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Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCPs) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n = 111 dietitians, n = 72 physicians, n = 42 allied HCPs), 96%–100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n = 142/220; dietitians: 88% vs. physicians: 40%) reported screening for malnutrition, which mostly occured in the postoperative period (n = 117) by dietitians (n = 94). Just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n = 121/212), time (40%, n = 84/212) and support from others (38%, n = 80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier. [ABSTRACT FROM AUTHOR]

• Nutrition screening tool for children (0 to 2 years) with cystic fibrosis. • Standardized equation for cystic fibrosis care team to identify nutrition risk. • Weight, length, weight-for-length z-scores predict nutrition risk best. • Simple, quick, easy tool to triage nutrition care of infants with cystic fibrosis. For children with cystic fibrosis (CF), achieving and maintaining optimal growth by the age of 2 years is critical for future health outcomes. A standardized nutrition screening is needed to identify growth problems, enable timely interventions, and improve nutritional outcomes for children (0 to 2 years) with CF. The purpose of this study was to develop a nutrition screening tool for children (0 to 2 years) with CF to identify nutrition risk at every clinical encounter. A retrospective cross-sectional study was used to develop a nutrition screening tool to determine if nutrition interventions needed to change (at-risk) or continue (not at-risk). Retrospective data for pertinent nutrition factors were collected for 99 children attending an accredited CF clinic. The nutrition factors were compared to a dietitian assessment. A stepwise discriminant analysis determined weight-for-age (WFA) and weight-for-length (WFL) z-scores were significant. Then anthropometric data and corresponding dietitian assessment results were collected for children with CF attending two other accredited CF clinics (n = 29, n = 30). Discriminant analysis was used to determine sensitivity and specificity of the nutrition factors and to create a nutrition screening tool equation. The nutrition screening model that included WFA z-score, LFA z-score, WFL z-score, and weight change velocity adequacy determined nutrition risk the best. The sensitivity was 89.7 %, specificity 83.2 %, NPV 93.3 %, and PPV 75.4 % for this model. The nutrition screening tool equation developed in this study standardizes the process to identify children (0 to 2 years) with CF at nutrition risk. Further validation is needed. [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition in hospitalised patients is a problem that is frequently observed all around the world. Malnutrition in hospitalised patients is related to poor patient outcomes and high healthcare expenditures. The purpose of this study is to assess the nutrition risk and explore the associated risk factors of malnutrition among hospitalised patient. Methods: A cross-sectional study was done in Sarawak General Hospital located in Kuching, Sarawak using convenience sampling among adult aged 18 and above. The Malnutrition Screening Tool (MST) was used to assess the nutritional risk. Demographic characteristics, anthropometric and biochemical data were compared according to nutritional status. The chi-square test was performed to compare the differences between categorical variables. The risk factors of malnutrition were identified using logistic regression analysis. Result: A total of 207 respondents were involved in this study with 63.3% and 36.7% were male and female, respectively. Malnutrition risk was observed in 61.3% of respondents according to MST score. The malnutrition risk was significantly higher in older age, those who were admitted to oncology wards and those with lower BMI and impaired biochemical profile. Multivariate analysis revealed that age and BMI of less than 18.5 kg/m2 were the main factors contributing to the presence of risk of malnutrition. Conclusion: The risk of malnutrition is observed to be prevalent among hospitalised patients in Sarawak General Hospital. Therefore, it is important to have a routine nutritional screening and assessment to allow for early nutritional intervention and therapy. [ABSTRACT FROM AUTHOR]

Nutrition screening is the first step in most acute care pediatric nutrition care pathways. However, there is a lack of understanding of patient and families' perception of nutrition screening in pediatric populations. The objective of this study was to explore the potential perceptions, feelings, and opinions of families if pediatric nutrition screening were to be completed during hospital admission. Nine members of the Family Advisory Council at the Alberta Children's Hospital participated in a focus group to discuss questions around nutrition screening practices, malnutrition, and the pediatric nutrition screening tool. Transcripts were analyzed using MAXQDA and thematic analysis using the Braun and Clarke methodology. Two major themes emerged: screening may raise sensitive emotions and understanding the purpose of nutrition screening and the questions. Participants agreed discussions around growth and nutrition are vital to comprehensive medical care; however, the timing and approach of nutrition screening can lead to anxiety and feelings of judgement. A lack of understanding of the purpose of screening, next steps, and benefit to the individual patient could limit acceptance of nutrition screening. The findings of this study can inform training and education of healthcare professionals involved in nutrition screening. [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]

