study in cancer inpatients. Clin Nutr 2021; 41:186-191. [PMID: 34891021 DOI: 10.1016/j.clnu.2021.11.028] [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: 08/02/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Disease-related malnutrition (DRM) coding rate is usually low in hospitalised patients. The objective of our study was to estimate the percentage of correct DRM coding in cancer inpatients and to calculate the economic losses caused by such lack of coding. METHODS This was an observational, prospective study that was conducted in patients hospitalised in the Medical Oncology Unit of our hospital. A nutritional assessment was performed through subjective global assessment (SGA). The all patient refined-diagnosis related group (APR-DRG) weights were obtained at the moment of discharge; moreover, recalculation was done after including the diagnosis of malnutrition in the medical record of those patients in whom it had not been initially coded. The associated cost reimbursement were calculated based on the weight before and after revising the diagnosis of DRM. RESULTS A total of 266 patients were evaluated. From them, 220 (82.7%) suffered from DRM according to the SGA. In 137 (51.5%) of these patients, diagnosis was coded, as opposed to 83 (31.2%) cases (33 subjects with moderate and 50 with severe DRM) in whom it was not coded. The sum of the APR-DRG weights before revising the diagnosis of malnutrition was 343.4 points (mean: 1.29 ± 0.89). Whereas, after revising the diagnosis, it increased up to 384.3 (1.44 ± 0.96). The total cost reimbursement for the hospital before revising the diagnosis of malnutrition was 1,607,861.21€ and after revision it increased up to 1,799,199.69€, which means that 191,338.48€ were not reimbursed to the hospital due to the lack of coding of malnutrition. The cost reimbursement for each admission increased an average of 719.32€. CONCLUSION The prevalence of DRM in cancer inpatients is high. Nevertheless, the diagnosis is not coded in one third of patients, which results in important economic losses for the hospitals.
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Affiliation(s)
- Ignacio Ruiz-García
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain.
| | - Victoria Contreras-Bolívar
- Servicio de Endocrinología y Nutrición, Hospital Universitario San Cecilio de Granada, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), Granada, Spain.
| | - Francisco José Sánchez-Torralvo
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain.
| | - Osmayda Ulloa-Díaz
- Servicio de Documentación y Archivo de Historias Clínicas Del Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - María Ruiz-Vico
- Universidad de Málaga, Málaga, Spain; Servicio de Oncología Médica, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - José Abuín-Fernández
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain.
| | - Manuel Barrios-García
- Servicio de Hematología y Hemoterapia, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Emilio Alba-Conejo
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain; Servicio de Oncología Médica, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Gabriel Olveira
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain; CIBERDEM (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas), Instituto de Salud Carlos III, Madrid, Spain.
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Wong A, Huang Y, Sowa PM, Banks MD, Bauer JD. Adult malnutrition, nutritional interventions and outcomes in Singapore: a scoping review of local studies for the past 20 years. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/2010105820964829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There is currently no review published on the prevalence and incidence of malnutrition in Singapore across various populations, or what interventions or policies are in place for preventing/treating malnutrition. Objectives: This review aims to determine the: (a) incidence and prevalence of malnutrition in the community, and in acute, intermediate and long-term care facilities; (b) interventions implemented for screening, assessing and treating/preventing malnutrition; (c) specific clinical populations investigated for malnutrition or nutritional therapy; and (d) implications of malnutrition and effectiveness of treating malnutrition or using nutritional therapy in Singapore. Methods: A structured search strategy was applied to available electronic databases (MEDLINE/PubMed, EMBASE, CINAHL, the Cochrane Library and Google Scholar) using selected search terms, with additional reports and grey literature identified using iterative searches. Results: Forty-two articles were found, with the majority of research performed in the community and acute care settings. Malnutrition screening and assessment is the most common nutritional research performed in Singapore. Approximately 14.7% to 65.0% of acute care and 2.8% to 31.5% of community populations are found to be malnourished. Limited interventional and economic-related studies are available. Conclusion: Malnutrition rates in Singapore appear to be similar to other developed countries. Future studies will need to focus on nutritional intervention, cost-effectiveness analyses and specific populations such as the underprivileged, chronically ill and those dependent on nutritional support.
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Affiliation(s)
- Alvin Wong
- Department of Dietetic and Food Services, Changi General Hospital, Singapore
- School of Human Movement and Nutrition Sciences, University of Queensland, Australia
| | - Yingxiao Huang
- Department of Dietetic and Food Services, Changi General Hospital, Singapore
| | - Przemyslaw M Sowa
- Centre for the Business and Economics of Health, University of Queensland, Australia
| | - Merrilyn D Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Australia
| | - Judith D Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Australia
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CT-Determined Sarcopenia in GLIM-Defined Malnutrition and Prediction of 6-Month Mortality in Cancer Inpatients. Nutrients 2021; 13:nu13082647. [PMID: 34444806 PMCID: PMC8398807 DOI: 10.3390/nu13082647] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023] Open
Abstract
Our objective was to evaluate the clinical application of third lumbar vertebra (L3)-computer tomography (CT)-determined sarcopenia as a marker of muscle mass in cancer inpatients diagnosed with malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and to establish its association with 6-month mortality. Methods: This was an observational, prospective study in patients from an inpatient oncology unit. We performed a nutritional assessment according to GLIM criteria, including muscle cross-sectional area at L3 by CT and skeletal muscle index (SMI). Six-month mortality was evaluated. Results: A total of 208 patients were included. The skeletal muscle cross-sectional area at L3 was 136.2 ± 32.5 cm2 in men and 98.1 ± 21.2 cm2 in women. The SMI was 47.4 ± 12.3 cm2/m2 in men and 38.7 ± 8.3 cm2/m2 in women. Sarcopenia (low SMI) was detected in 59.6% of the subjects. Using SMI as a marker of low muscle mass in application of GLIM criteria, we found 183 (87.9%) malnourished patients. There were 104 deaths (50%) at 6 months. The deceased patients had a lower skeletal muscle cross-sectional area (112.9 ± 27.9 vs. 126.1 ± 37.8 cm2; p = 0.003) and a lower SMI (41.3 ± 9.5 vs. 45.7 ± 12.9 cm2/m2; p = 0.006). An increased risk of 6-month mortality was found in malnourished patients according to GLIM criteria using SMI (HR 2.47; 95% confidence interval 1.07–5.68; p = 0.033). Conclusions: Low muscle mass, assessed by L3-CT, was observed to affect more than half of cancer inpatients. The deceased patients at 6 months had a lower skeletal muscle cross-sectional area and SMI. Malnutrition according to GLIM criteria using CT-determined sarcopenia was shown to adequately predict 6-month mortality.
