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Background: In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those identified as 'at risk' may help reduce malnutrition risk and associated healthcare use, and improve quality of life. The aim of this study is to explore how primary care practitioners (PCPs) and older adults perceive, use and respond to an intervention to support those identified as 'at risk'. Methods: We developed and optimised an intervention (screen and treat protocol, online tools and printed materials) to support primary care practitioners to identify malnutrition risk among older adults, and intervene where necessary. We recruited older adults (described as 'patients' here) taking part in a feasibility study, and carried out semi-structured interviews to assess PCPs' and patients' engagement with the intervention, and identify any contextual issues that supported or undermined their engagement. Results: Four themes were developed, encompassing patients' and PCPs' perceptions of undernutrition, study measures and appointments, constraints on PCPs' enthusiasm to make a difference, and patients' expectations of nutritional appointments. Key findings included patients commonly not accepting advice for undernutrition/malnutrition but welcoming support for their nutritional needs; checklists potentially distracting patients from recalling discussions about their nutritional needs; a tension between PCPs' desire to recruit less-well patients and logistical difficulties in doing so; and patients compromising their nutritional needs to suit others. Conclusions: Diverse factors influence whether an intervention succeeds in primary care. PCPs learn about an intervention/study in different ways, vary in how they understand and accept its aims, and desire to make a difference to their patients. Patients bring perceptions and expectations about the study's aims, coloured by their habits and preferences, prior experience of research and healthcare, and pressure from social expectations. Each aspect must be considered when developing a successful primary care intervention that is viewed as relevant and meaningful, and presented using language that aligns with participants' values and goals. Our findings suggest that references to 'malnutrition risk' should be avoided in any patient-facing materials/interactions as participants do not accept or identify with this label. [ABSTRACT FROM AUTHOR]

Introduction: For diagnosing malnutrition as an important modifiable risk factor in surgical cancer patients, GLIM criteria offer a standardised diagnostic pathway. Before assessing malnutrition, it is suggested to screen for malnutrition with an implemented screening tool, i.e., the NRS-2002. Validated data regarding the applied screening tool and its relevance for predicting outcome parameters in surgical patients is sparse. Methods: 260 patients undergoing major abdominal surgery for cancer were retrospectively analysed. Between January 2017 and December 2019, patients were prospectively screened for malnutrition with the Nutritional Risk Score 2002 (NRS). Irrespective of their screening result malnutrition was assessed with GLIM criteria using CT scan at lumbar level 3 for measuring skeletal muscle mass (GLIM MMCT). Patients with negative screening results (NRS ≤2) were analysed regarding their malnutrition assessment and outcome parameters. Results: Thirty four of 67 patients with NRS ≤2, posing no risk for malnutrition, were diagnosed malnourished according to GLIM MMCT (n = 34, 50.7%). 19 patients (55.9%) with NRS ≤2 and malnutrition according to GLIM had at least one complication, 12 patients (35.3%) had a severe complication (Clavien-Dindo grade ≥ 3a), in 26.5% re-laparotomy was necessary, readmission within 1 month in 20.6% of patients, and length of hospital stay was 18.76 ± 12.66, which was in total worse in outcome compared to the whole study group (n = 260). Patients with NRS ≤2 but diagnosed malnourished by GLIM were at significant higher risk to develop a severe complication (OR 2.256, 95% CI: 1.038–4.9095, p = 0.036) compared to patients with NRS ≤2 but not being diagnosed malnourished. The risk for overall complications was significantly increased in patients with malnutrition diagnosed by the GLIM criteria using MMCT (OR 2.028, 95% CI: 1.188–3.463, p = 0.009). Patients screened at risk with NRS ≥3 and diagnosed malnourished by GLIM were also at significant higher risk for developing complications (OR 1.728, 95% CI: 1.054–2.832, p = 0.029). Conclusion: GLIM MMCT is suitable for diagnosing malnutrition and estimating postoperative risk in gastrointestinal cancer patients. Nutritional assessment only in patients with NRS >2 may bear the risk to miss malnourished patients with high risk for poor clinical outcome. In every patient undergoing major cancer surgery, regular assessment of nutritional status regardless of screening result should be performed exploiting CT body composition analysis. [ABSTRACT FROM AUTHOR]

Introduction: The scored Patient‐Generated Subjective Global Assessment (PG‐SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient‐generated component and a healthcare professional (HCP)‐generated component. Aim: To translate the PG‐SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG‐SGA. Methods: In line with the methodology used in previously translated and culturally adapted versions, the standardised 10‐step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross‐sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG‐SGA. Item indices for comprehensibility (I‐CI), difficulty (I‐DI) and content validity (I‐CVI) were calculated and averaged into scale indices (S‐CI, S‐DI and S‐CVI). Cut‐off standards for item and scale indices were used as reference. Results: The Swedish version of the PG‐SGA rated excellent for comprehensibility (S‐CI 0.96) and difficulty (S‐DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S‐CI 0.89) and below acceptable for difficulty (S‐DI 0.70), with the physical examination rated most difficult (I‐DI 0.39 to 0.69). Content validity for the full Swedish PG‐SGA was rated excellent (S‐CVI 0.94). Conclusion: The patient component was considered clear and easy to complete. The full Swedish PG‐SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty with the physical examination, training of Swedish HCPs in using the PG‐SGA is essential before implementing the professional component into clinical practice or research. [ABSTRACT FROM AUTHOR]

Purpose: Accurate height and weight measurement can be challenging in older adults and complicates nutritional status assessment. Other parameters like the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte count (LC) could be an option to these measurements. We aimed to test these variables as subrogates of body mass index (BMI) or calf-circumference (CC) for malnutrition screening in community-dwelling older adults. Methods: This is a secondary analysis from the Salud, Bienestar y Envejecimiento (SABE) survey from Ecuador (2009). Includes data on demographics, health-related factors, physical assessments, and complete blood count, allowing to calculate NLR and LC to be used as part of the Mini Nutritional Assessment (MNA), instead of the BMI. Consequently, 4 models were included: standard MNA, MNA-CC, MNA-NLR and MNA-LC. Finally, age, sex, and comorbidities were considered as confounding variables. Results: In our analysis of 1,663 subjects, 50.81% were women. Positive correlations with standard MNA were found for MNA-NLR (Estimate = 0.654, p < 0.001) MNA-CC (Estimate = 0.875, p value < 0.001) and MNA-LC (Estimate = 0.679, p < 0.001). Bland-Altman plots showed the smallest bias in MNA-CC. Linear association models revealed varying associations between MNA variants and different parameters, being MNA-NLR strongly associated with all of them (e.g. Estimate = 0.014, p = 0.001 for albumin), except BMI. Conclusion: The newly proposed model classified a greater number of subjects at risk of malnutrition and fewer with normal nutrition compared to the standard MNA. Additionally, it demonstrated a strong correlation and concordance with the standard MNA. This suggests that hematological parameters may offer an accurate alternative and important insights into malnutrition. [ABSTRACT FROM AUTHOR]

Malnutrition significantly hampers wound healing processes. This study aimed to compare the effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) and Subjective Global Assessment (SGA) in diagnosing malnutrition and predicting wound healing in patients with diabetic foot ulcers (DFU). GLIM criteria were evaluated for sensitivity (SE), specificity (SP), positive predictive value, negative predictive value and kappa (κ) against SGA as the reference. Modified Poisson regression model and the DeLong test investigated the association between malnutrition and non-healing ulcers over 6 months. This retrospective cohort study included 398 patients with DFU, with a mean age of 66·3 ± 11·9 years. According to SGA and GLIM criteria, malnutrition rates were 50·8 % and 42·7 %, respectively. GLIM criteria showed a SE of 67·3 % (95 % CI 60·4 %, 73·7 %) and SP of 82·7 % (95 % CI 76·6 %, 87·7 %) in identifying malnutrition, with a positive predictive value of 80·0 % and a negative predictive value of 71·1 % (κ = 0·50) compared with SGA. Multivariate analysis demonstrated that malnutrition, as assessed by SGA, was an independent risk factor for non-healing (relative risk (RR) 1·84, 95 % CI 1·45, 2·34), whereas GLIM criteria were associated with poorer ulcer healing in patients with estimated glomerular filtration rate ≥ 60 ml/min/1·73m2 (RR: 1·46, 95 % CI 1·10, 1·94). SGA demonstrated a superior area under the receiver's operating characteristic curve for predicting non-healing compared with GLIM criteria (0·70 (0·65–0·75) v. 0·63 (0·58–0·65), P < 0·01). These findings suggest that both nutritional assessment tools effectively identify patients with DFU at increased risk, with SGA showing superior performance in predicting non-healing ulcers. [ABSTRACT FROM AUTHOR]

