Implementation of nutritional screening tools, nutritional assessment tools, and diagnostic criteria for malnutrition in convalescent rehabilitation wards: A nationwide survey

BACKGROUND & AIMS

The utilization of recommended nutritional assessment measures in rehabilitation settings remains unclear. This study explored methods for identifying nutritional disorders using data from a nationwide survey conducted in convalescent rehabilitation wards.

METHODS

This cross-sectional study analyzed the annual survey, including methods for identifying malnutrition, the risk of malnutrition, and overnutrition in Kaifukuki (convalescent) rehabilitation wards. Methods identifying malnutrition and risk of malnutrition were grouped into nutritional screening tools (NSTs), nutritional assessment tools (NATs), diagnostic criteria for malnutrition (DCM), and suboptimal methods (e.g., hypoalbuminemia). NSTs, NATs, and DCM were further categorized as "acceptable tools." The association between applying acceptable tools, hospital-based data (e.g., the number of beds), and ward-based data (e.g., assessor for nutritional status) was analyzed by logistic regression analysis with multiple imputations.

RESULTS

In total, 885 hospitals with Kaifukuki rehabilitation wards responded to the survey, and 754 hospitals were included in the analysis. Registered dietitians assessed the nutritional status in 88% of the hospitals, whereas other professionals (e.g., nurses) evaluated the nutritional status in the remainder. NSTs (e.g., Mini Nutritional Assessment Short-Form), NATs (e.g., Subjective Global Assessment), DCM (e.g., Global Leadership Initiative on Malnutrition criteria), and suboptimal tools were used in 13.1%, 5.4%, 4.8%, and 74.6% of cases, respectively. Most hospitals used acceptable measures (e.g., body mass index) for overnutrition (91.2%). Multiple logistic regression analysis showed that assessments by registered dietitians (adjusted odds ratio[OR]: 2.20.95% confidence interval[CI]: 1.09-4.45) and hospital-owned food services, a proxy for limited clinical practice time of dietitians, were associated with a low likelihood of implementing acceptable measures (adjusted OR: 0.64, 95%CI: 0.43-0.97).

CONCLUSIONS

Acceptable malnutrition measures, including the NSTs, NATs, and DCM, have not been widely applied in convalescent rehabilitation settings. The implementation of recommended tools for identifying malnutrition may be promoted when registered dietitians assess the patients' nutritional status.

Validity of nutrition screening tools for risk of malnutrition among hospitalized adult patients: A systematic review and meta-analysis

BACKGROUNDS & AIMS

Malnutrition is prevalent among hospitalized patients in developed countries, contributing to negative health outcomes and increased healthcare costs. Timely identification and management of malnutrition are crucial. The lack of a universally accepted definition and standardized diagnostic criteria for malnutrition has led to the development of various screening tools, each with varying validity. This complicates early identification of malnutrition, hindering effective intervention strategies. This systematic review and meta-analysis aimed to identify the most valid and reliable nutritional screening tool for assessing the risk of malnutrition in hospitalized adults.

METHODS

A systematic literature search was conducted to identify validation studies published from inception to November 2023, in the Pubmed/MEDLINE, Embase, and CINAHL databases. This systematic review was registered in INPLASY (INPLASY202090028). The risk of bias and quality of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). Meta-analyses were performed for screening tools accuracy using the symmetric hierarchical summary receiver operative characteristics models.

RESULTS

Of the 1646 articles retrieved, 60 met the inclusion criteria and were included in the systematic review, and 21 were included in the meta-analysis. A total of 51 malnutrition risk screening tools and 9 reference standards were identified. The meta-analyses assessed four common malnutrition risk screening tools against two reference standards (Subjective Global Assessment [SGA] and European Society for Clinical Nutrition and Metabolism [ESPEN] criteria). The Malnutrition Universal Screening Tool (MUST) vs SGA had a sensitivity (95% Confidence Interval) of 0.84 (0.73-0.91), and specificity of 0.85 (0.75-0.91). The MUST vs ESPEN had a sensitivity of 0.97 (0.53-0.99) and specificity of 0.80 (0.50-0.94). The Malnutrition Screening Tool (MST) vs SGA had a sensitivity of 0.81 (0.67-0.90) and specificity of 0.79 (0.72-0.74). The Mini Nutritional Assessment-Short Form (MNA-SF) vs ESPEN had a sensitivity of 0.99 (0.41-0.99) and specificity of 0.60 (0.45-0.73). The Nutrition Universal Screening Tool-2002 (NRS-2002) vs SGA had a sensitivity of 0.76 (0.58-0.87) and specificity of 0.86 (0.76-0.93).