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Impact of musculoskeletal degradation on cancer outcomes and strategies for management in clinical practice. Proc Nutr Soc 2020; 80:73-91. [PMID: 32981540 DOI: 10.1017/s0029665120007855] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The prevalence of malnutrition in patients with cancer is one of the highest of all patient groups. Weight loss (WL) is a frequent manifestation of malnutrition in cancer and several large-scale studies have reported that involuntary WL affects 50-80% of patients with cancer, with the degree of WL dependent on tumour site, type and stage of disease. The study of body composition in oncology using computed tomography has unearthed the importance of both low muscle mass (sarcopenia) and low muscle attenuation as important prognostic indications of unfavourable outcomes including poorer tolerance to chemotherapy; significant deterioration in performance status and quality of life (QoL), poorer post-operative outcomes and shortened survival. While often hidden by excess fat and high BMI, muscle abnormalities are highly prevalent in patients with cancer (ranging from 10 to 90%). Early screening to identify individuals with sarcopenia and decreased muscle quality would allow for earlier multimodal interventions to attenuate adverse body compositional changes. Multimodal therapies (combining nutritional counselling, exercise and anti-inflammatory drugs) are currently the focus of randomised trials to examine if this approach can provide a sufficient stimulus to prevent or slow the cascade of tissue wasting and if this then impacts on outcomes in a positive manner. This review will focus on the aetiology of musculoskeletal degradation in cancer; the impact of sarcopenia on chemotherapy tolerance, post-operative complications, QoL and survival; and outline current strategies for attenuation of muscle loss in clinical practice.
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Wong A, Goh QL, Goh SN, Sowa PM, Banks MD, Bauer JD. Medical Nutrition Reimbursement in Singapore: Who Are the Patients Receiving MediFund Assistance? An Audit of Clinical Outcomes and Issues Pertaining to Reimbursement in a Public Hospital in Singapore. JPEN J Parenter Enteral Nutr 2020; 45:1532-1541. [PMID: 33128464 DOI: 10.1002/jpen.2043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Financial reimbursement (MediFund) of medical nutrition products (MNPs) was recently implemented in some of the public hospitals in Singapore for patients with financial difficulties. This study aimed to investigate the sustainability of this policy and the benefits conferred. METHODS We performed a 1-year retrospective audit of patients in a tertiary hospital who received MediFund. Demographics, presupport and postsupport clinical outcomes, and cost of support were determined and analyzed. RESULTS A total of 129 patients received MediFund for MNPs. The median length of financial support was 115 days (interquartile range, 37-269). Overall, body mass index increased after nutrition support (20.9 ± 5.1 vs 20.4 ± 5.3; P = .012). There was a significant decrease in the number of malnourished patients (final, 55.1% vs initial, 86.8%; P < .001) and a significant increase in 7-point subjective global assessment scores (final, 4.9 ± 1.3 vs initial, 4.1 ± 1.3; P < .001) after MNP support. MNP adherence was high for 88.5% of patients who returned for follow-up appointments. Patients who defaulted follow-up appointments were more likely to have 30-day readmission (50% vs 19.5%; P < .001) and had higher mortality rates (35.7% vs 10.3%; P < .001). Total reimbursement of S $108,960 was provided to subsidize MNPs over 1 year. CONCLUSION Supporting patients with financial difficulties led to an improvement in their nutrition status. Regular dietitian reviews of patients and monitoring compliance to consumption of MNPs are essential to ensure patients benefit from the support.
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Affiliation(s)
- Alvin Wong
- Department of Dietetic and Food Services, Changi General Hospital, Singapore, Singapore.,School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Qiu Le Goh
- Department of Dietetic and Food Services, Changi General Hospital, Singapore, Singapore
| | - Soon Noi Goh
- Department of Medical Social Services, Changi General Hospital, Singapore, Singapore
| | - Przemyslaw M Sowa
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Australia
| | - Merrilyn D Banks
- Royal Brisbane and Women's Hospital, Department of Nutrition and Dietetics, Herston, Queensland, Australia
| | - Judith D Bauer
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
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Xu YC, Vincent JI. Clinical measurement properties of malnutrition assessment tools for use with patients in hospitals: a systematic review. Nutr J 2020; 19:106. [PMID: 32957989 PMCID: PMC7507822 DOI: 10.1186/s12937-020-00613-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
Background The use of malnutrition outcome measures (OM) by registered dietitians (RD) with inpatients in hospitals has increased promoting the achievement of nutritional care goals and supporting decision-making for the allocation of nutritional care resources in hospitals. There are 3 commonly used OMs: Subjective Global Assessment (SGA), Patient Generated-Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA). The purpose of this current study was to systematically review the evidence of the clinical measurement properties of malnutrition assessment tools for use with patients admitted in hospitals. Methods MEDLINE, Cinahl, EMBASE, and PubMed were searched for articles published between 2000 and 2019. Research articles were selected if they established reliability, validity, and responsiveness to change properties of the SGA, PG-SGA and MNA tools, were written in English, and used any of these OMs as an outcome measure. Abstracts were not considered. The risk of bias within studies was assessed using the Quality Appraisal for Clinical Measurement Study (QA-CMS). Results Five hundred five studies were identified, of which 34 articles were included in the final review: SGA (n = 8), PG-SGA (n = 13), and MNA (n = 13). Of the 34 studies, 8 had a quality score greater than 75%; 23 had a quality score of 40–75% and 3 studies had a quality score of less than 40%. PG-SGA was found to have excellentdiagnostic accuracy (ROC: 0.92–0.975; Sensitivity: 88.6–98%; Specificity: 82–100%), sufficient internal consistency (Cronbach’s alpha: 0.722–0.73), and strong test-retest reliability (r = 0.866). There was insufficient evidence to suggest adequate diagnostic accuracy and good inter-rater reliability for SGA. Only one study examined the minimum detectable change of MNA (MDC = 2.1). Conclusions The evidence of validity for the existing malnutrition assessment tools supports the use of these tools, but more studies with sound methodological quality are needed to assess the responsiveness of these OMs to detect the change in nutritional status.