Malnutrition is a frequently underdiagnosed condition leading to increased morbidity, mortality, and healthcare costs. The Mount Sinai Health System (MSHS) deployed a machine learning model (MUST-Plus) to detect malnutrition upon hospital admission. However, in diverse patient groups, a poorly calibrated model may lead to misdiagnosis, exacerbating health care disparities. We explored the model's calibration across different variables and methods to improve calibration. Data from adult patients admitted to five MSHS hospitals from January 1, 2021 - December 31, 2022, were analyzed. We compared MUST-Plus prediction to the registered dietitian's formal assessment. Hierarchical calibration was assessed and compared between the recalibration sample (N = 49,562) of patients admitted between January 1, 2021 - December 31, 2022, and the hold-out sample (N = 17,278) of patients admitted between January 1, 2023 - September 30, 2023. Statistical differences in calibration metrics were tested using bootstrapping with replacement. Before recalibration, the overall model calibration intercept was −1.17 (95% CI: −1.20, −1.14), slope was 1.37 (95% CI: 1.34, 1.40), and Brier score was 0.26 (95% CI: 0.25, 0.26). Both weak and moderate measures of calibration were significantly different between White and Black patients and between male and female patients. Logistic recalibration significantly improved calibration of the model across race and gender in the hold-out sample. The original MUST-Plus model showed significant differences in calibration between White vs. Black patients. It also overestimated malnutrition in females compared to males. Logistic recalibration effectively reduced miscalibration across all patient subgroups. Continual monitoring and timely recalibration can improve model accuracy. [ABSTRACT FROM AUTHOR]

Hospital malnutrition remains a significant public health issue, particularly in developing countries. The Global Leadership Initiative on Malnutrition (GLIM) proposed homogenizing criteria to standardize malnutrition diagnosis. This study aimed to retrospectively determine the prevalence of nutritional risk and malnutrition diagnoses among hospitalized patients using the Nutritional Risk Screening (NRS)-2002 screening instrument and the GLIM criteria, respectively. We conducted a retrospective, cross-sectional study from nutritional records of patients hospitalized in a single centre 2021. Nutrition data from records included medical diagnosis, gender, length of stay, age, weight, height, body mass index, weight loss, calf circumference, and middle upper arm circumference. Nutritional risk and malnutrition were evaluated using NRS-2002 and GLIM criteria. Its concordance was further evaluated by using a Kappa test. The study included 616 records of patients; 52.3% (n = 322) of the population were male. The prevalence of nutritional risk, according to NRS-2002, was 69.5% (n = 428). Nutritional risk as well as malnutrition diagnosis according to GLIM criteria was observed in 87.8% (n = 374) of patienttritional risk and malnutrition were evaluated using NRS-2002 and GLIM criteria. Its concordance was further evaluated by using a Kappa test. Ws. Tools showed a strong concordance (κ= 0.732). All anthropometric data, except for height, were found to be significantly different between patients with moderate and severe malnutrition (p < 0.05). Our findings highlight a high prevalence of malnutrition in this group of hospitalized patients in Mexico. NRS-2002 demonstrated good agreement with the diagnosis of malnutrition according to GLIM criteria and could be considered part of the straightforward two-step approach for malnutrition; however, further studies are needed. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is associated with increased morbidity, mortality, and healthcare costs. Early detection is important for timely intervention. This paper assesses the ability of a machine learning screening tool (MUST‐Plus) implemented in registered dietitian (RD) workflow to identify malnourished patients early in the hospital stay and to improve the diagnosis and documentation rate of malnutrition. Methods: This retrospective cohort study was conducted in a large, urban health system in New York City comprising six hospitals serving a diverse patient population. The study included all patients aged ≥ 18 years, who were not admitted for COVID‐19 and had a length of stay of ≤ 30 days. Results: Of the 7736 hospitalisations that met the inclusion criteria, 1947 (25.2%) were identified as being malnourished by MUST‐Plus‐assisted RD evaluations. The lag between admission and diagnosis improved with MUST‐Plus implementation. The usability of the tool output by RDs exceeded 90%, showing good acceptance by users. When compared pre‐/post‐implementation, the rate of both diagnoses and documentation of malnutrition showed improvement. Conclusion: MUST‐Plus, a machine learning‐based screening tool, shows great promise as a malnutrition screening tool for hospitalised patients when used in conjunction with adequate RD staffing and training about the tool. It performed well across multiple measures and settings. Other health systems can use their electronic health record data to develop, test and implement similar machine learning‐based processes to improve malnutrition screening and facilitate timely intervention. Key points/Highlights: Malnutrition is prevalent among hospitalised patients and frequently goes unrecognised, with the potential for severe sequelae. Accurate diagnosis, documentation and treatment of malnutrition have the potential of having a positive impact on morbidity rate, mortality rate, length of inpatient stay, readmission rate and hospital revenue. The tool's successful application highlights its potential to optimise malnutrition screening in healthcare systems, offering potential benefits for patient outcomes and hospital finances. [ABSTRACT FROM AUTHOR]

Background: Older adults with cancer are a growing population requiring tailored care to achieve optimum treatment outcomes. Their care is complicated by under-recognised and under-treated wasting disorders: malnutrition, sarcopenia, and cachexia. We aimed to investigate the prevalence, overlap, and patients' views and experiences of malnutrition, sarcopenia, and cachexia, in older adults with cancer. Methods: Mixed-methods study with cross-sectional study and qualitative interviews. Interviews were thematically analysed through a phenomenological lens, with feedback loop analysis investigating relationships between themes and findings synthesised using modified critical interpretative synthesis. Findings: n = 30 were screened for malnutrition, sarcopenia, and cachexia, n = 8 completed semi-structured interviews. Eighteen (60.0%) were malnourished, 16 (53.3%) sarcopenic, and 17 (56.7%) cachexic. One or more condition was seen in 80%, and all three in 30%. In univariate analysis, Rockwood clinical frailty score (OR 2.94 [95% CI: 1.26–6.89, p = 0.013]) was associated with sarcopenia, reported percentage meal consumption (OR 2.28 [95% CI: 1.24–4.19, p = 0.008]), and visible wasting (OR 8.43 [95% CI: 1.9–37.3] p = 0.005) with malnutrition, and percentage monthly weight loss (OR 8.71 [95% CI: 1.87–40.60] p = 0.006) with cachexia. Screening tools identified established conditions rather than 'risk'. Nutritional and functional problems were often overlooked, overshadowed, and misunderstood by both patients and (in patients' perceptions) by clinicians; misattributed to ageing, cancer, or comorbidities. Patients viewed these conditions as both personal impossibilities, yet accepted inevitabilities. Conclusion: Perceptions, identification, and management of these conditions needs to improve, and their importance recognised by clinicians and patients so those truly 'at risk' are identified whilst conditions are more remediable to interventions. [ABSTRACT FROM AUTHOR]