With the aging population in China, the number of elderly patients with hip fracture is increasing year by year. Malnutrition is common in the elderly patients with hip fracture, which can significantly increase the hospital stay, complication rate and postoperative mortality of patients. The purpose of this article is to review and summarize the latest research progress of different biomarkers and malnutrition screening tools in evaluating the nutritional status of elderly hip fracture patients, so as to provide a reference basis for doctors to correctly evaluate the nutritional status of elderly patients with hip fracture in clinical practice, and scientifically conduct nutritional intervention and treatment, so as to promote the postoperative recovery of patients with hip fracture, reduce complications and mortality. [ABSTRACT FROM AUTHOR]

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Background: Chimeric antigen receptor T (CAR‐T) cell therapy is a novel therapy demonstrating durable remissions in patients with refractory or relapsing non‐Hodgkin's B‐cell lymphoma. Maintaining a patient's nutritional status has been demonstrated to improve outcomes in cancer treatment. However, no studies have investigated how CAR‐T therapy affects nutritional status, nor compared its impact with other cancer treatments for this patient group. The primary aim of the present study was to investigate the effect of CAR‐T therapy on the prevalence of nutrition impact symptoms (NIS) and nutritional status within 30 days post‐treatment of patients with lymphoma compared to a conditioning regimen for autologous haematopoetic stem cell transplant (carmustine/BCNU, Etoposide, cytarabine/Ara‐C, Melphalan [BEAM] auto‐haematopoetic stem cell transplant [HSCT]). Methods: Clinical notes of patients with lymphoma who underwent either CAR‐T therapy or BEAM auto‐HSCT between 2018 and 2021 were reviewed. Data extracted included body weight measurements and NIS, including decreased appetite, nausea, vomiting, diarrhoea, constipation, mucositis, cytokine release syndrome (CRS) and neurotoxicity at baseline and 30 ± 7 days post‐treatment. Results: In total, 129 adults with lymphoma (n = 88 CAR‐T vs. n = 41 BEAM) were included. Nutritional status was assessed in both groups at baseline prior to treatment. Mean absolute weight change was significantly different between groups (3.05 kg in CAR‐T, −5.9 kg in BEAM, p ≤ 0.001). This was also significant when weight loss was categorised into percentage weight loss (p = 0.01). CAR‐T patients experienced a significantly lower prevalence of decreased appetite (52.3% vs. 97.6%) nausea (25% vs. 78%,) vomiting (10.2% vs. 53.7%), diarrhoea (43.2% vs. 96.7%) and mucositis (5.7% vs. 75.6%) combined across all levels of severity compared to BEAM chemotherapy (all p ≤ 0.01). CRS and neurotoxicity, which are specific side effects of CAR‐T therapy, were moderately positively associated with weight loss. Conclusions: Weight loss, percentage weight loss and NIS were significantly reduced in CAR‐T compared to BEAM treatment. However, patients who experienced neurotoxicity during treatment did have significant weight loss. Key points/Highlights: Our findings suggest approximately one quarter of adults receiving chimeric antigen receptor T (CAR‐T) therapy are malnourished at the time of commencing treatmentCAR‐T therapy is associated with significantly less weight loss and nutrition impact symptoms (nausea, vomiting, diarrhoea, mucositis) than autologous haematopoetic stem cell transplant (BEAM [carmustine/BCNU, Etoposide, cytarabine/Ara‐C, Melphalan] auto‐ haematopoetic stem cell transplant).Neurotoxicity in CAR‐T treatment is associated with significant weight loss and should trigger a dietitian referral. [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]