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Affiliation(s)
- Yue Camille Xu
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada. .,Clinical Dietitian at Bruyere Continuing Care, Ottawa, Canada.
| | - Joshua I Vincent
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
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Inciong JFB, Chaudhary A, Hsu HS, Joshi R, Seo JM, Trung LV, Ungpinitpong W, Usman N. Hospital malnutrition in northeast and southeast Asia: A systematic literature review. Clin Nutr ESPEN 2020; 39:30-45. [PMID: 32859327 DOI: 10.1016/j.clnesp.2020.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Hospital malnutrition is a prevalent yet frequently under-recognised condition that is associated with adverse clinical and economic consequences. Systematic reviews from various regions of the world have provided regional estimates of the prevalence of malnutrition and the magnitude of the associated health and economic burden; however, a systematic assessment of the prevalence and consequences of hospital malnutrition in northeast and southeast Asia has not been conducted. METHODS We performed a systematic literature search for articles on hospital malnutrition in 11 Asian countries published in English between January 1, 1997 and January 15, 2018. Studies reporting data on the prevalence, clinical consequences, or economic impact of hospital malnutrition in an adult inpatient population with a sample size ≥30 were eligible for inclusion. RESULTS The literature search identified 3207 citations; of these, 92 studies (N = 62,280) met the criteria for inclusion. There was substantial variability in study populations and assessment methods; however, a majority of studies reported a malnutrition prevalence of >40%. Malnutrition was associated with an increase in clinical complications, mortality, length of hospitalisation, hospital readmissions, and healthcare costs. CONCLUSIONS Hospital malnutrition is a highly prevalent condition among hospitalised patients in northeast and southeast Asia. Additionally, poor nutritional status is associated with increased morbidity and mortality and increased healthcare costs. Further research aimed at improving the identification and proactive management of hospitalised patients at risk for malnutrition is necessary to improve patient outcomes and alleviate the burden on local healthcare budgets.
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Affiliation(s)
- Jesus Fernando B Inciong
- St. Luke's Medical Center, Cathedral Heights Building Complex North Tower Suite 706, 279 E. Rodriguez Sr. Avenue, Quezon City 1112, Philippines.
| | - Adarsh Chaudhary
- Medanta the Medicity, CH Baktawar Singh Rd, Sector 38, Gurugram, Haryana 122001, India
| | - Han-Shui Hsu
- Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei 112, Taiwan
| | - Rajeev Joshi
- B.Y.L. Nair Charitable Hospital and Topiwala National Medical College, Dr. A. L. Nair Road, Mumbai, Maharashtra 400008, India
| | - Jeong-Meen Seo
- Samsung Medical Center, 81 Irwonro, Gangnam-gu, Seoul, South Korea
| | - Lam Viet Trung
- Cho Ray Hospital, 201B Nguyen Chi Thanh, Ward 12, District 5, Ho Chi Minh City, Viet Nam
| | - Winai Ungpinitpong
- Surin Hospital, Department of Surgery, 68 Lukmueang Road Tambon Naimueang, Amphoe Mueang, Surin 32000, Thailand
| | - Nurhayat Usman
- Hasan Sadikin General Hospital, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Kota Bandung, Jawa Barat 40161, Indonesia
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A narrative review of healthcare financing and reimbursement of nutritional support for patients in Singapore. Health Policy 2020; 124:1146-1154. [PMID: 32624248 DOI: 10.1016/j.healthpol.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
AIMS Nutritional support is used frequently in Singapore's healthcare settings, but limited research has been published on how it is financed. This paper aims to provide a narrative review on the financing of nutritional support in Singapore for acute care, step-down care, intermediate and long-term care (ILTC), community and home settings. METHODS A structured search strategy was applied to available electronic databases using selected search terms, with additional reports and grey literature identified using iterative searches. RESULTS A limited number of publications were found via electronic databases. The majority of publications were from governmental reports/ press releases, and healthcare organizations' websites. While funds are available via MediSave, MediShield Life, MediFund, and various other schemes, they may not be sufficient for individuals on long-term nutritional support. CONCLUSIONS More funding sources for nutritional support are urgently required for patients in ILTC. Means-testing mechanism and targeting may need to improve to ensure access to financial assistance for nutritional support and prevent poorer outcomes and higher medical costs. Medical providers, dietitians, pharmacists and social workers play a role in determining need, prescribing and accessing nutritional support for optimal care of individuals in hospitals and ILTC. Future policies will need to address the issues of access to nutritional support in the elderly and low-income populations.
