Nutrition in Clinical Practice最新文献

Background: Nutrition screening on admission is critically important to systematically identify patients with undernutrition given the known relationship with deleterious clinical outcomes. Limited data exist regarding optimal processes and criteria for pediatric nutrition screening. Therefore, we sought to characterize nutrition screening practices in pediatric hospitals.

Methods: A total of 365 inpatient pediatric hospitals in the United States were identified, eligible, and contacted. Eligible hospitals included general pediatric hospitals, adult hospitals with pediatric units, and specialty pediatric hospitals. One respondent at each eligible hospital was asked to complete a 33-question survey of admission nutrition screening practices.

Results: Of 268 survey respondents, 37% represented pediatric units in adult hospitals, 35% general pediatric hospitals, and 28% pediatric specialty or psychiatric hospitals. A total of 98.5% endorsed the existence of a screening process on admission. Anthropometrics (eg, body mass index z score, 84%) and nutrition status (eg, change in intake, 67%) were the most common screening criteria applied. A nutrition screening instrument was used in 37% of institutions, and only 31% of institutions reported using pediatric-specific screening instruments. Pediatric units within adult hospitals were 1.38 times more likely to use a screening instrument validated in any population. Barriers to nutrition screening included the lack of a standard screening procedure and insufficient staff to conduct screening. Fifty-four percent of respondents reported a desire to change their hospital's nutrition screening process.

Conclusion: Most pediatric hospitals screen for nutrition risk on admission. However, methods and criteria varied widely across pediatric hospitals, highlighting the importance of standardized best practices.

Information on the use of validated malnutrition risk screening tools in pediatric facilities to guide malnutrition identification, diagnosis, and treatment is scarce. Therefore, a survey of pediatric healthcare facilities and practitioners to ascertain malnutrition risk screening practices in North America was conducted. A pediatric nutrition screening practices survey was developed and sent to members of the American Society for Parenteral and Enteral Nutrition, the Council for Pediatric Nutrition Professionals and the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group. Respondents represented 113 pediatric hospitals in the United States and six in Canada, of which 94 were inpatient and 59 were outpatient. Nutrition risk screening was completed in 90% inpatient settings, and 63% used a validated screening tool. Nurses performed most malnutrition risk screens in the inpatient setting. Nutrition risk screening was reported in 51% of outpatient settings, with a validated screening tool being used in 53%. Measured anthropometrics were used in 78% of inpatient settings, whereas 45% used verbally reported anthropometrics. Measured anthropometrics were used in 97% outpatient settings. Nutrition risk screening was completed in the electronic health record in 80% inpatient settings and 81% outpatient settings. Electronic health record positive screen generated an automatic referral in 80% of inpatient and 45% of outpatient settings. In this sample of pediatric healthcare organizations, the results demonstrate variation in pediatric malnutrition risk screening in North America. These inconsistencies justify the need to standardize pediatric malnutrition risk screening using validated pediatric tools and allocate resources to perform screening.

Malnutrition in patients with obesity presents a complex and often overlooked clinical challenge. Although obesity is traditionally associated with overnutrition and excessive caloric intake, it can also coincide with varying degrees of malnutrition. The etiopathogenesis of obesity is multifaceted and may arise from several factors such as poor diet quality, nutrient deficiencies despite excess calorie consumption, genetics, and metabolic abnormalities affecting nutrient absorption and utilization. Moreover, a chronic low-grade inflammatory state resulting from excess adipose tissue, commonly observed in obesity, can further exacerbate malnutrition by altering nutrient metabolism and increasing metabolic demands. The dual burden of obesity and malnutrition poses significant risks, including immune dysfunction, delayed wound healing, anemia, metabolic disturbances, and deficiencies in micronutrients such as vitamin D, iron, magnesium, and zinc, among others. Malnutrition is often neglected or not given enough attention in individuals with obesity undergoing rapid weight loss through aggressive caloric restriction, pharmacological therapies, and/or surgical interventions. These factors often exacerbate vulnerability to nutrition deficiencies. We advocate for healthcare practitioners to prioritize nutrition assessment and initiate medical intervention strategies tailored to address both excessive caloric intake and insufficient consumption of essential nutrients. Raising awareness among healthcare professionals and the general population about the critical role of adequate nutrition in caring for patients with obesity is vital for mitigating the adverse health effects associated with malnutrition in this population.