Our primary study objectives were to (i) determine the proportion of children admitted to the Pediatric Intensive Care Unit (PICU) with malnutrition diagnoses, (ii) compare healthcare utilization by malnourished and non-malnourished PICU patients, and (iii) examine the impact of implementing malnutrition screening and coding practices at a major academic urban tertiary care medical center. Using patient records, we conducted a retrospective analysis of 4106 children admitted to the PICU for severe illnesses between 2011 and 2019. Patients were identified as malnourished if records showed an ICD-9 or ICD-10 code for malnutrition. We compared malnourished and non-malnourished patients by age, admitting diagnoses, number of comorbid conditions, and clinical outcomes (length of stay, hospital readmission). About 1 of every 5 PICU-admitted patients (783/4106) had a malnutrition diagnosis. Patients with malnutrition were younger (mean age 6.2 vs. 6.9 years, p < 0.01) and had more comorbid conditions (14.3 vs. 7.9, p < 0.01) than those without. Malnourished patients had longer hospital stays (26.1 vs. 10.0 days, p < 0.01) and higher 30-day readmission rates (10% vs. 7%, p = 0.03). Implementation of malnutrition screening and coding practices was associated with an increase in malnutrition diagnosis. In this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses and used more healthcare resources (prolonged hospitalizations and higher 30-day readmission rates), leading to higher healthcare costs. Such findings underscore the need for policies, training, and programs emphasizing identification and treatment of malnutrition at hospitals caring for critically ill children. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic diseases patients are especially prone to malnutrition, which is often underestimated. Screening tools were developed to detect the risk of malnutrition. However, screening tools for patients with liver disease were frequently underestimated. Fluid overload is the main issue to perform nutritional screening in liver disease patients. Therefore, this study aimed to validate the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) among patients and to evaluate association between RFH-NPT, Nutritional Risk Screening (NRS 2002) and Subjective Global Assessment (SGA). Methods: This cross sectional study was conducted in 3 phases; transcultural adaptation, criterion validity and reliability phases. Content validity was confirmed by interviewing eight liver disease professionals. Face validity was assessed by surveying forty nurses working in the liver disease ward. In addition, agreement between NRS 2002 and RFH-NPT assessment was assessed using the SGA tool. Results: Eighty patients with liver disease took part in this study. The SGA assessment found malnutrition in 75% of patients (95% CI, 60%-95%) while 80% (95% CI, 65%-80) were found as at risk of malnutrition using RFH-NPT. Moderate specificity and high sensitivity of RFHNPT were 97% and 74%, respectively, and 95% positive predictive value was measured. Conclusion: The RFH-NPT nutritional screening tool is the initial and most reliable in this population to assess the malnutrition risk. Thus, inclusion of the RFH-NPT with NRS 2002 demonstrated positive and a fair agreement between the SGA and RFH-NPT tool to be used as a routine nutrition screening protocol for identifying patients at risk of malnutrition. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of nutrition clinical nursing pathway for nasopharyngeal carcinoma patients (NPC) undergoing concurrent radiotherapy and chemotherapy. Methods: A total of 162 patients with NPC who received the concurrent radiotherapy and chemotherapy were randomly divided into the control group (n = 81) and experimental group (n = 81). The control group was received routine nutrition management, while the experimental group received nutrition clinical nursing pathway intervention. Physiological condition, social/family status, emotional status and functional status of quality of life between the two groups before and after the intervention were assessed and compared. Results: The scores of functional status and additional attention in the experimental group were significantly higher than those in the control group (P < 0.001), The score of social/family status in the experimental group was also significantly higher than that in the control group (P < 0.001). Conclusion: The nutritional clinical nursing pathway can improve the functional status scores and additional attention scores for head and neck tumors, and also played a certain role in improving social/family status scores. To a certain extent, it can effectively improve the quality of life of patients with NPC undergoing radiotherapy and chemotherapy. [ABSTRACT FROM AUTHOR]