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Ryan AM, Prado CM, Sullivan ES, Power DG, Daly LE. Effects of weight loss and sarcopenia on response to chemotherapy, quality of life, and survival. Nutrition 2019; 67-68:110539. [PMID: 31522087 DOI: 10.1016/j.nut.2019.06.020] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/20/2019] [Indexed: 02/07/2023]
Abstract
It has frequently been shown that patients with cancer are one of the largest hospital patient groups with a prevalence for malnutrition. Weight loss is a frequent manifestation of malnutrition in patients with cancer. Several large-scale studies over the past 35 y have reported that involuntary weight loss affects 50% to 80% of these patients with the degree of weight loss dependent on tumor site and type and stage of disease. The aim of this review was to determine the consequences of malnutrition, weight loss, and muscle wasting in relation to chemotherapy tolerance, postoperative complications, quality of life, and survival in patients with cancer. The prognostic impact of weight loss on overall survival has long been recognised with recent data suggesting losses as little as 2.4% predicts survival independent of disease, site, stage or performance score. Recently the use of gold-standard methods of body composition assessment, including computed tomography, have led to an increased understanding of the importance of muscle abnormalities, such as low muscle mass (sarcopenia), and more recently low muscle attenuation, as important prognostic indicators of unfavourable outcomes in patients with cancer. Muscle abnormalities are highly prevalent (ranging from 10-90%, depending on cancer site and the diagnostic criteria used). Both low muscle mass and low muscle attenuation have been associated with poorer tolerance to chemotherapy; increased risk of postoperative complications; significant deterioration in a patients' performance status, and poorer psychological well-being, overall quality of life, and survival.
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Affiliation(s)
- Aoife M Ryan
- School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Ireland; Cork Cancer Research Centre, University College Cork, Cork, Ireland.
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Erin S Sullivan
- School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Ireland; Cork Cancer Research Centre, University College Cork, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy and Cork University Hospitals, Cork, Ireland
| | - Louise E Daly
- School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Ireland; Cork Cancer Research Centre, University College Cork, Cork, Ireland
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Hirose EY, de Molla VC, Gonçalves MV, Pereira AD, Szor RS, da Fonseca ARBM, Fatobene G, Serpa MG, Xavier EM, Tucunduva L, Rocha V, Novis Y, Arrais-Rodrigues C. The impact of pretransplant malnutrition on allogeneic hematopoietic stem cell transplantation outcomes. Clin Nutr ESPEN 2019; 33:213-219. [PMID: 31451264 DOI: 10.1016/j.clnesp.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Malnutrition is a common finding in allogeneic hematopoietic stem cell transplantation (alloHSCT) patients, and there is some evidence that malnutrition might negatively affect the transplant outcomes. METHOD We performed a retrospective study with 148 patients aged 18-75 years, who underwent alloHSCT between 2011 and 2017. Patients were classified according to the body mass index (BMI) and the Subjective Global Assessment (SGA). The SGA was assessed on the day of hospitalization for the transplant, and classifies patients into three groups: A (well-nourished), B (moderately malnourished) and C (severely malnourished). RESULTS The SGA classified 49 (33%) patients as well-nourished, 54 (37%) as moderately malnourished, and 45 (30%) as severely malnourished. SGA-C was also associated with severe acute graft versus host disease (aGVHD) with a cumulative incidence (CI) of 31% vs. a CI of 14% for combined well-nourished or moderately malnourished group (SGA-A or -B, P = 0.017). In multivariate analysis, SGA-C compared to SGA-A or -B, remained as an independent risk factor for aGVHD (hazard ratio - HR 1.68, 95% confidence interval - 95% CI 1.02-2.74), and nonrelapse mortality (NRM - HR 3.63, 95% CI 1.76-7.46), worse progression free survival (HR 2.12, 95% CI 1.25-3.60), and worse overall survival (HR 3.27, 95% CI 1.90-5.64). CONCLUSION Malnutrition increases the risk of aGVHD and NRM and has a negative impact on survival.
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Affiliation(s)
- Erika Yuri Hirose
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius Campos de Molla
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil.
| | | | - André Domingues Pereira
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ana Rita Brito Medeiro da Fonseca
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Vanderson Rocha
- Hospital Sírio Libanês, São Paulo, Brazil; Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo/ICESP, São Paulo, Brazil; Churchill Hospital, NHS-BT, Oxford, United Kingdom
| | - Yana Novis
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Celso Arrais-Rodrigues
- Hospital Sírio Libanês, São Paulo, Brazil; Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
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Wester P, Angus R, Easlea D, Lin M, Chen B, Bisset L. Use of the malnutrition screening tool by non-dietitians to identify at-risk patients in a rehabilitation setting: A validation study. Nutr Diet 2018; 75:324-330. [PMID: 29498182 DOI: 10.1111/1747-0080.12416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/04/2017] [Accepted: 01/16/2018] [Indexed: 11/26/2022]
Abstract
AIM Malnutrition is highly prevalent in rehabilitation patients, and screening is important to allow for timely intervention to reduce the incidence of adverse clinical outcomes. We aimed to determine the reliability and validity of the commonly employed malnutrition screening tool by non-dietitian staff in categorising patients at risk of malnutrition in the rehabilitation setting. METHODS This prospective observational cohort study recruited 100 participants on admission to a rehabilitation ward. The malnutrition screening tool was applied by nursing staff and repeated by nutrition assistants. Results were compared to malnutrition as determined by dietitian-applied subjective global assessment of each patient. Inter-rater reliability tests were conducted with two dietitians, two nutrition assistants and two nurses independently but simultaneously recording malnutrition screening tool scores on a subgroup of 15 participants. RESULTS Agreement between dietitian-determined malnutrition and risk as identified by nutrition assistant and nursing staff screening tool application was only modest (64% and 51%, respectively). While both professions met the a priori criteria for acceptable specificity (≥60%), neither met the criterion for adequate sensitivity (≥80%). The inter-rater reliability of the tool was excellent, with almost perfect agreement (≥0.89) between ward dietitian and nutrition assistants, and moderate to substantial agreement (0.56-0.65) with nursing staff, when compared to a senior dietitian. CONCLUSIONS Non-dietitian staff failed to apply the malnutrition screening tool with sufficient sensitivity in normal ward practice to warrant its use in the rehabilitation setting. Alternative options for identification of malnutrition need to be considered to ensure appropriate treatment.