One in three hospitalized children have disease-related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay; however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group (n = 13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of online Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third rounds 27 and 8 questions were asked, respectively. Consensus was defined as any question/issue in which at least 80% agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients, the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening <24 h of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA) <48 h of admission, as well as prevention, and treatment of DRM divided into standard, advanced, and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Mid-upper arm circumference (MUAC) measures the arm muscle and fat area. The use of MUAC as a screening measure for assessing undernutrition has the following advantages; it makes use of a simple equipment, is easy to carry at the field sites, and requires minimal training. In India, "mid-upper arm circumference" is widely used and accepted in many nutritional programs. Objectives: This study was conducted with the primary objective to compare different anthropometric parameters of children and to validate the usefulness and limitations of MUAC to screen out undernourished children. Subject and Methods: Anthropometric measurements were recorded for all the anganwadi centers of the selected sub-center that comes under the field practice area of our department. The measurements like weight, height, MUAC were done according to the standard guidelines as per WHO, and further, calculations were done with the help of "Anthro software 3.2.2." Comparisons were done between categorization of MUAC tape and Weight-for-Height Z-scores (WHZ), and hence, the sensitivity and specificity of the MUAC tape to screen the malnourished child were found out. Results: Sensitivity of MUAC to categorize a child in red/yellow was only 9.03%, negative predictive value (NPV) was 40.75%, specificity came 95.10%, and positive predictive value was 73.68% on taking WHZ as the gold standard. Conclusion: MUAC has a limited role in screening out an undernourished child (red/yellow category), whereas it has a good role in screening healthy children (green category). [ABSTRACT FROM AUTHOR]

The article is a review of scientific publications that consider the impact of micronutrients on a woman’s reproductive health, fertility, pregnancy, and modern principles of vitamin and nutrient deficiency prevention. In the modern world, and especially in countries with a developing economy, the problem of the deficiency of certain micronutrients is particularly acute. According to the WHO, the number of people in the world who have encountered it in one form or another reaches 2 billion. Chronic deficiency of certain micronutrients has a significant negative impact on health, at the same time has no specific clinical manifestations, diagnosis is expensive for mass implementation, and treatment of pathological conditions resulting from micronutrient deficiency requires a significant amount of resources. That is why the development of optimal programs and recommendations for the prevention or correction of micronutrient deficiencies is the focus of attention of WHO and leading scientists [ABSTRACT FROM AUTHOR]

Purpose: In 2019, the Global Leadership Initiative on Malnutrition (GLIM) suggested a 2-step diagnostic format for malnutrition including screening and diagnosis. Prospective validation and feasibility studies, using the complete set of the five GLIM criteria, are needed. The aims of this study were to determine the prevalence of malnutrition, and investigate how the prevalence varied with mode of screening. Furthermore, we assessed the feasibility of GLIM in geriatric patients. Methods: Consecutive patients from two acute geriatric wards were included. For screening risk of malnutrition, the Mini Nutritional Assessment-Short Form (MNA-SF) or Malnutrition Screening Tool (MST) were used. In accordance with GLIM, a combination of phenotypic and etiologic criteria were required for the diagnosis of malnutrition. Feasibility was determined based on % data completeness, and above 80% completeness was considered feasible. Results: One hundred patients (mean age 82 years, 58% women) were included. After screening with MNA-SF malnutrition was confirmed by GLIM in 51%, as compared with 35% after screening with MST (p = 0.039). Corresponding prevalence was 58% with no prior screening. Using hand grip strength as a supportive measure for reduced muscle mass, 69% of the patients were malnourished. Feasibility varied between 70 and 100% for the different GLIM criteria, with calf circumference as a proxy for reduced muscle mass having the lowest feasibility. Conclusion: In acute geriatric patients, the prevalence of malnutrition according to GLIM varied depending on the screening tool used. In this setting, GLIM appears feasible, besides for the criterion of reduced muscle mass. [ABSTRACT FROM AUTHOR]

Objective: Parkinson's disease (PD) is a chronic, progressive disease commonly affecting the elderly. Among patients with PD (pwPD), those above 60 years old are considered to be at high risk of malnutrition. Weight loss is a common complaint in pwPD. Thus, we defined the risk factors for malnutrition in geriatric pwPD. Materials and Methods: We enrolled 66 pwPD above the age of 60 years. Socio-demographic features were recorded and comprehensive geriatric assessments were evaluated. Malnutrition was assessed using a mini-nutritional assessment questionnaire. Anthropometric measurements including body mass index, mid-upper arm circumference, and calf circumference (CC) were recorded. Results: Seven (10.6%) pwPD had malnutrition, 22 (33.3%) pwPD were at risk of malnutrition. Univariate logistic regression analysis results revealed that low CC, presence of dyskinesia, advanced Hoehn & Yahr stage, levodopa doses of ≥400 mg/day, and difficulty in swallowing (p=0.035, p=0.041, p=0.048, p=0.027 and p=0.007, respectively) were strongly related to malnutrition among the pwPD. Difficulty in swallowing was independently related to malnutrition in pwPD [odds ratio: 7.81 (confidence interval: 2.17-28.10), p=0.002]. Conclusion: PD is the second most common neurodegenerative disease in the geriatric population and is likely to cause malnutrition because of several disabling symptoms in the progressive course of the disease, such as dysphagia. To avoid or delay poorer outcomes, clinicians should be careful to identify malnutrition with appropriate screening tools during follow-up of pwPD. [ABSTRACT FROM AUTHOR]

Malnutrition and frailty affect up to one-third of community-dwelling older adults in Australia and New Zealand (ANZ), burdening individuals, health systems and the economy. As these conditions are often under-recognised and untreated in the community, there is an urgent need for healthcare professionals (HCPs) from all disciplines to be able to identify and manage malnutrition and frailty in this setting. This paper describes the systematic and iterative process by which a practical guide for identifying and managing malnutrition and frailty in the community, tailored to the ANZ context, was developed. The development of the guide was underpinned by the Knowledge-to-Action Framework and included the following research activities: (1) a comprehensive literature review; (2) a survey of ANZ dietitians' current practices and perceptions around malnutrition and frailty; (3) interviews with ANZ dietitians; and (4) a multidisciplinary expert panel. This resulted in the development of a guide tailored to the ANZ context that provides recommendations around how to identify and manage malnutrition and frailty in the community. It is now freely available online and can be used by all HCPs across several settings. The approach used to develop this guide might be applicable to other conditions or settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment. Malnutrition and frailty are common in Australian and New Zealand communities, burdening individuals, health systems and the economy. This paper describes the process by which an evidence-informed guide for identifying and managing these conditions in the community was developed. The guide is now freely available online and can be used by all healthcare professionals across several settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment. [ABSTRACT FROM AUTHOR]

Background: Malnutrition and poor functional reserves place patients at risk for negative surgical outcomes. In this prospective study we aimed to measure preoperative nutritional and sarcopenia risk and evaluate their impact on postoperative outcomes. Methods: Adults scheduled to undergo elective general and gastrointestinal surgery were screened for nutrition risk using the Malnutrition Universal Screening Tool screening tool. Sarcopenia risk was measured using the SARC‐F tool and hand‐grip strength. Patients were followed postoperatively. Incidence of complications, length of stay (LOS), readmission rates, and need for step‐down care were recorded. Results: One hundred and twenty‐two patients were included. Mean age was 53.8 years (standard deviation [SD] 16.44). Sixty‐six (54%) were scheduled for day‐case procedures, and 56 (46%) for nonday‐case procedures. About 18.9% (n = 23) were at nutritional risk preoperatively. Ten patients (8.2%) had probable sarcopenia based on SARC‐F, whereas seven (5.7%) had measurably reduced HG. Incidence of postoperative complications was 23.8% (n = 29). Nutrition risk was associated with the development of complications (p = 0.018). In the nonday‐case group, nutritional risk was associated with greater LOS (p = 0.013). Older age was associated with need for step‐down care (p = 0.002) as was SARC‐F (p = 0.003). Conclusions: Preoperative nutritional screening can predict postoperative complications and LOS, whereas sarcopenia screening is predictive of the need for step‐down care after discharge. Screening tools are quick and inexpensive and could provide valuable information to clinicians and allow patients the opportunity to enhance their physical preparedness for surgery thereby mitigating their risk for negative surgical outcomes. Key points: Simple, inexpensive preoperative screening tools can predict postoperative outcomes: nutritional risk as measured by the Malnutrition Universal Screening Tool (MUST) was associated with increased incidence of postoperative complications and length of stay (LOS), whereas the SARC‐F screening tool for sarcopenia was predictive of the need for step‐down care postoperatively.Routine use of nutritional and sarcopenia screening tools in a preoperative surgical outpatient setting tools can provide clinically relevant information to clinicians and allow patients the opportunity to enhance their physical preparedness for surgery thereby mitigating their risk for negative surgical outcomes. [ABSTRACT FROM AUTHOR]