This review examines our current understanding of consensus definitions for frailty, sarcopenia, and cachexia and their perceived overlap with malnutrition. Patients with these syndromes will often meet the criteria for malnutrition. It is common for these overlap syndromes to be misapplied by practitioners, and confusion has been further exacerbated by the lack of a common malnutrition language. To address the latter concern, we recommend using either the standalone Global Leadership Initiative in Malnutrition (GLIM) framework or the GLIM consensus criteria integrated with other accepted approaches as dictated by preference and available resources. Established care standards should guide the recognition and treatment of malnutrition to promote optimal clinical outcomes and quality of life. The effectiveness of nutrition interventions may be reduced in settings of severe acute inflammation and in end-stage disease that is associated with cachexia. However, such interventions may still assist patients to tolerate treatments that target the underlying etiology for an overlap syndrome, and they may help to improve select clinical outcomes and quality of life. Recent, large, well-designed randomized controlled trials have demonstrated the compelling positive clinical effects of medical nutrition therapy. The application of concurrent malnutrition risk screening and assessment is therefore a high priority. The necessity to deliver specific interventions that target the underlying mechanisms of these overlap syndromes and also diagnose and address malnutrition is paramount. It must be highlighted that securing beneficial outcomes for frailty, sarcopenia, and cachexia will also require nonnutrition interventions, like comprehensive care plans, pharmacologic agents, and prescribed exercise.

Background: Differences in definitions and operational diagnoses for sarcopenia create difficulties in understanding the epidemiology of the disease. We examined the prevalences of sarcopenia using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) and the Sarcopenia Definitions and Outcomes Consortium (SDOC) consensuses and analyzed their level of agreement in patients receiving hemodialysis.

Methods: Data from the SARCopenia trajectories and associations with clinical outcomes in patients receiving hemodialysis (SARC-HD) multicenter study in Brazil were analyzed. Muscle strength was assessed using handgrip strength, muscle mass by calf circumference, and physical performance by the 4-m gait speed test. Sarcopenia was diagnosed according to both the EWGSOP2 (low muscle strength plus low muscle mass) and the SDOC (low muscle strength plus low physical performance). The Cohen kappa statistic was used to determine the level of agreement between the consensuses.

Results: 838 patients (57.8 ± 15.0 years; 61% men) from 19 dialysis units were included. We found similar prevalences of sarcopenia between the consensuses (EWGSOP2, n = 128, 15.3%; SDOC, n = 105, 12.5%) but with weak agreement (50 of 233 patients, 21.5%; κ = 0.34, 95% CI 0.25-0.43). Agreement was also weak within age categories (≥60 years, κ = 0.34; <60 years, κ = 0.15; both P < 0.001). Of the 51 patients diagnosed by the EWGSOP2 criterion as having severe sarcopenia, all but 1 (98.0%) met the SDOC criterion for sarcopenia (κ = 0.61, 95% CI 0.52-0.70). Low muscle strength was more frequently diagnosed using the SDOC than with the EWGSOP2 (52.3% vs 25.9%).

Conclusion: We found a weak agreement between the EWGSOP2 and SDOC consensuses for the diagnosis of sarcopenia in patients receiving hemodialysis. Although still weak, agreement was marginally better for older patients. These findings highlight the importance of a global and standardized conceptual diagnosis of sarcopenia.

Background: There exists a bidirectional relationship between tuberculosis (TB) and nutrition, wherein they mutually influence and interact causally. However, current guidance for providing nutrition support to individuals diagnosed with TB remains inadequate, leading to a significant gap in comprehensive patient care. This study aims to assess the nutrition status of patients with TB and endeavors to provide insights into early nutrition interventions for individuals vulnerable to TB-associated malnutrition.

Methods: Data from 2204 newly admitted patients at Beijing Chest Hospital in 2020 were collected, with 1735 patients with confirmed TB aged ≥18 years after exclusions. Patient data, encompassing diagnosis and results from routine blood tests and biochemical analyses conducted on the day after admission, were gathered using the electronic medical records system. Nutrition risk screening was conducted using the Nutritional Risk Screening 2002 (NRS 2002) tool, and questionnaire-based assessments were administered. Statistical analyses were performed using SPSS 17.0 software.

Results: Among 1735 patients with TB, the occurrence rate of nutrition risk was 74.58%. Factors such as age ≥65 years, sputum smear positivity for TB, and concurrent illnesses significantly increased the occurrence rate of nutrition risk. Nutrition risk among patients with TB exhibited negative correlations with parameters such as body weight, hemoglobin, and serum albumin level while showing positive correlations with white blood cell count and C-reactive protein, among others.

Conclusion: The occurrence rate of nutrition risk among patients with TB at Beijing Chest Hospital was notably high, particularly among older individuals, those with sputum smear positivity, and those with concurrent illnesses.