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Affiliation(s)
- Paulina Wester
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Rebecca Angus
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Dayle Easlea
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michelle Lin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Benjamin Chen
- Rehabilitation Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Leanne Bisset
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Nutritional status of allogeneic hematopoietic stem cell transplantation recipients: influencing risk factors and impact on survival. Support Care Cancer 2017; 25:3085-3093. [DOI: 10.1007/s00520-017-3716-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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18
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Sharma Y, Thompson C, Shari R, Hakendorf P, Miller M. Malnutrition in Acutely Unwell Hospitalized Elderly - "The Skeletons Are Still Rattling in the Hospital Closet". J Nutr Health Aging 2017; 21:1210-1215. [PMID: 29188881 DOI: 10.1007/s12603-017-0903-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Malnutrition is common in hospitalized patients with prevalence rates of up to 30% in Australian hospitals with adverse consequences for both the patients and health care services. Despite formulation of nutritional screening protocols, not all hospitalized patients get nutritional screening. Real life screening rates of hospitalized elderly patients are unknown. AIM The present study explored nutrition screening rate in acutely unwell elderly patients admitted in a large tertiary hospital and how these patients fared depending upon their nutrition status. METHODS A prospective cross-sectional study involving 205 general medical patients ≥60years recruited between November 2014 and November 2015. The number of patients who missed nutrition screening were noted and all patients underwent nutritional assessment by a qualified dietitian using PG-SGA and quality of life was measured using EQ-5D 5L. A survival curve was plotted and multivariate cox proportional hazard model was used to adjust for confounders. RESULTS Only 99 (49.7%) patients underwent nutritional screening. One hundred and six (53.5%) patients were confirmed as malnourished by PG-SGA. Malnourished patients had significantly longer length of hospital stay and had worse quality of life. Mortality was significantly higher in malnourished patients at one year (23 (21.7%) vs 4 (4.3%); p<0.001) and cox proportional hazard model suggests that malnutrition significantly affects survival even after adjustment for confounders like age, sex, Charlson index and polypharmacy. CONCLUSION This study confirms that nutrition screening is still suboptimal in elderly hospitalized patients with adverse consequences and suggests need for review of policies to improve screening practices.
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Affiliation(s)
- Y Sharma
- Michelle Miller, Flinders University, Australia,
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Sharma Y, Miller M, Shahi R, Hakendorf P, Horwood C, Thompson C. Malnutrition screening in acutely unwell elderly inpatients. BRITISH JOURNAL OF NURSING 2016; 25:1006-1014. [PMID: 27734728 DOI: 10.12968/bjon.2016.25.18.1006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Yogesh Sharma
- Consultant Physician, Department of General Medicine, Flinders Medical Centre, South Australia and Senior Lecturer, School of Medicine, Flinders University, South Australia
| | - Michelle Miller
- Professor, Nutrition & Dietetics Department, Flinders University, South Australia
| | - Rashmi Shahi
- Lecturer, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Paul Hakendorf
- Clinical Epidemiologist, Department of Clinical Epidemiology, Flinders Medical Centre, South Australia
| | - Chris Horwood
- Clinical Epidemiologist, Department of Clinical Epidemiology, Flinders Medical Centre, South Australia
| | - Campbell Thompson
- Professor of Medicine, Discipline of Medicine, University of Adelaide, South Australia
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Xia YA, Healy A, Kruger R. Developing and Validating a Renal Nutrition Screening Tool to Effectively Identify Undernutrition Risk Among Renal Inpatients. J Ren Nutr 2016; 26:299-307. [DOI: 10.1053/j.jrn.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/03/2016] [Accepted: 04/08/2016] [Indexed: 02/08/2023] Open
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Morán López JM, Piedra León M, Beneítez Moralejo B, Enciso Izquierdo FJ, Luengo Pérez LM, Amado Señaris JA. Efficiency, cost-effectiveness and need of inversion in nutritional therapy. Importance of detecting and documenting undernutrition. Clin Nutr ESPEN 2016; 13:e28-e32. [PMID: 28531565 DOI: 10.1016/j.clnesp.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/28/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022]
Abstract
Disease Related Malnutrition (DRM) is highly prevalent in Spanish hospitals. WHO estimates that 20-40% of health-associated expenses are lost due to inefficiency. Demonstration that DRM is a component of inefficiency and hiring a specialist physician for its detection and treatment is cost-effective. MATERIAL AND METHODS Comparison between nutritional diagnosis and procedures detected and encoded at discharge using McNemar test. Recoding of 162 discharge reports including nutritional diagnoses and procedures. Determine changes on Case-Mix Index (IC), cost of procedure and cost procedure/DRG index. Comparison using T-student paired test. RESULTS Only 10 of 162 diagnoses of malnutrition were coded in delivery statements (p < 0.001). After right codification, IC increased in 103,3 DRG points (p < 0.001). Consequently, procedure cost/DRG index was reduced in 978.81 € (p < 0.001). CONCLUSIONS DRM is underdiagnosed in our hospital. DRM and nutritional procedures detection by a doctor specialist in clinical nutrition led to a reduction in cost procedure/DRG index of 16.8% of officially established by the Health System. Loss of 16.8% of health expenses, estimated in 424.785,15 € was described. Proper codification would have justified 343.291,2 € reimbursement just for nutritional diagnoses and processes. Both expenses were lost due to system's inefficiency. Those amounts are much higher than cost associated of hiring a specialist in clinical nutrition.