Context Early adverse experience can have a long-term effect on growth and development and negative repercussions into adulthood. Among the various consequences of undernutrition is depression. Objective The present work aimed to evaluate the relationship between early-life undernutrition and depression in adult life. Data Sources Data were obtained from the PubMed, SCOPUS, and Web of Science databases in November 2021 and were selected using the systematic bibliographic review manager program State of the Art Through Systematic Review. Data Extraction Data were extracted using the State of the Art Through Systematic Review program. Data Analysis Of the 559 articles that were identified, 114 were duplicates, and 426 were excluded after inclusion and exclusion criteria were applied to the title and abstract. One other relevant study was included. From the 20 remaining articles, 8 were excluded after the full-text screening. Finally, 12 articles remained for review in the present work. The studies described in these articles investigated humans, rats, or mice, and correlated early-life malnutrition and depression in adulthood as the principal outcome. Conclusions Undernutrition in early life and later depression are linked. Furthermore, the knowledge that the risk factors for depression start at the beginning of life points to public health policies starting in intrauterine life and extending throughout childhood and adolescence. [ABSTRACT FROM AUTHOR]

Registered dietitian nutritionists working in ambulatory clinics should not be waiting for an administrator to invite them to the planning group for the transition from fee for service to value-based care payment models. Registered dietitian nutritionists should be identifying and promoting the services they can provide to ensure quality healthcare for patients. In this article, we describe value-based care as it is presented in dietetics literature. We also describe how registered dietitian nutritionists in our family medicine practice demonstrate their value as a member of the expanded interprofessional ambulatory care team providing quality care, reducing costs, and providing an exceptional experience for the patient. We call on educators of dietetics students, interns, and professionals to teach the necessary interprofessional skills to be successful in value-based care models of care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore dietitians' perceptions of their current practice for identifying and managing malnutrition/frailty in the community, to fill an evidence gap. Methods: This mixed‐methods study involved an online survey distributed to dietitians practising in Australia and New Zealand, and semi‐structured interviews with a subset of survey participants. The 34‐item survey and interviews explored dietitians' practices for identifying/managing malnutrition and frailty, focusing on the community setting. Survey data were analysed descriptively and some simple association tests were conducted using statistical software. Interview data were analysed thematically. Results: Of the 186 survey respondents, 18 also participated in an interview. Screening and assessment for malnutrition varied in the community and occurred rarely for frailty. Dietitians reported practising person‐centred care by involving clients/carers/family in setting goals and selecting nutrition interventions. Key barriers to providing nutrition care to community‐dwelling adults included a lack of awareness/understanding of nutrition by clients and other health professionals (leading to them not participating in or valuing nutrition care), lack of time and resources in the community, and client access to foods/supplements. Enablers included engaging family members/carers and coordinating with other health professionals in nutrition care planning. Conclusion: Reported practices for identifying malnutrition and frailty vary in the community, suggesting guidance may be needed for health professionals in this setting. Dietitians reported using person‐centred care with malnourished and frail clients but encountered barriers in community settings. Engaging family members/carers and multidisciplinary colleagues may help overcome some of these barriers. [ABSTRACT FROM AUTHOR]

Sarcopenia, sarcopenic obesity, malnutrition, and cachexia clinical guidelines were created by expert consensus over the past decade. These pathological states all share in common deficits in skeletal muscle mass, and in some cases muscle function, which adversely impact patient outcomes. Early identification is key as some detrimental outcomes are potentially preventable with available treatments. The four guidelines share common design features: patients suspected of having the condition are first screened with a focused clinical history; if positive, the next step is evaluation with either a measure of body "form" (e.g., mass, shape, and composition) or function (e.g., mechanical, endurance, and metabolic); combined form and functional criteria are also recognized. The form and functional "gateway" nodes establish whether or not to proceed with further evaluations and treatments. Intensive discussions among experts focus on selection of these gateway nodes and the final choice is made when consensus is reached. Form and functional measures are often treated as equivalent alternatives when framed in the context of "outcomes" for which they are intended to predict. Here we adapt a classic biological concept stating that "function follows form" to show that pathophysiological links are present between these two different muscle qualities and clinical outcomes. We argue that a hierarchy exists such that outcomes closely follow functions that, in turn, follow form...the OFF rule. The OFF rule explains why functional measures often show stronger associations with outcomes than those quantifying form, helps to frame debates on how to structure the gateway nodes used to identify patients for further evaluation and treatment, and sets out a pathophysiological structure for developing future outcome prediction models. [ABSTRACT FROM AUTHOR]

Background: Nutrition screening is recommended to identify children at risk for malnutrition. A unique screening tool was developed based on American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations and embedded in the electronic medical record to assess for nutrition risk. Methods: The components of the tool included the Paediatric Nutrition Screening Tool (PNST) and other elements recommended by ASPEN. To evaluate the screening tool, retrospective data were analysed on all patients admitted to acute care units of Children's Wisconsin in 2019. Data collected included nutrition screen results, diagnosis and nutrition status. All patients who received at least one full nutrition assessment by a registered dietitian (RD) were included in analysis. Results: One thousand five hundred seventy‐five patients were included in analysis. The following screen elements were significantly associated with a diagnosis of malnutrition: any positive screen (p < 0.001), >2 food allergies (p = 0.009), intubation (p < 0.001), parenteral nutrition (p = 0.005), RD‐identified risk (p < 0.001), positive risk per the PNST (p < 0.001), BMI‐for‐age or weight‐for‐length z‐score (p < 0.001), intake <50% for 3 days (p = 0.012) and NPO > 3 days (p = 0.009). The current screen had a sensitivity of 93.9%, specificity of 20.3%, positive predictive value (PPV) of 30.9% and negative predictive value (NPV) of 89.8%. This is compared with the PNST which had a sensitivity of 32%, specificity of 94.2%, PPV of 71% and NPV of 75.8% in this study population. Conclusion: This unique screening tool is useful for predicting nutrition risk and has a greater sensitivity than the PNST alone. Key points: A nutrition screening tool embedded in the electronic medical record is feasible for children's hospitals.The tool, which also incorporates the Paediatric Nutrition Screening Tool (PNST), has greater sensitivity than the PNST alone. [ABSTRACT FROM AUTHOR]

Primary failure of eruption is a rare condition, which results in partial or complete failure of a tooth or several teeth to erupt. The postulated cellular process is a malfunction in the eruption mechanism, which fails to completely drive the tooth along its eruption axis. The aetiology is genetic, with a specific link to a mutation in the parathyroid hormone 1 receptor gene, hence a familial pattern of inheritance may be observed. Diagnosis and treatment can be challenging, often necessitating an interdisciplinary approach. CPD/Clinical Relevance: Knowledge of the features of primary failure of eruption is useful for clinicians. [ABSTRACT FROM AUTHOR]