Patients undergoing total knee arthroplasty (TKA) who have malnutrition possess an increased risk of periprosthetic joint infection (PJI). Although malnutrition screening and intervention may decrease the risk of PJI, it utilizes healthcare resources. To date, no cost-effectiveness analyses have been performed on the screening and treatment of malnutrition prior to TKA. A Markov model projecting lifetime costs and quality-adjusted life years (QALYs) was built to determine the cost-effectiveness of malnutrition screening and intervention for TKA patients from a societal perspective. Costs, health state utilities, and state transition probabilities were obtained from previously published literature, hospital costs at our institution, and expert opinions. Two important assumptions included that 30% of patients would be malnourished and that a malnutrition intervention would be 50% effective. The primary outcome of this study was the incremental cost-effectiveness ratio, with a willingness-to-pay threshold of $100,000 per QALY. One-way and two-way sensitivity analyses were performed to evaluate model parameter assumptions. When using the base case values, universal malnutrition screening and intervention was cost-effective compared to no malnutrition screening or intervention, with an incremental cost-effectiveness ratio of $6,454 per QALY. Universal screening and intervention remained cost-effective, provided the cost of screening remained less than $3,373, the cost of nutritional intervention remained less than $12,042, the prevalence of malnutrition among surgical candidates was higher than 2%, and the risk of PJI among patients with malnutrition was greater than 1%. Universal preoperative malnutrition screening and intervention among TKA candidates is cost-effective at parameters encountered in clinical practice. Nutritional optimization programs should be considered to facilitate malnutrition screening and intervention and future studies should evaluate their efficacy at lowering PJI risk. [ABSTRACT FROM AUTHOR]

(1) Background: Prevalence studies on hospital malnutrition are still scarce in the Middle East region despite recent global recognition of clinical malnutrition as a healthcare priority. The aim of this study is to measure the prevalence of malnutrition in adult hospitalized patients in Lebanon using the newly developed Global Leadership Initiative on Malnutrition tool (GLIM), and explore the association between malnutrition and the length of hospital stay (LOS) as a clinical outcome. (2) Methods: A representative cross-sectional sample of hospitalized patients was selected from a random sample of hospitals in the five districts in Lebanon. Malnutrition was screened and assessed using the Nutrition Risk Screening tool (NRS-2002) and GLIM criteria. Mid-upper arm muscle circumference (MUAC) and handgrip strength were used to measure and assess muscle mass. Length of stay was recorded upon discharge. (3) Results: A total of 343 adult patients were enrolled in this study. The prevalence of malnutrition risk according to NRS-2002 was 31.2%, and the prevalence of malnutrition according to the GLIM criteria was 35.6%. The most frequent malnutrition-associated criteria were weight loss and low food intake. Malnourished patients had a significantly longer LOS compared to patients with adequate nutritional status (11 days versus 4 days). Handgrip strength and MUAC measurements were negatively correlated with the length of hospital stay. (4) Conclusion and recommendations: the study documented the valid and practical use of GLIM for assessing the prevalence and magnitude of malnutrition in hospitalized patients in Lebanon, and highlighted the need for evidence-based interventions to address the underlying causes of malnutrition in Lebanese hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia's health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index =0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management. [ABSTRACT FROM AUTHOR]

Background: The prevalence of malnutrition is unknown in patients with Hirschsprung disease. Undernutrition is associated with poor clinical outcomes. This study aims to describe the nutrition status among patients with Hirschsprung disease at admission. Methods: We retrospectively used data from children with Hirschsprung disease admitted to three pediatric surgery centers in China from January 2016 to December 2020. The weight‐for‐age z scores (WAZ), height‐for‐age z scores (HAZ), and body mass index‐for‐age z scores (BAZ) were calculated as the reference for nutrition risk according to the World Health Organization child growth standards. The nutrition status of enrolled children was described and nutrition risk in each clinical characteristic was compared. The association between nutrition status and clinical outcomes was analyzed using univariate and multivariate logistic regression. Results: A total of 624 patients were included in this study. The mean WAZ, HAZ, and BAZ of all patients was −0.64 ± 1.40, −0.45 ± 1.78, and −0.43 ± 1.50, respectively. Moderate to severe overall undernutrition was 16.3% (102/624). We found that WAZ and BAZ were significantly reduced with the length of aganglionic segments (P = 0.001). Children who had a definitive surgery at 3 years of age or older had significantly lower HAZ (P = 0.001). A multivariate regression model assessing postoperative Hirschsprung‐associated enterocolitis showed that the WAZ was one of the independent risk factors (P = 0.001). Conclusion: Undernutrition is prevalent among children with Hirschsprung disease. Nutrition assessment to identify individuals at risk of undernutrition for further intervention is necessary. [ABSTRACT FROM AUTHOR]