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Temba MC, Njobeh PB, Adebo OA, Olugbile AO, Kayitesi E. The role of compositing cereals with legumes to alleviate protein energy malnutrition in Africa. Int J Food Sci Technol 2016. [DOI: 10.1111/ijfs.13035] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Makumba C. Temba
- Department of Biotechnology and Food Technology; Faculty of Science; University of Johannesburg; P. O. Box 17011 Doornfontein Campus Johannesburg South Africa
| | - Patrick B. Njobeh
- Department of Biotechnology and Food Technology; Faculty of Science; University of Johannesburg; P. O. Box 17011 Doornfontein Campus Johannesburg South Africa
| | - Oluwafemi A. Adebo
- Department of Biotechnology and Food Technology; Faculty of Science; University of Johannesburg; P. O. Box 17011 Doornfontein Campus Johannesburg South Africa
| | - Adetola O. Olugbile
- Department of Food Science and Technology; College of Food Science and Human Ecology, Federal University of Agriculture; P.M.B. 2240 Alabata Abeokuta Nigeria
| | - Eugenie Kayitesi
- Department of Biotechnology and Food Technology; Faculty of Science; University of Johannesburg; P. O. Box 17011 Doornfontein Campus Johannesburg South Africa
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Batool R, Butt MS, Sultan MT, Saeed F, Naz R. Protein-energy malnutrition: a risk factor for various ailments. Crit Rev Food Sci Nutr 2015; 55:242-53. [PMID: 24915388 DOI: 10.1080/10408398.2011.651543] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The wheel of industrialization that spun throughout the last century resulted in urbanization coupled with modifications in lifestyles and dietary habits. However, the communities living in developing economies are facing many problems related to their diet and health. Amongst, the prevalence of nutritional problems especially protein-energy malnutrition (PEM) and micronutrients deficiencies are the rising issues. Moreover, the immunity or susceptibility to infect-parasitic diseases is also directly linked with the nutritional status of the host. Likewise, disease-related malnutrition that includes an inflammatory component is commonly observed in clinical practice thus affecting the quality of life. The PEM is treatable but early detection is a key for its appropriate management. However, controlling the menace of PEM requires an aggressive partnership between the physician and the dietitian. This review mainly attempts to describe the pathophysiology, prevalence and consequences of PEM and aims to highlight the importance of this clinical syndrome and the recent growth in our understanding of the processes behind its development. Some management strategies/remedies to overcome PEM are also the limelight of the article. In the nutshell, early recognition, prompt management, and robust follow up are critical for best outcomes in preventing and treating PEM.
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Affiliation(s)
- Rizwana Batool
- a National Institute of Food Science & Technology, University of Agriculture , Faisalabad , Pakistan
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24
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Guerra RS, Sousa AS, Fonseca I, Pichel F, Restivo MT, Ferreira S, Amaral TF. Comparative analysis of undernutrition screening and diagnostic tools as predictors of hospitalisation costs. J Hum Nutr Diet 2014; 29:165-73. [DOI: 10.1111/jhn.12288] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R. S. Guerra
- Departamento de Bioquímica; Faculdade de Medicina da Universidade do Porto; Porto Portugal
- UISPA-IDMEC; Faculdade de Engenharia da Universidade do Porto; Porto Portugal
- Unidade de Nutrição; Centro Hospitalar do Porto; Porto Portugal
| | - A. S. Sousa
- Unidade de Nutrição; Centro Hospitalar do Porto; Porto Portugal
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto; Porto Portugal
| | - I. Fonseca
- Unidade de Nutrição; Centro Hospitalar do Porto; Porto Portugal
| | - F. Pichel
- Unidade de Nutrição; Centro Hospitalar do Porto; Porto Portugal
| | - M. T. Restivo
- UISPA-IDMEC; Faculdade de Engenharia da Universidade do Porto; Porto Portugal
| | - S. Ferreira
- Serviço de Informação de Gestão; Centro Hospitalar do Porto; Porto Portugal
| | - T. F. Amaral
- UISPA-IDMEC; Faculdade de Engenharia da Universidade do Porto; Porto Portugal
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto; Porto Portugal
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Khalaf A, Westergren A, Ekblom Ö, Al-Hazzaa HM, Berggren V. Nurses' views and experiences of caring for malnourished patients in surgical settings in Saudi Arabia - a qualitative study. BMC Nurs 2014; 13:29. [PMID: 25317076 PMCID: PMC4196725 DOI: 10.1186/1472-6955-13-29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 10/06/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although the occurrence of malnutrition in hospitals is a growing concern, little is known about how hospital staff understand the care that nurses provide to patients with malnutrition. The purpose of this study was to explore nurses' views and experiences of caring for malnourished patients in Saudi Arabia (KSA). METHODS Using a qualitative explorative design, fifteen nurses were interviewed as part of a purposive sample hospital staff. The transcripts were analyzed using latent content analysis. RESULTS The nurses spontaneously and consistently linked malnutrition with physical inactivity. The two main categories, which emerged, were: 'Potentials for nurses to provide good nutrition and physical activity', and 'Having the ability but not the power to promote proper nutrition and physical activity'. These arose from the subcategories: Good nursing implies providing appropriate health education; Acknowledging the Mourafiq (sitter) as a potential resource for the nursing, but also as a burden; Inadequate control and lack of influence; Cultural diversity and lack of dialog; and Views of women's weight gain in KSA society. CONCLUSIONS The nurses felt they have the capacity and passion to further improve the nutrition and activity of their patients, but obstacles in the health care system are impeding these ambitions. The implications for nursing practice could be acknowledgement of the nurses' views in the clinical practice; culturally adjusted care, improved communication and enhanced language skills.