Introduction: The synergistic impact of coexistent malnutrition and sarcopenia on morality in hospitalized patients with decompensated cirrhosis remains elusive. This prospective cohort study aimed to delineate the prevalence concerning coexistence of malnutrition and sarcopenia and the prognosticating role on long-term mortality among cirrhosis. Methods: Adult cirrhotic patients with decompensated episodes between 2019 and 2021 were consecutively enrolled. Malnutrition and sarcopenia were diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, respectively. The entire cohort was divided into three groups: non-malnutrition and non-sarcopenia (NN), malnutrition or sarcopenia, and coexistent malnutrition and sarcopenia (MS). Log-rank test and multivariate Cox regression model were utilized to evaluate survival status and independent risk factors for mortality, respectively. Results: Our findings indicated that malnutrition manifested in 44.6% of inpatients with decompensated cirrhosis, while sarcopenia presented in 16.4% of the entire cohort, indicative of a prevalence of 14.7% regarding coexistent malnutrition and sarcopenia. The Kaplan-Meier graphic demonstrated a significant difference regarding survival curves among the three groups, referring to the MS group presented with the lowest survival rate (log-rank test: p < 0.001). Moreover, coexistent malnutrition and sarcopenia were associated with nearly 4 times higher mortality risk (model 1: hazard ratio [HR] = 3.31, 95% confidence interval [CI]: 1.20–9.13, p = 0.020; model 2: HR = 4.34, 95% CI: 1.52–12.4, p = 0.006) in comparison with patients without any condition (NN group). Conclusions: Malnutrition and sarcopenia had superimposed negative impacts on inpatients with decompensated cirrhosis. It is imperative to identify this vulnerable subset to provide prompt therapeutic intervention for better prognosis. [ABSTRACT FROM AUTHOR]

Guidelines for bioelectrical impedance analysis (BIA) recommend fasting before measurements, but how it affects the outcomes is unclear. This descriptive, before-and-after study examines the effect of fasting on BIA results and its impact on the diagnosis of malnutrition in hospitalized cancer patients. Fifty-three oncology patients (admitted in January–March 2020) were consecutively enrolled regardless of their nutritional status. Patients were assessed by the same dietician 24–48 h after admission, following the usual clinical practice. The measurements were taken after 12-h fasting (fasting state) and 60–90 min after breakfast (non-fasting state). Bioimpedance parameters (resistance [R], reactance [Xc], phase angle [PA]) and body composition indices (free-fat mass index [FFMI] and appendicular skeletal muscle index [ASMI]) were calculated. On average, R values did not significantly differ between fasting and non-fasting states (mean difference: +1.82 Ω; p = 0.64). The non-fasting Xc and PA were reduced (mean differences: −1.55 Ω, p = 0.93 and 0.09°, p = 0.82, respectively). Fasting and non-fasting FFMI and ASMI were similar (mean differences: −0.13 kg/m2 (p = 0.5) and −0.10 kg/m2 (p not calculated)). These results suggest that BIA does not require fasting, facilitating its routine use in hospitalized cancer patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health & Life Sciences / Sağlık ve Yaşam Bilimleri Dergisi is the property of Istanbul Kultur University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Body weight is a significant risk factor for the disease burden of noncommunicable diseases (NCDs). Anthropometric measurements are the first step in determining NCDs risk, and clinicians must have access to valid cutoffs. This study aims to review the literature of Saudi national guidelines and studies previously conducted in Saudi Arabia (SA) and to provide insights and recommendations to establish national guidelines in anthropometric measurements for Saudi adults/elderly in line with the Saudi 2030 Vision. In total, 163 studies were included, and 12 of them contributed to the development of specific anthropometric cutoffs. Cutoffs for metabolic syndrome, waist circumference, and body mass index were established in Saudi adults. However, limited studies were conducted in the elderly. This review warrants establishing standard cutoffs of Saudi adult anthropometrics to avoid over/underreporting of malnutrition and adiposity. This review will help policymakers and the Ministry of Health to establish national guidelines and standard cutoffs to be used in SA for anthropometric measurements that may assist in detecting malnutrition and NCDs. [ABSTRACT FROM AUTHOR]

Introduction: We launched this study to compare subjective global assessment (SGA) and nutrition risk index (NRI) as malnutrition screening tools for nurses to use in the care of End-stage Liver Disease (ESLD) patients. Methods: This pilot study was conducted on liver transplant patients in two hospitals in Iran from May to September 2021. Sensitivity, specificity, and predictive values of NRI were evaluated compared with SGA in ESLD patients. Results: Sixty-five cirrhotic patients were assessed. The sensitivity, specificity, positive and negative predictive values for NRI in detecting malnutrition based on SGA were 97.67%, 31.82%, 77.68%, and 87.5%, respectively. However, the agreement between NRI and SGA was low (k=0.349). Changing the NRI cut-off value to 83.7 could yield acceptable sensitivity (72.7%) and specificity (58.1%). Conclusion: NRI can be used as a screening tool in ESLD patients, but a different cut-off might be required to improve its validity against SGA in ESLD patients. [ABSTRACT FROM AUTHOR]

Disease-related malnutrition is common in hospital patients. The Health Standards Organization Canadian Malnutrition Prevention, Detection, and Treatment Standard was published in 2021. The purpose of this study was to determine the current state of nutrition care in hospitals prior to implementation of the Standard. An online survey was distributed to hospitals across Canada via email. A representative reported on nutrition best practices based on the Standard at the hospital level. Descriptive and bivariate statistics were completed for selected variables based on size and type of hospital. One hundred and forty-three responses from nine provinces were received (56% community, 23% academic, and 21% other). Malnutrition risk screening was being completed on admission in 74% (n = 106/142) of hospitals, although not all units participated in screening all patients. Nutrition-focused physical exam is completed as part of a nutrition assessment in 74% (n = 101/139) of sites. Flagging a malnutrition diagnosis (n = 38/104) and physician documentation (18/136) were sporadic. Academic and medium (100–499 beds) and large hospitals (500+ beds) were more likely to have a physician document a malnutrition diagnosis. Some, but not all, best practices are occurring in Canadian hospitals on a regular basis. This demonstrates a need for continued knowledge mobilization of the Standard. [ABSTRACT FROM AUTHOR]

Early assessment of malnutrition in cancer patients is essential. This study analyzed the accuracy of the Global Leadership Initiative on Malnutrition (GLIM) and the Subjective Global Assessment (SGA), in diagnosing malnutrition, considering the Patient Generated-SGA (PG-SGA) as a reference, and the impact of malnutrition on hospital days. We conducted a prospective cohort study in 183 patients with gastrointestinal, head and neck, and lung cancer. Malnutrition was assessed within 48 h, of hospital admission according to the SGA, PG-SGA, and GLIM. Accuracy tests and regression analysis were performed to assess the criterion validity of the GLIM and SGA for diagnosing malnutrition. Malnutrition was diagnosed in 57.3% (SGA), 86.3% (PG-SGA), and 74.9% (GLIM) of the inpatients. The median of hospitalization was 6 (3–11) days, with 47% hospitalized > 6 day. The SGA presented the best accuracy (AUC = 0.832) than the GLIM (AUC = 0.632) compared to PG-SGA. Patients diagnosed with malnutrition by SGA, GLIM, and PG-SGA remained hospitalized for 2.13, 3.19, and 4.56 day more than well-nourished patients, respectively. Compared to PG-SGA, the SGA presents good accuracy and adequate specificity (>80%). Malnutrition evaluated by SGA, PG-SGA, and GLIM was associated with more days of hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to construct a formula to predict L3 skeletal muscle cross‐sectional area (CSA) from C3 CSA and to select the cutoff values to evaluate the nutritional status in OSCC. Materials and Methods: A total of 220 OSCC patients in Nanfang Hospital were divided into two groups: the training set (n = 100) and the validation set (n = 120). Patients in the training set were performed the preoperative whole‐body positron emission tomography‐computed tomography (PET/CT) scans, and patients in the validation set received preoperative head‐and‐neck computed tomography (CT) scans. C3 CSA and L3 CSA were delineated. The predictive formula was established, and the gender‐specific thresholds of malnutrition were obtained by X‐tile software in training set. Finally, the formula and cutoff values were validated. Results: The predictive formula was successfully established. The gender‐specific cutoff values for L3 SMI were 55.0 cm2/m2 for men and 36.6 cm2/m2 for women. There were no differences between the overall survival (OS) of patients diagnosed with malnutrition and that of patients who are not malnutrition. Conclusions: Our studies reveal that the L3 CSA could be calculated by C3 CSA conveniently with our formula in OSCC, which allowed us to assess malnutrition with head‐and‐neck CT image. However, there is no direct connection found between malnutrition and OS in OSCC. Hence, further studies with a larger sample size may be required. [ABSTRACT FROM AUTHOR]