CONCLUSIONS

The MUST demonstrated high accuracy in detecting malnutrition risk in hospitalized adults. However, the quality of the studies included varied greatly, possibly introducing bias in the results. Future research should compare tools within a specific patient population using a valid and universal gold standard to ensure improved patient care and outcomes.

Prevalence and factors associated with sarcopenia among older adults in a post-acute hospital in Singapore

BACKGROUND

Sarcopenia is common in older adults worldwide, but its prevalence varies widely owing to differences in diagnostic criteria, population sampled, and care setting. We aimed to determine the prevalence and factors associated with sarcopenia in patients aged 65 and above admitted to a post-acute hospital in Singapore.

METHODS

This was a cross-sectional study of 400 patients recruited from a community hospital in Singapore. Data including socio-demographics, physical activity, nutritional status, cognition, clinical and functional status, as well as anthropometric measurements were collected. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 criteria [AWGS2019].

RESULTS

Of the 383 patients with complete datasets, overall prevalence of sarcopenia was 54% while prevalence of severe sarcopenia was 38.9%. Participants with increased age, male gender and a low physical activity level were more likely to be sarcopenic, while those with higher hip circumference and higher BMI of ≥27.5m/kg2 were less likely to be sarcopenic. Other than the above-mentioned variables, cognitive impairment was also associated with severe sarcopenia.

CONCLUSIONS

More than 1 in 2 older adults admitted to a post-acute hospital in Singapore are sarcopenic. There is an urgent need to address this important clinical syndrome burden and to identify patients at risk of sarcopenia in post-acute settings in Singapore for early intervention.

Efficiency of an intervention study on nursing students' knowledge and practices regarding nutrition and dietary habits

Poor eating habits and hazardous weight-control measures are prevalent among university students. Hence, practical and efficient intervention programs are necessary to enhance nutritional awareness and promote healthy dietary practices encompassing food choices and diet quality. This study aims to evaluate the efficiency of an intervention study on nursing students' knowledge and practices regarding nutrition and dietary habits. A quasi-experimental research design with pre-post phases was used to study 250 nursing students at the College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, in the Kingdom of Saudi Arabia. The sample was non-randomized and taken from March 2023 until the end of May of the same year. The closed-ended questionnaire focused on participant demographics, knowledge, and practices relating to nutrition and eating habits. The survey was divided into three main sections. Technical terms were consistently defined throughout the questionnaire, and the language used was clear and objective. The research adhered to conventional academic structure and formatting, following the guidelines of the relevant style manual. Grammatical correctness and precise word choice were ensured, and filler words were avoided. The participants in the study displayed an increase in knowledge scores from 33.7 ± 4.6 in the pre-test to 52.6 ± 7.2 in the post-test. Moreover, prior to program implementation, their overall nutrition practice scores stood at 64 ± 9.5, but after the program, the score had risen to 107.7 ± 4.22. A significant difference in the total knowledge and practice scores was identified between the pre- and post-test phases, with an a p-value of 0.001. The nursing students' scores for both knowledge and practical application of nutrition and eating habits showed a significant increase following the implementation of the program. Therefore, it is imperative to introduce well-structured training programs on nutrition and promote healthy diet habits for all medical faculties, paramedics, and applied health institutions across Saudi Arabia.

Adult malnutrition, nutritional interventions and outcomes in Singapore: a scoping review of local studies for the past 20 years

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.

The food diary as a pedagogical strategy in undergraduate nursing nutrition education: A student evaluation

BACKGROUND

Few studies have evaluated educational nutrition activities in undergraduate nursing, and none have published how the established food assessment method, the food diary, can be used as a pedagogical method in this context.

OBJECTIVE

To describe undergraduate nursing students' learning outcomes of basic nutrition and important elements for their learning after conducting a one-day food record with a subsequent seminar (henceforth: "the food diary method").

DESIGN

Cross-sectional.

SETTING

Undergraduate nursing program in Sweden.

PARTICIPANTS

161 students.

METHODS

Participants conducted a one-day food record by documenting their food intake and calculating the nutritional values. After completion, students participated in a seminar, and an evaluative questionnaire was distributed at the end. The questionnaires contained both numerical and free-text questions.

RESULTS

Of 162 students attending the seminar, all but one completed the questionnaire (response rate: 99%). The highest rated learning outcome, on the 5-point Likert scale, was an increased understanding for the nutritional recommendations (Median, M = 5). The highest rated educational aspects were that they compared their records with the nutritional recommendations (M = 5), and the calculations of nutritional values of their records (M = 5). Participants also indicated that they gained information that would be useful for them as practicing nurses (M = 5).

CONCLUSIONS

Overall, the food diary method appeared to be a feasible method in educating and engaging undergraduate nursing students in the field of basic nutrition. These findings support results from previous studies in this area, such that educational nutrition activities that utilize active, experiential, and social learning strategies were appreciated by the students.

