Nutrition in Clinical Practice最新文献

Background: Ileostomy and colostomy patients benefit from more nutrition education than patients who receive bowel resections without ostomy creation. Nutrition can influence the adaptation to a stoma and may help manage complications. The impact of nutrition education on health outcomes is known, but a gap exists for the type and timing of nutrition information for patients with newly formed ostomies.

Methods: A survey of open-ended and closed-ended questions was designed to evaluate experiences about nutrition education provided for living with an ostomy. The survey was conducted during hospital admission for ostomy reversal: 39 patients were approached, 36 consented, and all 36 completed the survey.

Results: Of the 36 patients who took part in the study, 20 (56%) were male. The mean age was 57.7 years. Twenty-four (67%) patients were admitted for an ileostomy reversal and 12 (33%) patients for a colostomy reversal. When patients were asked about their preferred timing of nutrition education, 28% (n = 10) wanted information before surgery, 58% (n = 21) wanted the information in the hospital when admitted for ostomy creation, and 14% (n = 5) wanted to receive it after discharge. A total of 25% (n = 9) of patients commented on the need for a follow-up phone call after discharge to ask questions.

Conclusion: Nutrition education is valuable for patients, and most patients want to receive nutrition information while in the hospital. A follow-up session with a dietitian after discharge could assist patients in developing strategies to manage weight changes, prevent dehydration, and lower the risk of malnutrition.

Background: This study aimed to assess the prevalence of malnutrition according to Subjective Global Assessment (SGA), Mini Nutritional Assessment-Full Form (MNA-FF), and different combinations of the Global Leadership Initiative on Malnutrition (GLIM) criteria in older adults who are institutionalized, and the impact of malnutrition on 5-year mortality.

Methods: Nutrition status was assessed by the SGA, MNA-FF, and 15 GLIM criteria combinations. The Katz scale was used to assess the level of dependence. The SGA was considered the reference method, and the agreement (Kappa test), sensitivity, and specificity values were calculated for each GLIM criteria combination. The variables associated with 5-year mortality were assessed using multivariate logistic regression models.

Results: One hundred eleven participants (mean age: 81y; interquartile range: 76.0-87.0; 90.9% women) were included; the prevalence of malnutrition according to the SGA and MNA-FF were 49.5% (n = 55) and 8.1% (n = 9), respectively. The prevalence of malnutrition varied from 1.8% to 36.0% considering GLIM combinations. Eight GLIM criteria combinations had a fair agreement with SGA (κ: 0.21-0.40), and two had sensitivity >80%. Regarding mortality, 43 participants (38.7%) died within 5 years. Malnutrition according to the SGA (odds ratio [OR]: 2.82; 95% confidence interval [CI]: 1.06-7.46) and the Katz scale score (OR: 4.64; 95% CI:1.84-11.70) were independent predictors of mortality.

Conclusion: The prevalence of malnutrition varied according to the assessment tools. Malnutrition diagnosed by the SGA, but not by the GLIM criteria or MNA-FF, was associated with 5-year mortality in older adults who were institutionalized.

Background: The aim of this study was to pilot a protocol for prospective validation of the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospital patients and evaluate its feasibility and patient acceptability.

Methods: The validation protocol follows the GLIM consortium's rigorous methodological guidance. Protocol feasibility was assessed against criteria on recruitment (≥50%) and data collection completion (≥80%); protocol acceptability was assessed via patient satisfaction surveys and interviews. Adult inpatients in a tertiary hospital underwent four nutrition assessments (each by a different assessor); two Subjective Global Assessments (SGAs) and two GLIM assessments. All five GLIM criteria were assessed with bioelectrical impedance analysis used for muscle mass. Interrater reliability, criterion validity, and predictive validity were reported to detect trends.

Results: All primary feasibility criteria were met (consent rate 76%; data for GLIM criterion validity collected on 83% participants). Of predictive outcome data, 100% of hospital-related data, 82% of 6-month mortality data, and 39% of 6-month health-related quality of life data were collected. The mean (SD) age of participants was 61.0 ± 16.2 years, and 51.5% were male. The median (interquartile range) length of stay and body mass index were 7 (4-15) days and 25.6 (24.2-33.0) kg/m², respectively. GLIM criteria diagnosed 70% of the patients as malnourished vs 55% with SGA. Most patients found the data collection acceptable with minimal burden.

Conclusion: The methods outlined in this rigorous GLIM validation protocol are feasible to undertake in hospitals and acceptable to patients. This paper provides practical methodological guidance for future prospective GLIM validation studies.

Background: The aim of the study was to investigate the frequency of malnutrition in hospitalized children and compare national growth standards with World Health Organization (WHO) standards.