Our primary study objectives were to (i) determine the proportion of children admitted to the Pediatric Intensive Care Unit (PICU) with malnutrition diagnoses, (ii) compare healthcare utilization by malnourished and non-malnourished PICU patients, and (iii) examine the impact of implementing malnutrition screening and coding practices at a major academic urban tertiary care medical center. Using patient records, we conducted a retrospective analysis of 4106 children admitted to the PICU for severe illnesses between 2011 and 2019. Patients were identified as malnourished if records showed an ICD-9 or ICD-10 code for malnutrition. We compared malnourished and non-malnourished patients by age, admitting diagnoses, number of comorbid conditions, and clinical outcomes (length of stay, hospital readmission). About 1 of every 5 PICU-admitted patients (783/4106) had a malnutrition diagnosis. Patients with malnutrition were younger (mean age 6.2 vs. 6.9 years, p < 0.01) and had more comorbid conditions (14.3 vs. 7.9, p < 0.01) than those without. Malnourished patients had longer hospital stays (26.1 vs. 10.0 days, p < 0.01) and higher 30-day readmission rates (10% vs. 7%, p = 0.03). Implementation of malnutrition screening and coding practices was associated with an increase in malnutrition diagnosis. In this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses and used more healthcare resources (prolonged hospitalizations and higher 30-day readmission rates), leading to higher healthcare costs. Such findings underscore the need for policies, training, and programs emphasizing identification and treatment of malnutrition at hospitals caring for critically ill children.

Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements. [ABSTRACT FROM AUTHOR]

Aim: Adults living with severe mental illness experience a greater burden of physical comorbidities and earlier mortality than the general population. Malnutrition, overnutrition, dysphagia, constipation and disordered eating have been observed in this population and can lead to poor nutritional status. Early identification of such conditions may reduce their impact on functional status, quality of life and health outcomes. This scoping review aimed to identify all nutrition risk screening methods published in English internationally for use with adults living with severe mental illness and ascertain which, if any, were validated for the target population. Methods: A four‐step search strategy was used to search six electronic databases and grey literature, from inception to April 2020, for articles reporting nutrition risk screening methods used in this population. Information on the content and validity of screening methods was extracted and analysed by three independent reviewers. Results: Seventeen nutrition risk screening methods were identified, of which three were validated within a population of adults with severe mental illness. One screening method was found for both malnutrition and dysphagia risk, respectively, and three for constipation risk. No single method was found for overnutrition. Eleven screening methods were identified for disordered eating risk, of which two were validated for the target population. Conclusions: Nutrition risk screening methods and their validation in adults living with severe mental illness are inadequately researched. This scoping review highlights the need for future research to develop new or validate existing screening methods specifically for the target population. [ABSTRACT FROM AUTHOR]