Nursing Students' Eating Habits, Subjective, and Mediterranean Nutrition Knowledge During the COVID-19 Pandemic

BACKGROUND

Mediterranean nutrition knowledge, healthy eating habits, and subjective nutritional knowledge are crucially important to nursing students' health. The study strives to examine, during the COVID-19 pandemic period: (a) nursing students' eating habits and their subjective nutritional knowledge according to three groups: novice, advanced, and senior; and (b) subjective knowledge and its role as a mediator between Mediterranean nutritional knowledge and nursing students' eating habits.

METHODS

A cross-sectional study design with a convenience sample consisting of 212 university nursing students. Participants volunteered to complete a questionnaire that examined their eating habits, subjective nutritional knowledge, and Mediterranean diet knowledge. The university's institutional review board provided permission to conduct the current study.

RESULTS

Nursing students from the novice group had better eating habits than the advanced and senior groups, and no significant differences were found between the advanced and senior groups regarding eating habits. Additionally, Mediterranean nutritional knowledge had a positive indirect effect on eating habits through subjective nutritional knowledge. Therefore, subjective nutritional knowledge partially mediated the relationship between Mediterranean nutritional knowledge and eating habits.

CONCLUSION

First, especially for the advanced and senior groups, it is important to create opportunities for learning via seminars, symposia, and webinars. Interprofessional teams, such as clinical nutritionists or a registered certified dietitian and nursing student, can engage with important, authentic information. Second, since subjective nutritional knowledge was found to be a partial mediator, it may be assumed that there are other mediating variables that we did not examine in this study. Therefore, it is necessary to conduct further research to examine other factors that can serve as mediators for eating habits, in addition to subjective knowledge, especially during COVID-19 times.

[Assessing the implementation of a nutritional screening protocol in patients admitted to the Medicine Department of a local hospital]

Introduction

Background: the techniques for screening and nutritional intervention in hospitalized patients are a cost-effective measure. In clinical practice the problem lies in their administration. Objective: to evaluate the implementation of a nutritional screening tool in patients admitted to our Medicine Ward (M). Material and methods: a single-center, prospective, observational study in patients admitted to M. Exclusion criteria: end-stage cancer patients, inpatient stay less than 72 h, and hospital readmission of previously included patients. One out of every 2 hospital admissions was selected. We assessed the following: whether nurses performed the screening test, the Short Nutritional Assessment Questionnaire (SNAQ); the score obtained; consultations with dieticians (ICD); prescribed nutritional support; and coding of malnutrition in the discharge report. Dieticians repeated the SNAQ for one in every 3 patients. Results: during the study period 726 patients were admitted, 377 were selected, and 315 were included. The nursing staff administered the SNAQ to 93.6% of patients and malnutrition was present in 19%. Dieticians detected malnutrition in 37.8%. In 41.9% of patients with severe malnutrition an ICD was performed, whereas in 40% of them no nutritional intervention was implemented. The diagnosis of malnutrition was recorded in the discharge report of 42.1% of our cases. Conclusion: Compliance with screening test administration was good, but there is disagreement with the assessment made by dieticians. For most malnourished patients nutritional support fals to be prescribed, no ICDs are performed, and a malnutrition diagnosis is not included in the discharge report.

Validity and Reliability of a Nutrition Screening Tool in Identifying Malnutrition Among Hospitalized Adult Patients

BACKGROUND

Malnutrition among hospitalized patients is closely associated with various medical complications. This study aimed to determine the validity and reliability of a 3-Minute Nutrition Screening (3-MinNS) tool in identifying the risk of malnutrition among hospitalized patients that can be administered by healthcare professionals.

METHODS

A cross-sectional study was conducted between January and December 2012. A total of 350 adult patients in a teaching hospital were screened for risk of malnutrition using 3-MinNS and Subjective Global Assessment (SGA). To assess interrater reliability, each patient was screened for risk of malnutrition using 3-MinNS by 2 different nurses on 2 different occasions within 24 hours after admission. To assess the validity of 3-MinNS, the level of risk of malnutrition identified by the nurses using 3-MinNS was compared with the risk of malnutrition as assessed by a dietitian using SGA within 48 hours after the patients' enrolment into the study. The sensitivity, specificity, and predictive values were calculated in detecting patients at risk of malnutrition. Interrater reliability was determined using κ statistics.

RESULTS

Using SGA, the estimated prevalence of moderate to severe malnutrition was 36.3% (127/350). There was 94% proportional agreement between 2 nurses using 3-MinNS, and interrater reliability was substantial (κ = 0.79, P < .001). The analysis showed that 3-MinNS had moderate sensitivity (61.4%-68.5%) but high specificity (95.1%).

