Simple Nutritional Screening Tool (SNST) Has Good Validity to Identify Risk of Malnutrition on Hospitalized Elderly Patients

Analisis Mikrobia dan Organoleoptik Makanan Cair Instan Berbasis Pangan Lokal untuk Perbaikan Status Gizi Pasien

ABSTRACT Background: Every hospital has high demand of nutritional support for patient but limitation of hospital funding to get commercial enteral nutrition that may influence the hospital of making its own enteral nutrition. It has some weakness such as not ready to use, not durable, and unstandardized nutrition content. Pumpkin, fish cork, and tempeh are less costly local food which contain high protein and antioxidant that may lead nutritional status improvement. Objectives: Determining total fungal count, total bacterial count and organoleptic properties of instant local food based-enteral nutrition.Methods: Pure-experimental study with completely random design was conducted on March-August 2018.  There are 4 flavors of the instant formula such as vanilla, ginger, cinnamon, and original. Total fungal count (TFC) and total bacterial count (TBC) were used for microbiological analysis. Organoleptic properties was evaluated by 80 panelists from Yayasan Stroke Indonesia. Inclusion criterias: aged 19-years or above and signing the informed consent. Organoleptic evaluation determined by 5 score of appearance, taste, texture, odour and overall formula. Statistical analysis used Kruskal Wallis to determine the difference of enteral nutrition acceptability for each flavor. Results: Mean of TBC of local food based-enteral nutrition was 3.5 x 104 ± 0.14 cfu/mg and mean of TFC was 1.65 x 102 ± 0.21 cfu/g. The acceptability of local food based-enteral nutrition was significantly different based on taste, odour, and overall aspect.Conclusions: Based on microbiology analysis showed that local food based-enteral nutrition was desirable. Panelist liked original flavor most based on appearance, taste, and texture. While the vanilla flavor was liked the most based on the odour and overall aspect. The score of acceptability showed significantly different on ginger, vanilla, and original flavors based on taste, odour, and overall aspect.ABSTRAKLatar Belakang: Tingginya kebutuhan dukungan gizi pasien namun terbatasnya biaya penyediaan makanan enteral komersial mendorong Rumah Sakit (RS) untuk membuat formula enteral sendiri. Kekurangan dari formula enteral buatan RS diantaranya tidak praktis, tidak tahan lama, dan nilai gizi yang tidak terpantau. Labu kuning, ikan gabus dan tempe merupakan bahan pangan lokal yang terjangkau dengan kandungan protein dan antioksidan tinggi  bermanfaat untuk perbaikan status gizi.Tujan: Mengetahui angka total mikrobia (bakteri dan jamur) dan sifat organoleptik dari makanan cair instan berbasis pangan lokal.Metode: Penelitian eksperimental dengan rancangan acak lengkap dilakukan pada Maret-Agustus 2018. Formula makanan cair memiliki 4 varian: vanilla, jahe, kayu manis, dan original. Analisis mikrobiologi menggunakan metode angka lempeng total (ALT) untuk bakteri dan jamur. Pengujian sifat organoleptik formula dilakukan oleh  80 panelis tidak terlatih dari anggota  Yayasan Stroke Indonesia. Kriteria inklusi untuk panelis uji organoleptik antara lain bersedia menjadi panelis dengan mengisi informed consent, usia ≥19 tahun. Uji organoleptik dengan 5 skala kesukaan berdasarkan aspek warna, aroma, rasa, tekstur, dan keseluruhan. Uji statistik menggunakan Kruskal Wallis untuk melihat perbedaan tingkat kesukaan dari tiap varian formula makanan cair.Hasil: Hasil analisis mikrobia dari formula menunjukkan rerata ALT bakteri 3,5 x 104 ± 0,14 cfu/mg, dan ALT jamur 1,65 x 102 ± 0,21 cfu/g. Terdapat perbedaan yang signifikan pada tingkat kesukaan varian formula makanan cair dari segi rasa, aroma, dan keseluruhan formula.Kesimpulan: Uji mikrobia formula makanan cair masih dalam batas aman untuk dikonsumsi. Responden paling menyukai varian rasa original dari aspek warna, rasa, dan tekstur, sedangkan secara keseluruhan dan aroma formula rasa vanilla yang paling disukai. Perbedaan rerata skor yang signifikan ditunjukkan pada varian rasa jahe, vanilla dan original dari segi rasa, serta varian rasa jahe dengan vanilla dari segi aroma dan keseluruhan.

A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study

BACKGROUND

Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults.

METHODS

A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings. A database of screening tools was created containing information on how each tool was validated.

RESULTS

Seventy-four articles containing 119 validation studies of 34 malnutrition screening tools used in older adults were identified across the settings. Twenty-three of these tools were designed for older adults. Sensitivity and specificity ranged from 6 to 100% and 12-100% respectively. Seventeen different reference standards were used in criterion validation studies. Acceptable reference standards were used in 68 studies; 38 compared the tool against the Mini Nutritional Assessment-Full Form (MNA-FF), 16 used clinical assessment by a nutrition-trained professional and 14 used the Subjective Global Assessment (SGA). Twenty-five studies used inappropriate reference standards. Predictive validity was measured in 14 studies and was weak across all settings.

CONCLUSIONS

Validation results differed significantly between tools, and also between studies using the same tool in different settings. Many studies have not been appropriately conducted, leaving the true validity of some tools unclear. Certain tools appear to be more valid for use in specific settings.

Evaluating the effectiveness of five screening tools used to identify malnutrition risk in hospitalized elderly: A systematic review

This systematic review investigated 5 frequently used nutrition screening tools (NSTs) used in hospitals and their effectiveness at identifying malnutrition risk in the elderly. A literature review was conducted to obtain research articles focused on malnutrition screening in hospitalized elderly and effectiveness of the NST used. Twenty six articles were reviewed and evaluated, resulting in 8 that met inclusion criteria. The Mini Nutritional Assessment-Short Form, designed for use in the elderly, resulted in overestimation of malnutrition. Four screening tools did demonstrate more effectiveness in identifying malnutrition risk; however, several different biochemical and anthropometric parameters were used, which prevented meaningful comparisons. There is a need for a universal NST "gold standard" for use in the elderly, and further research is indicated.