Methods: After obtaining height, weight, and mid-upper arm circumference values for 250 children aged 1 month to 5 years, nutrition status was assessed separately according to Neyzi and WHO standards. Weight-for-age z score (WAZ), weight-for-height z score (WHZ), height-for-age z score (HAZ), and mid-upper arm circumference z score (MUACz) were calculated based on age. Patients with WHZ < -2 were considered to have acute malnutrition, while those with HAZ < -2 were considered to have chronic malnutrition per WHO's definition.

Results: According to the WHO and Neyzi standards, the z scores were as follows: WAZ (-0.53 ± 1.54/-0.61 ± 1.52), HAZ (-0.42 ± 1.61/-0.45 ± 1.38), WHZ (-0.33 ± 1.26/none), MUACz (-0.58 ± 1.31/none). The difference between WAZ scores for the two standards was highly significant (P = 0.0001), whereas the difference between HAZ scores didn't reach statistical significance (P = 0.052). In our study when evaluated according to WHO standards, the prevalence of acute and chronic malnutrition was 9.6% and 13.6%, respectively. The prevalence of chronic malnutrition in those aged <2 years was higher than in the 2-5 years age group (16.8% and 4.5%, respectively; P = 0.012).

Conclusion: There were highly significant differences in the assessment of malnutrition between the WHO and national Neyzi according to WAZ standards, contradicting the claim that WHO curves can be universally applicable. The high rates of acute and chronic malnutrition in our study indicate that malnutrition remains a significant nutrition problem in our country.

Background: Phase angle (PhA) correlates with body composition and could predict the nutrition status of patients and disease prognosis. We aimed to explore the feasibility of predicting PhA-diagnosed malnutrition using facial image information based on deep learning (DL).

Methods: From August 2021 to April 2022, inpatients were enrolled from surgery, gastroenterology, and oncology departments in a tertiary hospital. Subjective global assessment was used as the gold standard of malnutrition diagnosis. The highest Youden index value was selected as the PhA cutoff point. We developed a multimodal DL framework to automatically analyze the three-dimensional (3D) facial data and accurately determine patients' PhA categories. The framework was trained and validated using a cross-validation approach and tested on an independent dataset.

Results: Four hundred eighty-two patients were included in the final dataset, including 176 with malnourishment. In male patients, the PhA value with the highest Youden index was 5.55°, and the area under the receiver operating characteristic curve (AUC) = 0.68; in female patients, the PhA value with the highest Youden index was 4.88°, and AUC = 0.69. Inpatients with low PhA had higher incidence of infectious complications during the hospital stay (P = 0.003). The DL model trained with 4096 points extracted from 3D facial data had the best performance. The algorithm showed fair performance in predicting PhA, with an AUC of 0.77 and an accuracy of 0.74.

Conclusion: Predicting the PhA of inpatients from facial images is feasible and can be used for malnutrition assessment and prognostic prediction.

Background: Ethical competencies dealing with decision-making for clinicians involved in artificially administered nutrition and hydration (AANH) have not been defined in the literature. Although clinical assessments identify nutrition needs and appropriate routes of nutrition administration, an assessment of the ethical, cultural, and spiritual implications of the medical nutrition therapy may be overlooked.

Methods: Eleven competency statements were developed by members of two international sections of the American Society for Parenteral and Enteral Nutrition. This descriptive cross-sectional survey study was conducted to measure the importance of the competency statements to the membership of two sections using a five-point Likert scale of 1-5 (1-low to 5-high).

Results: A total of 113 responses (12.5% response rate) were obtained predominantly from physicians and dietitians from 25 countries. There was a wide range of world regions of the 49% respondents outside of the United States. Means and SDs were calculated for agreement with the 11 competency statements with overall means ranging from 4.32 to 4.67. Most of the participants cared for adult/older adult patients (63.7%) exclusively, and 12.4% cared for pediatric/neonate patients exclusively; the remainder (23.9%) cared for both populations. Respondents reported they were either experienced, competent, or expert (88.6%) in dealing with ethical issues related to AANH.

Conclusion: This international interdisciplinary group agreed that the integration of ethical, cultural, and spiritual competencies into clinical decision-making regarding artificially AANH is important.

Background: Mid-upper arm circumference (MUAC) is a simple anthropometric tool used to screen for childhood undernutrition in humanitarian settings or low-income and middle-income countries. However, there is conflicting evidence and a lack of consensus with regard to its diagnostic use in clinical settings or population groups beyond this context. In 2023, a project officer was appointed by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) to lead the development of a consensus review into the use of MUAC in the pediatric clinical setting.