CONCLUSIONS

The 3-MinNS is a reliable and valid screening tool for use by healthcare professionals for identifying newly admitted medical and surgical patients who are at risk of malnutrition.

Nutritional Screening Tools among Hospitalized Children: from Past and to Present

Increased awareness of the importance of nutrition among hospitalized children has increased the use of nutrition screening tool (NST). However, it is not well known the NST for hospitalized children. Therefore, the purpose of this study is to understand the past and present state of adult and child NST and discuss the pros and cons of each NST.

Clinical and economic outcomes of nutrition interventions across the continuum of care

Optimal nutrition across the continuum of care plays a key role in the short- and long-term clinical and economic outcomes of patients. Worldwide, an estimated one-quarter to one-half of patients admitted to hospitals each year are malnourished. Malnutrition can increase healthcare costs by delaying patient recovery and rehabilitation and increasing the risk of medical complications. Nutrition interventions have the potential to provide cost-effective preventive care and treatment measures. However, limited data exist on the economics and impact evaluations of these interventions. In this report, nutrition and health system researchers, clinicians, economists, and policymakers discuss emerging global research on nutrition health economics, the role of nutrition interventions across the continuum of care, and how nutrition can affect healthcare costs in the context of hospital malnutrition.

A new way to measure mid-upper-arm circumference in african villages

In 2011 we published a study on how to detect the threshold for malnutrition in children, simply using their own hands and without any technical tool. The fight against malnutrition can only be reached when its measurements involve every single child, almost continuously, in the affected villages. In this paper we try to show that, thanks to our method, it is possible to use mid-upper-arm-circumference as a measurement for malnutrition in children, discriminating between severe and moderate malnutrition and providing the basis for the decision on whether to admit a child to a nutritional rehabilitation unit or not. We trained 63 participants in four groups (Group 1: doctors and clinical officers; Group 2: nurses and students; as Group 3 we defined the 20 best participants and Group 4 consisted of 10 more intensely trained participants) to measure the circumference of 9 different artificial arms (between 9 and 13 cm) using their own fingers and hands. The training was short and consisted of an introduction of 5 min, a first training phase of 10-15 min, a test, the critical discussion of the results, a second training phase of 5 min and a final test. We found that 95.3% of participants in the general group and 97.9% in the intensely trained group have identified the severely malnourished child; 87.3% in the general group and 91.9% in the intensely trained group have additionally identified the moderately malnourished child. Both groups haven't admitted the well nourished child to a therapeutic feeding program retaining their resources. The third group reached without any additional training the results in the above categories. A subsequent discussion with the participants on the influence of procurement, maintenance and pricing of our tool, found our method much less vulnerable than others. We conclude that this method should be considered as a future training in the villages to detect the trend towards malnutrition early enough.

A Pre-post Evaluation of an Ambulatory Nutrition Support Service for Malnourished Patients Post Hospital Discharge: A Pilot Study

Introduction: Malnutrition is common among hospitalised patients, with poor follow up of nutrition support post-discharge. Published studies on the efficacy of ambulatory nutrition support (ANS) for malnourished patients post-discharge are scarce. The aims of this study were to evaluate the rate of dietetics follow-up of malnourished patients post discharge, before (2008) and after (2010) implementation of a new ANS service, and to evaluate nutritional outcomes post-implementation. Materials and Methods: Consecutive samples of 261 (2008) and 163 (2010) adult inpatients referred to dietetics and assessed as malnourished using Subjective Global Assessment (SGA) were enrolled. All subjects received inpatient nutrition intervention and dietetic outpatient clinic follow-up appointments. For the 2010 cohort, ANS was initiated to provide telephone follow-up and home visits for patients who failed to attend the outpatient clinic. Subjective Global Assessment, body weight, quality of life (EQ-5D VAS) and handgrip strength were measured at baseline and five months post-discharge. Paired t-test was used to compare pre- and post-intervention results. Results: In 2008, only 15% of patients returned for follow-up with a dietitian within four months post-discharge. After implementation of ANS in 2010, the follow-up rate was 100%. Mean weight improved from 44.0 ± 8.5 kg to 46.3 ± 9.6 kg, EQ-5D VAS from 61.2 ± 19.8 to 71.6 ± 17.4 and handgrip strength from 15.1 ± 7.1 kg force to 17.5 ± 8.5 kg force; P <0.001 for all. Seventy-four percent of patients improved in SGA score. Conclusion: Ambulatory nutrition support resulted in significant improvements in follow-up rate, nutritional status and quality of life of malnourished patients post-discharge. Key words: Home visit, Malnutrition, Outcomes, Telephone, 7-point Subjective Global Assessment