Healthcare systems and patients today are challenged by high and ever-escalating costs for care. With increasing costs and declining affordability, public and private healthcare payers are all seeking value in care. As the evidence regarding health benefits of nutrition products and interventional nutrition care is increasing, cost-effectiveness of these interventions needs consideration. Health economics and outcomes research (HEOR) examines the value of healthcare treatments, including nutrition interventions. This review summarizes how HEOR tools are used to measure health impact, that is, the burden of illness, the effect of interventions on the illness, and the value of the nutrition intervention in terms of health and cost outcomes. How studies are designed to compile data for economic analyses is briefly discussed. Then, studies that use HEOR methods to measure efficacy, cost-effectiveness, and cost savings from nutrition care across the healthcare spectrum-from hospitals to nursing homes and rehabilitation centers, to care for community-living individuals, with an emphasis on individuals who are older or experiencing chronic health issues-are reviewed. Overall, findings from HEOR studies over the past decade build considerable evidence to show that nutrition care improves the health of at-risk or malnourished patients effectively and at a reasonable cost. As such, the evidence suggests that nutrition care brings value to healthcare across multiple settings and populations.

Background: Malnutrition is common in hospitalized patients with cancer and adversely affects clinical outcomes. We evaluated the prevalence of malnutrition risk, dietitian-identified malnutrition (DIMN), and physician-diagnosed malnutrition (PDMN) at admission.

Methods: This retrospective study included adults diagnosed with a stage I-IV solid tumor malignancy and admitted to Atrium Health Carolinas Medical Center from January 2016 to May 2019. Malnutrition risk was determined by a score ≥2 on the Malnutrition Screening Tool (MST) administered by a registered nurse during the intake process. Registered dietitian nutritionist (RDN) assessments were reviewed for DIMN and grade (mild, moderate, or severe). PDMN included malnutrition International Classification of Diseases, Tenth Revision codes in the discharge summary. Univariate models were estimated; multivariate logistic regression models identified associations between clinicodemographic factors and malnutrition prevalence with stepwise selection.

Results: A total of 5143 patients were included. Median age was 63 (range 18-102) years, 48% were female, 70% were White, and 24% were Black. Upper gastrointestinal (21%), thoracic (18%), and genitourinary (18%) cancers were most common. A total of 28% had stage IV disease. MST scores were available for 4085 (79%); 1005 of 4085 (25%) were at malnutrition risk. Eleven percent (n = 557) had malnutrition coded by a physician or documented by an RDN; 4% (n = 223) of these were identified by both clinicians, 4% (n = 197) by RDNs only, and 3% (n = 137) by physicians only.

Conclusion: Malnutrition appears to be underdiagnosed by both RDNs and physicians. Underdiagnosis of malnutrition may have significant clinical, operational, and financial implications in cancer care.

Background: Hospitalized individuals present high rates of malnutrition and loss of muscle mass (MM). Imaging techniques for assessing MM are expensive and scarcely available in hospital practice. The Global Leadership Initiative on Malnutrition (GLIM) proposed a framework for malnutrition diagnosis that includes simple measurements to assess MM, such as calf circumference (CC) and mid-upper arm circumference (MUAC). This study aimed to analyze the validity of the GLIM criteria with CC and MUAC for malnutrition diagnosis, using Subjective Global Assessment (SGA) as the reference standard, in inpatients.

Methods: A prospective cohort study was conducted on 453 inpatient adults in a university hospital. The presence of malnutrition was assessed within 48 h of hospital admission using SGA and GLIM criteria using CC and MUAC as phenotypic criteria for malnutrition diagnosis. Accuracy, agreement tests, and logistic regression analysis adjusted for confounders were performed to test the validity of the GLIM criteria for malnutrition diagnosis.

Results: The patients were aged 59 (46-68) years, 51.4% were male, and 67.8% had elective surgery. Compared with SGA, the GLIM criteria using the two MM assessment measures showed good accuracy (area under the curve > 0.80) and substantial agreement (κ > 0.60) for diagnosing malnutrition. The highest sensitivity was obtained with GLIM_CC (89%), whereas GLIM_MUAC showed high specificity (>90%). Also, malnutrition identified by GLIM_CC and GLIM_MUAC was significantly associated with prolonged hospitalization and in-hospital death.

Conclusion: In the absence of imaging techniques to assess MM, the use of CC and MUAC measurements from the GLIM criteria demonstrated satisfactory validity for diagnosing malnutrition in hospitalized patients.