Methods: An AuSPEN appointed multidisciplinary group of informed clinicians used the Delphi method to critically appraise the evidence and develop a series of consensus statements. Delphi surveys were anonymous and distributed electronically. Members were asked to rate their level of agreement with each consensus statement using a 5-point Likert scale. A priori definition of consensus was established as ≥80% responses "agree" or "strongly agree."

Results: Three Delphi rounds were required to reach consensus. A total of 18 consensus statements, including rationale, were developed across the topics 'assessment and diagnosis', 'screening and monitoring' and 'clinical settings'.

Conclusion: An evidence-based, region-specific consensus approach to the use of MUAC in pediatric malnutrition is a valuable tool for clinicians. MUAC is a straightforward, non-invasive and cost-effective tool, and may provide an advantage over traditional anthropometric tools in some clinical settings. There are limitations to the utility of MUAC and this consensus paper provides an empirical summary of advantages and limitations as they apply to the screening, assessment, diagnosis, and monitoring of pediatric malnutrition.

Most every new clinician practicing in nutrition support enters their practice environment with wide open eyes and a sense of curiosity as they encounter new patient and clinical experiences. As clinicians expand their expertise, they often identify challenges they are eager to address. Eagerness turns to passion as the desire to affect change grows. Malnutrition has sparked curiosity and interest in many, and, in some, it has become a passion. As a result, many major achievements have occurred both in the United States and globally that have the capability of moving the needle favorably to achieve better outcomes for our patients. This lecture will highlight how curiosity, eagerness, and passion have led to successes in addressing aspects of malnutrition. These successes offer the structure to continue our efforts to move the needle forward. Our patients deserve nothing more.

Background: Several screening tools have been developed to identify sarcopenia. However, data on the use of these screening tools in hospital settings are limited. This study assessed the diagnostic accuracy of three screening methods-strength, assistance walking, rising from a chair, climbing stairs, and falls (SARC-F); SARC-F combined with calf circumference (SARC-CalF); and the Ishii tests-for detecting sarcopenia in older individuals who are hospitalized.

Methods: This study included 204 older people who were hospitalized. Sarcopenia was assessed relative to the diagnostic criteria established by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Muscle mass, muscle strength, and physical performance were evaluated using bioimpedance analysis, handgrip strength, and usual gait speed, respectively. Sensitivity and specificity analyses were conducted for the SARC-F, SARC-CalF, and Ishii tests to determine their effectiveness. Receiver operating characteristics curves were generated, and the area under curve was calculated to compare the overall diagnostic accuracy of the SARC-F, SARC-CalF, and Ishii tests.

Results: The SARC-F, SARC-CalF, and Ishii tests demonstrated sensitivities of 72%, 88.6%, and 93.5%, respectively, and specificities of 41%, 78.5%, and 30.3%, respectively.

Conclusions: SARC-CalF demonstrates the highest performance in terms of sensitivity and specificity compared with the other two tests, making it a valuable tool for detecting sarcopenia in hospital settings. In contrast, the Ishii test exhibits high sensitivity but low specificity within this population. Based on our results, we found that SARC-CalF can be used as a simple, effective test for identifying sarcopenia in older patients in the hospital setting.

Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria have rapidly developed into a principal methodological framework for nutrition diagnosis. However, the applicability of the GLIM criteria in patients with acute abdomen has not been validated.

Methods: This is a cross-sectional study conducted on patients diagnosed with acute abdomen and admitted to a tertiary hospital in southwest China. Nutrition risk screening was conducted using the Nutrition Risk Screening 2002, and patients identified with nutrition risk were assessed for malnutrition based on the GLIM criteria.

Results: We enrolled a total of 440 patients with acute abdomen. The top three diagnoses of acute abdomen were intestinal obstruction (47.2%), acute appendicitis (23.1%), and digestive system perforation (8.8%). The prevalence of nutrition risk was 46.5%, with a malnutrition rate of 32.5% based on the GLIM. Patients with malnutrition according to the GLIM showed significantly higher rates of intensive care unit (ICU) admission (13.28% vs 7.07%; P = 0.003), increased hospitalization costs (median: 3315USD [interquartile range (IQR): 978-7852] vs 1641 [IQR: 816-3523] USD; P < 0.001), and longer length of hospital stay (LOS) (median: 8 [IQR: 5-13] vs 6 [IQR: 4-8] days; P < 0.001) compared with patients without malnutrition. Multivariate analysis indicated that GLIM-defined malnutrition was an independent predictor of hospitalization costs, and severe malnutrition was an independent predictor of ICU admission.

Conclusion: GLIM criteria are applicable for diagnosing malnutrition in patients with acute abdomen. The prevalence of malnutrition was high in patients with acute abdomen. Malnutrition was associated with increased ICU admission and LOS, along with higher economic burden.