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Affiliation(s)
- Atika Khalaf
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Elmetorpsvägen 15, S-291 88 Kristianstad, Sweden
- The Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Albert Westergren
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Elmetorpsvägen 15, S-291 88 Kristianstad, Sweden
| | - Örjan Ekblom
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Hazzaa M Al-Hazzaa
- Paediatric Exercise Physiology Research Laboratory, College of Education and Obesity Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Vanja Berggren
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
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Lee HK, Choi HS, Son EJ, Lyu ES. Analysis of the Prevalence and Risk Factors of Malnutrition among Hospitalized Patients in Busan. Prev Nutr Food Sci 2014; 18:117-23. [PMID: 24471120 PMCID: PMC3892498 DOI: 10.3746/pnf.2013.18.2.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/27/2013] [Indexed: 01/04/2023] Open
Abstract
This study investigated the prevalence of and risk factors for malnutrition in hospitalized patients in Busan, Republic of Korea. 944 patients (440 men and 504 women) were hospitalized in four Busan general hospitals from March through April, 2011. Nutritional status was assessed on admission by the Nutritional Risk Screening 2002. Data were collected from the electronic medical records system for the characteristics of the subjects, clinical outcomes, biochemical laboratory data, and nutrition support states. Clinical dietitians interviewed the patients using structured questionnaires involving data on weight loss and problems related to oral intakes. Malnourished patients were significantly older (P<0.001) than well-nourished patients, but the values for BMI, serum albumin, total cholesterol, TLC, hemoglobin, and hematocrit were significantly lower (P<0.001) for malnourished than for well-nourished patients. Logistic regression indicated that the main determinant factors for nutritional status were the age, length of stay, BMI, serum albumin, and total cholesterol. In order to increase therapeutic effects of hospitalized patients, clinical dietitians need to offer proper nutritional intervention based on the results of nutrition assessment and identification of malnutrition.
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Affiliation(s)
| | - Hee-Sun Choi
- Department of Food Science and Nutrition, Dong-A University, Busan 604-714, Korea
| | - Eun-Joo Son
- Department of Nutrition Care, Dongnam Institute of Radiological & Medical Sciences, Busan 619-953, Korea
| | - Eun-Soon Lyu
- Department of Food Science and Nutrition, Pukyong National University, Busan 608-737, Korea
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27
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NRS2002 assesses nutritional status of leukemia patients undergoing hematopoietic stem cell transplantation. Chin J Cancer Res 2013. [DOI: 10.1007/s11670-012-0267-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Liu P, Zhang ZF, Cai JJ, Wang BS, Yan X. NRS2002 assesses nutritional status of leukemia patients undergoing hematopoietic stem cell transplantation. Chin J Cancer Res 2013; 24:299-303. [PMID: 23359777 DOI: 10.3978/j.issn.1000-9604.2012.09.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/07/2012] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To discuss whether nutritional risk screening 2002 (NRS2002) is appropriate for nutritional risk screening for leukemia patients before and after hematopoietic stem cell transplantation (HSCT), and whether there are risk differences in other conditions, such as age, gender and matching degree; to find the methods and indicators of nutritional risk screening for these patients before and after HSCT, in order to give timely intervention to guarantee the successful completion of the entire transplantation process. METHODS Nutritional risk of 99 leukemia patients was screened with NRS2002 before and after HSCT. The (χ) (2) test was applied to compare the risk differences between groups such as age, gender and matching degree, while the differences of other enumeration data, such as recent (1-3 months) weight loss, reduced food intake within one week and BMI, were compared by continuity correction. RESULTS Of the 99 leukemia patients, 22 cases (22.2%) had nutritional risk before HSCT, while all patients had nutritional risk after HSCT; there is no significant difference in nutritional risk between male and female, and patients of less than 30 years old, not-full matched, recent (1-3 months) weight loss, reduced food intake within a week or BMI <18.5 were more likely to have nutritional risk; and 77 cases (77.8%) had weight loss, among which 49 patients (63.6%) had more than 5% weight loss within one month. CONCLUSIONS This study showed that leukemia patients should receive the nutritional risk screening conventionally before and after HSCT, and NRS2002 was only appropriate for nutritional risk screening before HSCT. More attention should be paid to the patients less than 30 years old or not-full matched. Weight change was one of the important nutritional indicators for patients after HSCT.
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Affiliation(s)
- Peng Liu
- Department of Clinical Nutrition, Peking University People's Hospital, Beijing 100044, China
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29
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Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 2012; 31:345-50. [DOI: 10.1016/j.clnu.2011.11.001] [Citation(s) in RCA: 545] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/04/2011] [Accepted: 11/03/2011] [Indexed: 01/15/2023]
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Filnut-escala: justificación y utilidad en el cribaje de riesgo por desnutrición dentro del proceso infornut. FARMACIA HOSPITALARIA 2010; 34:231-6. [DOI: 10.1016/j.farma.2009.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 12/08/2009] [Accepted: 12/10/2009] [Indexed: 11/24/2022] Open
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Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr Diet 2009. [DOI: 10.1111/j.1747-0080.2009.01383.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Isenring EA, Bauer JD, Banks M, Gaskill D. The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care. J Hum Nutr Diet 2009; 22:545-50. [DOI: 10.1111/j.1365-277x.2009.01008.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazaré M, Sousa Pereira N. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr 2007; 26:778-84. [DOI: 10.1016/j.clnu.2007.08.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 08/08/2007] [Accepted: 08/10/2007] [Indexed: 01/09/2023]
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Malnutrition in acute care patients: A narrative review. Int J Nurs Stud 2007; 44:1036-54. [DOI: 10.1016/j.ijnurstu.2006.07.015] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2006] [Revised: 07/12/2006] [Accepted: 07/13/2006] [Indexed: 01/15/2023]
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Kandiah J, Stinnett L, Lutton D. Visual Plate Waste in Hospitalized Patients: Length of Stay and Diet Order. ACTA ACUST UNITED AC 2006; 106:1663-6. [PMID: 17000200 DOI: 10.1016/j.jada.2006.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Indexed: 11/29/2022]
Abstract
The purpose of this pilot research was to investigate the effect of diet order, sex, diagnosis, and length of stay on visual lunch plate waste in hospitalized patients. Information on 346 patients was collected using the computer program CBORD Diet Office. Visual plate waste during lunch was measured and analyzed for 4 consecutive days. Neither sex nor diagnosis at admittance was associated with visual plate waste. However, the odds of visual plate waste increased by 14.1% for every day a patient was admitted. In patients receiving a diabetic diet order, odds of visual plate waste decreased by 61.2%, indicating there was reduction in plate waste. Conversely, in patients receiving altered consistency diet orders, odds of visual plate waste increased by 344%, signifying a rise in plate waste. Due to an increase of visual plate waste associated with long length of stay and altered consistency diet orders, registered dietitians working in acute-care facilities need to develop strategies to create cost-effective, nutritionally balanced, altered consistency diets that would enhance patient acceptance and consumption of food.