More information is needed about the impact of outpatient nutrition care from a registered dietitian nutritionist (RDN) on patient outcomes. This study aimed to assess the feasibility of a cohort study design to evaluate impact of RDN nutrition care on patient outcomes, describe clinic malnutrition screening practices, and estimate statistical parameters for a larger study. Seventy-seven patients with lung, esophageal, colon, rectal, or pancreatic cancer from six facilities were included (41 received RDN care and 36 did not). RDN nutrition care was prospectively documented for six months and documented emergency room visits, unplanned hospitalizations and treatment changes were retrospectively abstracted from medical records. Most facilities used the Malnutrition Screening Tool (MST) to determine malnutrition risk. Patients receiving RDN care had, on average, five, half hour visits and had more severe disease and higher initial malnutrition risk, although this varied across sites. Documented medical and treatment outcomes were relatively rare and similar between groups. Estimated sample size requirements varied from 113 to 5856, depending on tumor type and outcome, and intracluster correlation coefficients (ICCs) ranged from 0 to 0.47. Overall, the methods used in this study are feasible but an interventional or implementation design might be advantageous for a larger study. [ABSTRACT FROM AUTHOR]

Despite improvement in child health outcomes, undernutrition in children aged under five years continues to be a major public health problem, contributing to childhood morbidity and mortality. The aim was to determine the knowledge and practice patterns used in the identification of malnutrition by nurses at PHC facilities. The attendance rates and the impact of in-house paediatric courses were also examined. An observational, descriptive, cross-sectional study was undertaken from June to September 2018. The study was conducted at 36 primary healthcare clinics in the West Rand Health District Council Area, Gauteng, South Africa. All nurses working with children aged under five years in the study clinics. The response rate was 94% (49) with a mean age of 42.5 years (±9.7) with the majority (98%) being females. Nearly two-thirds (61%) of the participants had good knowledge, 33% had excellent knowledge and 6% had poor knowledge. The mean knowledge score was 20.3 (8–27, SD). The practice categories indicated that two-thirds of the participants (61%) displayed poor practices, and 21% had good practices whilst only 18% displayed best practices. The mean practice score was 4.5 (1.75, SD). There was no association between attendance at courses, knowledge scores and practice patterns. Most participants had good or excellent knowledge around issues of malnutrition. There was poor attendance on courses and there was no association between knowledge and attendance on the courses. More than 60% of the nurses had poor practice patterns and there was no association between knowledge, attendance on courses and practice patterns. [ABSTRACT FROM AUTHOR]

Copyright of Actualización en Nutrición is the property of Sociedad Argentina de Nutricion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Experience and research show that screening for malnutrition in primary care mainly takes place by monitoring the weight parameter and that validated screening instruments are hardly used. In this study we examined the effectiveness and predictive value of weight evolution in screening for (risk of) malnutrition in older people living at home, in comparison with a validated screening tool, namely the Mini Nutritional Assessment Short Form (MNA-SF). Methods: This project was a prospective, longitudinal study with quantitative data that took place in the province of Antwerp (Belgium) from December 2020 until June 2021. The target group of this study consisted of people over 70 living at home who were visited by a home nurse on a regular basis (at least once a month). The outcome measure was the weight evolution over six months compared with the score on the MNA-SF at month six. Weight was measured and recorded once a month during 6 months. At the last weight measurement, the MNA-SF was administered. In order to assess their own nutritional state, three additional questions were asked after taking the MNA-SF. Results: A total of 143 patients gave consent to participate, of which 89 were women and 54 men. The mean age was 83.7 years (SD6.62) with a range of 70 to 100 years. Based on the MNA-SF score measured after six months, 53.1% (76/143) of participants had a normal nutritional status, 37.8% (54/143) scored risk of malnutrition and 4.9% (7/ 143) was malnourished. In order to detect people with (risk of) malnutrition, a PPV of 78.6%, a NPV of 60.7%, a sensitivity of 19.3% and a specificity of 96.0% were established with a weight evolution of ≥ 5% weight loss at six months. To detect malnutrition, our results showed respectively 33.3%, 98.4%, 71.4% and 92.3%. Conclusion: In this study, weight evolution has a low sensitivity in screening for (risk of) malnutrition in people over 70 living at home compared to the MNA-SF. However, in order to detect people with malnutrition, this study demonstrated a sensitivity of 71.4% and a specificity of 92.3% for a weight loss of ≥ 5% at six months. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware of the link between malnutrition in children and faltering growth • To understand how regular surveillance of child growth can prevent or identify malnutrition • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Malnutrition can be defined as 'a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals cause measurable adverse effects on body composition, function or clinical outcome'. Identification of malnutrition in children, therefore, requires an understanding of their growth. Faltering growth is the failure to achieve the expected rate of weight gain, linear and brain growth at a normal rate for age, which is a known consequence of inadequate nutrition. There are many medical, social and behavioural factors that can place a child at risk of malnutrition and faltering growth. This article examines malnutrition and faltering growth in children. It discusses monitoring and measurement of child growth, the aetiology and consequences of malnutrition, some risk factors and malnutrition screening. The article also considers some prevention strategies and the role of the nurse in the prevention of malnutrition. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is underdiagnosed in primary care. GPs are key healthcare contacts for older adults at risk of protein-energy malnutrition; however, lack of knowledge and confidence in its diagnosis and treatment is often reported. Aim: To evaluate the impact of a bespoke online education module on GP malnutrition knowledge and management. Design & setting: A prospective pre—post pilot study with 23 GPs and eight GP trainees in the Republic of Ireland. Method: The module included units on the following: ‘malnutrition definition, prevalence, and latest evidence’; ‘identifying malnutrition in clinical practice’; ‘food-first advice’; ‘reviewing malnutrition’; and ‘oral nutritional supplements’. Participant knowledge was measured using a multiple choice questionnaire (MCQ) before and after the module (n = 31), and 6 weeks following completion (n = 11). Case studies assessing identification and management of malnutrition were evaluated by a clinical specialist dietitian with expertise in managing malnutrition. Changes in assessment performance were calculated using paired t-tests. Acceptability was evaluated using a questionnaire. Results: Post-training, 97% of GPs increased MCQ scores from baseline (+25%, P<0.001), with the greatest improvement in ‘identifying malnutrition in clinical practice’ (mean increase 47%, P<0.001). Eleven GPs completed the 6-week MCQ with scores remaining significantly higher than baseline (mean increase 15%, P = 0.005); ‘identifying malnutrition in clinical practice’ remained the most highly scored (mean increase 40%, P<0.001). Seventeen GPs completed the case studies; 76% at baseline and 88% post-module correctly calculated malnutrition risk scores. Appropriate malnutrition management improved for 47% of GPs after module completion. Conclusion: This e-learning module improved malnutrition knowledge, with good short-term retention in a small cohort. Development of online evidence-based nutrition education may improve GP nutrition care. [ABSTRACT FROM AUTHOR]