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Affiliation(s)
- Jay Kandiah
- Department of Family and Consumer Science, Ball State University, Muncie, IN.
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Porbén SS. The state of the provision of nutritional care to hospitalized patients--results from The Elan-Cuba Study. Clin Nutr 2006; 25:1015-29. [PMID: 16764970 DOI: 10.1016/j.clnu.2006.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Revised: 03/31/2006] [Accepted: 04/10/2006] [Indexed: 12/20/2022]
Abstract
Current nutritional care provision to 1905 patients hospitalized in 12 Cuban hospitals is presented in this article, diagnosed after conducting the Hospital Nutrition Survey (HNS), as part of the activities comprising the Cuban Study of Hospital Malnutrition (Elan-Cuba). The obtained HNS results were contrasted with standards regarding the nutritional assessment of hospitalized patient, the diagnosis of nutritional disorders occurring in the patient, and the identification of patients in need of nutritional intervention. The Elan-Cuba Study returned a 41.2% malnutrition rate [Barreto Penié J, Cuban Group for the Study of Hospital Malnutrition. State of malnutrition in Cuban hospitals. Nutrition 2005;21:487-97]. However, malnutrition was recorded as an independent diagnosis in only 0.4% of the surveyed clinical charts. It could not be shown that medical care teams were systematically applying any of the techniques and procedures recommended for the assessment of the nutritional status of hospitalized patients. In the best of the cases, only 40.6% of the surveyed patients had their height and weight recorded in their clinical charts at admission, 9.0% of those with more than 15 days of hospitalization had a prospective value of weight, and less than 20.0% of them had their serum albumin levels and/or their counts of Lymphocytes annotated on their clinical charts. Although 10.9% of the surveyed patients (median of the subcategories values; range: 3.5-41.2%) fulfilled an indication for nutritional intervention, support (enteral and/or parenteral) was only provided to less than 15.0% of them, with the exception made of patients on NPO, of whom 32.3% received either of the two modes of artificial nutrition listed above. It is to be noticed that none of the patients with chronic organic failure were on nutritional support at the time of the survey. The current nutritional care provision to the hospitalized patient might explain the increased rates of hospital malnutrition documented in the Elan-Cuba Study, and should lead to the design and urgent implementation of nutritional and metabolic intervention programs in the surveyed hospitals, given the deleterious effects of nutritional disorders upon the ultimate results of the medical and surgical actions, and the quality and costs of medical care.
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Barbosa-Silva MCG, Barros AJD. Indications and limitations of the use of subjective global assessment in clinical practice: an update. Curr Opin Clin Nutr Metab Care 2006; 9:263-9. [PMID: 16607126 DOI: 10.1097/01.mco.0000222109.53665.ed] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Subjective global assessment is a clinical tool for assessing nutritional status that merges alterations in body composition and physiological function. Although it was first described almost two decades ago, many studies using this method have been published during the past few years. This review describes recent findings from such studies. RECENT FINDINGS Subjective global assessment has proved to be a good nutritional assessment and prognostic indicator in several clinical situations. Agreement between subjective global assessment and newer screening methods is not always acceptable, and it has not been validated with respect to clinical outcome. Some modifications have been suggested that may increase the sensitivity of subjective global assessment as a screening tool. A scored version of subjective global assessment for cancer patients is now being validated for use in other patient groups. This could increase its utility in nutritional intervention studies if it can be demonstrated that subtle changes in nutritional status are reflected by numerical scores in patient-generated subjective global assessment. SUMMARY Subjective global assessment represents a good option for assessing nutritional status in various clinical situations. As a screening tool, it better identifies established malnutrition than nutritional risk but its sensitivity is suboptimal. The scored version of subjective global assessment may have advantages and extend the usefulness of this tool even further.
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Isenring E, Cross G, Daniels L, Kellett E, Koczwara B. Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy. Support Care Cancer 2006; 14:1152-6. [PMID: 16622648 DOI: 10.1007/s00520-006-0070-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 03/22/2006] [Indexed: 12/01/2022]
Abstract
GOALS OF WORK To determine the relative validity of the Malnutrition Screening Tool (MST) compared with a full nutrition assessment by the scored Patient Generated-Subjective Global Assessment (PG-SGA) and to assess MST inter-rater reliability in patients receiving chemotherapy. PATIENTS AND METHODS An observational, cross-sectional study was conducted at an Australian public hospital in 50 oncology outpatients receiving chemotherapy. Inter-rater reliability was assessed in a subsample of 20 patients. MAIN RESULTS According to PG-SGA global rating, the prevalence of malnutrition was 26%. The MST was a strong predictor of nutritional risk relative to the PG-SGA (100% sensitivity, 92% specificity, 0.8 positive predictive value, 1.0 negative predictive value). MST inter-rater reliability was acceptable with agreement by administration staff/nursing staff/patient and the dietitian in 18/20 cases (kappa=0.83; p0.001). CONCLUSION The MST has acceptable relative validity, inter-rater reliability, sensitivity, and specificity to identify chemotherapy outpatients at risk of malnutrition and, hence, is an acceptable nutrition screening tool in this patient population.
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Lazarus C, Hamlyn J. Prevalence and documentation of malnutrition in hospitals: A case study in a large private hospital setting. Nutr Diet 2005. [DOI: 10.1111/j.1747-0080.2005.tb00008.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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