Malnutrition in adults can often go undetected and untreated. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the potential causes of malnutrition in people with learning disabilities • To learn about strategies to use in your practice to manage malnutrition • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) People with learning disabilities are at greater risk of malnutrition compared with the general population. Congenital conditions and mental health issues significantly increase this risk. Further, inadequate access to equipment, such as weighing scales, and challenges related to the provision of social support can be barriers to ensuring adequate nutritional status in this population. This article discusses malnutrition as a health inequality experienced by people with learning disabilities. It describes the effects of malnutrition in this population, explores how to identify the causes of malnutrition and outlines various management strategies. The authors also consider some of the challenges associated with managing malnutrition in people with profound and multiple learning disabilities, dysphagia and dementia. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is associated with adverse outcomes in patients on chronic haemodialysis. Thus, identifying accurate methods for diagnosing malnutrition is essential. The present retrospective study investigated the utility of the new Global Leadership Initiative on Malnutrition (GLIM) criteria in patients undergoing chronic haemodialysis. Methods: Phase angle and fat‐free mass index (FFMI) were derived using bioelectrical impedance analysis. Malnutrition was determined when the subjects had at least one phenotypic criterion (weight loss, low body mass index [BMI] or FFMI). Results: This study included 103 patients undergoing chronic haemodialysis and 46 (44.7%) patients were diagnosed as malnourished. Malnutrition determined using the GLIM criteria was associated with increased risks of all‐cause death (hazard ratio = 3.0, p = 0.044) and infection requiring hospitalisation (hazard ratio = 2.4, p = 0.015), independent of age, sex and comorbidities. However, malnutrition was not related to major adverse cardiovascular events (p = 0.908). We further evaluated the longitudinal changes in phenotypic parameters. Subjects with median levels of high‐sensitivity C‐reactive protein exceeding 5 mg L–1 exhibited decreased body weight and BMI (p = 0.015 and 0.016, respectively). In addition, body weight, BMI and FFMI were reduced in subjects with a median protein catabolic rate of < 1.0 mg kg–1 day–1, even after adjustment for age, sex and comorbidities (p = 0.026, 0.053 and 0.039, respectively). Conclusions: Malnutrition assessed using the GLIM criteria could be a useful predictor of mortality and infection in patients on chronic haemodialysis. To improve nutritional status, approaches for decreasing inflammation and increasing protein intake are needed. Key points: The present study retrospectively investigated the usefulness of the Global Leadership Initiative on Malnutrition (GLIM) criteria for patients with end‐stage renal disease receiving chronic haemodialysis.The GLIM criteria‐defined malnutrition was associated with increased incidences of all‐cause death and infection requiring hospitalisation.In the longitudinal data, subjects with higher levels of high‐sensitivity C‐reactive protein and total carbon dioxide exhibited decreased body weight and body mass index (BMI), conversely, those with higher normalised protein catabolic rate exhibited increases in body weight, BMI and fat‐free mass index over time. [ABSTRACT FROM AUTHOR]

Background: Malnutrition defined by the Global Leadership Initiative on Malnutrition (GLIM) has been associated with cancer mortality, but the effect is limited and inconsistent. We performed this meta‐analysis aiming to assess this relationship in patients with cancer. Methods: We systematically searched Embase, PubMed, Web of Science, Cochrane, CINAHL, CNKI, Wanfang, and VIP databases from January 1, 2019, to July 1, 2022. Studies evaluating the prognostic effect of GLIM‐defined malnutrition on cancer survival were included. A fixed‐effect model was fitted to estimate the combined hazard ratio (HR) with a 95% CI. Heterogeneity of studies was analyzed using the I2 statistic. Quality assessment were performed using the Newcastle‐Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results: The search strategy identified 4378 articles in all databases combined. Nine studies (8829 patients) meeting the inclusion criteria were included for quantitative analysis. Meta‐analysis revealed significant associations between GLIM‐defined pooled malnutrition (HR = 1.75; 95% CI, 1.43–2.15), moderate malnutrition (HR = 1.44; 95% CI, 1.29–1.62), and severe malnutrition (HR = 1.79; 95% CI, 1.58–2.02) with all‐cause mortality. Sensitivity analysis supported the robustness of these associations. The between‐study heterogeneity was low (all I2 < 50%), and study quality assessed with NOS was high (all scores > 6). The evidence quality according to the GRADE tool was very low. Conclusions: Our meta‐analysis suggests a significant negative association of malnutrition, as defined by the GLIM, with overall survival in patients with cancer. However, definitive conclusions cannot be made, owing to the low quality of the source data. [ABSTRACT FROM AUTHOR]

Background: The Global Leadership Initiative on Malnutrition (GLIM) has been built to diagnose malnutrition; however, its validity among patients with cirrhosis remains enigmatic. We aimed to investigate the prevalence of malnutrition according to GLIM criteria and compare the differences by using a specific screening tool. Methods: We conducted a descriptive cross‐sectional study analyzing hospitalized patients. The Royal Free Hospital‐Nutritional Prioritizing Tool (RFH‐NPT) was chosen as the screening tool. Estimated prevalence was shown with and without the initial screening process. Diverse combinations of phenotypic and etiologic criteria and distinct body mass index (BMI) cutoffs were applied to detect frequency of malnourished patients with cirrhosis. Results: Overall, 363 patients were recruited (median age, 64 years; 51.2% female). The prevalence of malnutrition according to GLIM criteria with and without RFH‐NPT screening was 33.3% and 36.4%, respectively. Low BMI and inflammation represented the most prevalent combination resulting in a malnutrition diagnosis (42.4%), followed by low BMI and reduced food intake (39.4%). By contrast, the least prevalence was found when combining reduced muscle mass with inflammation to diagnose malnutrition. Furthermore, the frequency of malnourished and well‐nourished participants was not statistically different when using divergent BMI reference values across the study population. Conclusions: GLIM criteria may serve a specific proxy to diagnose malnutrition, along with RFH‐NPT screening. Relevant investigation is required to report on the applied combination of phenotypic/etiologic criteria, taking into consideration the marked impact of different models. More attempts are warranted to delineate the prognostic role of GLIM criteria in the context of cirrhosis. [ABSTRACT FROM AUTHOR]

Early assessment of malnutrition in cancer patients is very important. The Mini Nutritional Assessment (MNA) is often used to assess malnutrition in adult cancer patients. However, the diagnostic values of MNA are controversial. We aimed to analyze the diagnostic values of MNA in assessing malnutrition in adult cancer patients. A systematic search was performed using Embase, Web of Science, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP). Studies comparing MNA with other tools or criteria in cancer patients were included. The quality of the included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled sensitivity, specificity, the area under the receiver-operating characteristic curve (AUC), and the diagnostic odds ratio (DOR) were calculated using Stata 17.0 and Meta-DiSc1.4. In addition, sensitivity, subgroup, meta-regression, and publication bias analyses were conducted. In total, 11 studies involving 1367 patients involving MNA were included. The pooled sensitivity, specificity, ROC, and DOR were 0.84 (95% CI: 0.81–0.87), 0.66 (95% CI: 0.63–0.69), 0.84 (95% CI: 0.81–0.87), and 16.11 (95% CI: 7.16–36.27), respectively. In the assessment of malnutrition in adult cancer patients, MNA has high sensitivity and moderate specificity. [ABSTRACT FROM AUTHOR]

Malnutrition is associated with adverse clinical outcomes and increased health care utilization for hospitalized children. Yet pediatric malnutrition often goes undiagnosed and national prevalence research in this population is scarce. The aim was to assess change in the coded diagnosis of malnutrition (CDM) among US hospitalized children given increased awareness of the need for improved recognition and standardized diagnosis. Retrospective, cross-sectional analysis using nationally representative data from the Nationwide Inpatient Sample. Our sample was 13.2 million hospitalizations from 2012 to 2019 among pediatric patients between age 1 month and 17 years. CDM using International Classification of Diseases Ninth and 10th Revision-Clinical Modification diagnosis codes. Descriptive statistics and sampling weights were used to estimate the national frequency and prevalence of CDM. Temporal trends in CDM overall and stratified by age, race/ethnicity, and hospital type were analyzed using joinpoint regression. CDM prevalence increased from 3.9% in 2012 to 6.4% in 2019. During this period, failure to thrive decreased from 40.6% to 23.3% of all cases with concomitant increases in the diagnosis of protein-calorie malnutrition and children identified with more than one malnutrition subtype. Differences in CDM diagnoses are evident by hospital type, race/ethnicity, and age of the patient. Although pediatric malnutrition continues to be underdiagnosed in hospital settings, this study demonstrates improvement over time. There continues to be a need for continued professional education regarding best practices for diagnosis to improve health care provider knowledge and self-efficacy on this topic, especially in nonteaching hospitals. [ABSTRACT FROM AUTHOR]

Objectives: To investigate associations between nutrition risk (determined by SCREEN-II) and malnutrition (diagnosed by the GLIM criteria) with five-year mortality in Māori and non-Māori of advanced age. Design: A longitudinal cohort study. Setting: Bay of Plenty and Lakes regions of New Zealand. Participants: 255 Māori; 400 non-Māori octogenarians. Measurements: All participants were screened for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). Those at high nutrition risk (SCREEN-II score <49) had the Global Leadership Initiative in Malnutrition (GLIM) criteria applied to diagnose malnutrition or not. Demographic, physical and health characteristics were obtained by trained research nurses using a standardised questionnaire. Five-year mortality was calculated from Government data. The association of nutrition risk (SCREEN-II) and a malnutrition diagnosis (GLIM) with five-year mortality was examined using logistic regression and cox proportional hazard models of increasing complexity. Results: 56% of Māori and 46% of non-Māori participants had low SCREEN-II scores indicative of nutrition risk. The prevalence of GLIM diagnosed malnutrition was lower for both Māori and non-Māori (15% and 19% of all participants). Approximately one-third of participants (37% Māori and 32% non-Māori) died within the five-year follow-up period. The odds of death for both Māori and non-Māori was significantly lower with greater SCREEN II scores (better nutrition status), (OR (95% CI); 0.58 (0.38, 0.88), P < 0.05 and 0.53 (0.38, 0.75), P < 0.001, respectively). GLIM diagnosed malnutrition was not significantly associated with five-year mortality for Māori (OR (95% CI); 0.88 (0.41, 1.91), P >0.05) but was for non-Māori. This association remained significant after adjustment for other predictors of death (OR (95% CI); 0.50 (0.29, 0.86), P< 0.05). Reduced food intake was the only GLIM criterion predictive of five-year mortality for Māori (HR (95% CI); 10.77 (4.76, 24.38), P <0.001). For non-Māori, both aetiologic and phenotypic GLIM criteria were associated with five-year mortality. Conclusion: Nutrition risk, but not malnutrition diagnosed by the GLIM criteria was significantly associated with mortality for Māori. Conversely, both nutrition risk and malnutrition were significantly associated with mortality for non-Māori. Appropriate phenotypic criteria for diverse populations are needed within the GLIM framework. [ABSTRACT FROM AUTHOR]

Background: Single‐ventricle patients require a series of surgeries, with the final stage being the Fontan. This form of circulation results in several long‐term complications, but the impact and consequences of nutrition status remain unclear. We sought to evaluate the incidence of malnutrition in Fontan patients and the impact on outcomes. Methods: This study was a retrospective cohort study of children who underwent Fontan surgery between 1997 and 2018. Clinical, demographic, and nutrition data were collected, including weight, height, body mass index (BMI), and their respective z scores (z score for weight‐for‐age [WAZ], z score for height‐for‐age [HAZ], and z score for BMI‐for‐age [BMIZ]) pre‐Fontan, at discharge, 6 months, and 1, 5, and 10 years post‐Fontan. Malnutrition status was categorized using the American Society for Parenteral and Enteral Nutrition guidelines and the Michigan MTool. Fontan failure was defined as listing for heart transplant or death. Results: Of the 69 patients, moderate‐severe malnutrition occurred at any time point in 11% (n = 8) by WAZ, 16% (n = 11) by HAZ, and 6% (n = 4) by BMIZ. Moderate‐severe malnutrition persisted in 6.5%–12.9% at 10 years post‐Fontan. Compared with the pre‐Fontan period, there was no change in these parameters over time. There was no statistically significant difference in Fontan failure between degrees of pre‐Fontan malnutrition. Conclusion: There is a 6%–16% incidence of moderate‐severe malnutrition in Fontan patients. Malnutrition is a condition that remains present in follow‐up. There was no association with anthropometric parameters and transplant‐free survival. A prospective multi‐institutional study is needed to understand the impact of malnutrition on long‐term outcomes. [ABSTRACT FROM AUTHOR]

Background: Children with medical complexity (CMC) often require enteral tube feedings to meet their nutrition needs. Many, however, experience symptoms of feeding intolerance, such as vomiting and pain. The goal of this analysis was to examine the relationship between diet and the gut microbiome, controlling for medications, among CMC receiving enteral tube feedings, CMC consuming oral nutrition, and healthy controls. Given the variety of available commercial formula preparations, we were also interested in examining the impact of different formula types on the CMC microbiome. Methods: Fecal samples from 91 children (57 CMC and 34 healthy controls) were collected and analyzed. Parents completed clinical and dietary questionnaires. 16S ribosomal RNA amplicon sequencing was completed using the QIIME2 pipeline. Results: A significant decrease in alpha diversity among CMC receiving exclusive enteral nutrition (CMC EEN) compared with healthy controls (Shannon P = 0.006 and Faith's phylogenetic distance P = 0.006) was found that was not observed between CMC receiving oral nutrition and healthy controls. Significant differences in beta diversity were also observed between CMC EEN and healthy controls, with CMC EEN having a greater relative abundance of Enterobacteriaceae and obligate anaerobes. Differences were also noted between CMC EEN and CMC receiving oral nutrition (Aitchison distance P = 0.001); however, no differences were observed between CMC receiving oral nutrition and healthy controls. Conclusion: Despite similarities in medication profiles, CMC EEN have decreased alpha diversity and differences in beta diversity compared with healthy controls not observed in CMC receiving oral nutrition, highlighting the impact of diet over medications. [ABSTRACT FROM AUTHOR]

Background: Body mass index (BMI) presents prognostic value in chronic obstructive pulmonary disease (COPD), and despite its limitations in capturing malnutrition, its use is common to assess nutritional status. We aimed to confirm the association between BMI and in‐hospital outcomes in acute exacerbation of COPD (AECOPD) and its inaccuracy in diagnosing malnutrition. Methods: We diagnosed malnutrition using the Subjective global assessment (SGA), Academy of Nutrition and Dietetics–American Society for Parenteral and Enteral Nutrition (AND‐ASPEN), and two cutoff values for reduced BMI (age‐related and ≤ 21.0). BMI accuracy was assessed using the area under the receiver operating characteristic (AUC‐ROC) curve and SGA and AND‐ASPEN as references. We evaluated in‐hospital mortality and hospital stay outcomes and constructed logistic regression models. Results: The median hospital stay was 11 (7–18) days, and 7.5% of patients died. Malnutrition prevalence according to BMI, SGA, and AND‐ASPEN was 21.4% (mean of both cutoff values), 50%, and 54%, respectively. Reduced BMI presented low agreement (κ = 0.315–0.383) and unsatisfactory accuracy (AUC‐ROC curve = 0.333–0.679) with reference methods for malnutrition diagnosis. Age‐related reduced BMI (odds ratio [OR] = 2.11; 95% CI, 1.10–4.04) and BMI ≤ 21.0 (OR = 2.25; 95% CI, 1.13–4.48) were associated with hospital stays longer than the median in adjusted models, but not in‐hospital mortality. Conclusion: BMI was inaccurate in identifying malnutrition in hospitalized patients with AECOPD and was associated with hospital stays longer than ten days. [ABSTRACT FROM AUTHOR]