Weight‐for‐age (WFA) growth faltering often precedes severe acute malnutrition (SAM) in children, yet it is often missed during routine growth monitoring. Automated interpretation of WFA growth within electronic health records could expedite the identification of children at risk of SAM. This study aimed to develop an automated screening tool to predict SAM risk from WFA growth, and to determine its predictive ability compared with simple changes in weight or WFA z‐score. To develop the screening tool, South African child growth experts (n = 30) rated SAM risk on 100 WFA growth curves, which were then used to train an artificial neural network (ANN) to assess SAM risk from consecutive WFA z‐scores. The ANN was validated in 185 children under five (63 SAM cases; 122 controls) using diagnostic accuracy methodology. The ANN's performance was compared with that of changes in weight or WFA z‐score. Even though experts' SAM risk ratings of the WFA growth curves differed considerably, the ANN achieved a sensitivity of 73.0% (95% confidence interval [CI]: 60.3; 83.4), specificity of 86.1% (95% CI: 78.6; 91.7) and receiver‐operating characteristic curve area of 0.795 (95% CI: 0.732; 0.859) during validation with real cases, outperforming changes in weight or WFA z‐scores. The ANN, as an automated screening tool, could markedly improve the identification of children at risk of SAM using routinely collected WFA growth information. Key messages: Growth faltering preceding severe acute malnutrition (SAM) is poorly identified during routine growth monitoring, and opportunities for preventative interventions are missed.Consistently identifying growth faltering is challenging, even for experts in child growth. Digitized growth monitoring tools incorporating automated pattern recognition by an artificial neural network (ANN) can assist clinicians in identifying growth faltering.In this study, an ANN was trained to identify children at risk of SAM based on weight‐for‐age growth curves, with promising results. With further refinement, the ANN could greatly improve the identification of children with growth faltering and facilitate earlier interventions to prevent SAM. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is present in 20-50% of hospital patients but its recognition is often neither timely nor complete. The Global Leadership Initiative on Malnutrition (GLIM) aims to improve this, but its successful implementation may be compromised by its dependence on (a choice of) prior screening tools and difficulties in consistent assessment of muscle mass., Aims: To explore different approaches to screening and muscle assessment in GLIM and to offer simpler choices for its more widespread application., Methods: (1) Data from 300 consenting in-patients provided Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Subjective Global Assessment (SGA) scores. GLIM scoring was preceded by NRS-2002 or MUST (using threshold scores of 1 or 2 for MUST), or no prior screening. The results of GLIM scoring preceded by different screening approaches were compared with those of SGA. (2) The literature on mid-upper arm circumference (MUAC) and calf circumference (CC) as simple, non-invasive, objective methods of muscle assessment methods was reviewed (3) The cumulative times taken to obtain GLIM scores were measured and corrected for the different screening strategies., Results: (1) Participants' mean age was 60 years, 157 (52%) were female and mean BMI was 27.8 kg/m 2 . In comparison with SGA, GLIM with no prior screening had the highest sensitivity (65%) and negative predictive value (NPV) (76%), but the lowest specificity (90%) and positive predictive value (PPV) (84%). The equivalent figures for GLIM with prior MUST "1" were 62%, 75%, 93% and 88%; with prior NRS-2002, 55%∗, 73%, 98%∗ and 95%∗; and with prior MUST "2", 44%∗, 69%∗, 98%∗, 95%∗. The area under an ROC curve was the highest (0.78) when GLIM was performed without screening or with prior MUST "1". (2) Being less affected by oedema and gender differences than calf circumference, MUAC could serve as a standard globally accessible muscle mass assessment method which can be supplemented by technical approaches if available and deemed necessary. (3) The overall per-capita time requirement of GLIM was 240-245 s without prior screening, and was increased by 2-3% with prior MUST "1", by 27-29% with prior NRS-2002 and decreased by 8-9% with prior MUST "2"., Conclusions: Preceding GLIM by screening can decrease its sensitivity and increase overall time utilisation; "gold standard" muscle assessment is not globally accessible. Our results therefore support considering using GLIM as a combined screening and assessment tool, with MUAC as the method of muscle assessment which can be supplemented by technical approaches if available and deemed necessary. This could potentially both simplify the use of GLIM and improve the early detection of malnutrition. ∗Indicates statistically significant difference from use of GLIM without prior screening., Competing Interests: Declaration of competing interest None of the authors has any specific conflicts of interest to declare. Participating in the study formed part of the coursework of CK-B, GK and AL towards the University of Tartu Masters in Clinical Nutrition., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: The emergency department (ED) is the most frequent access route to the hospital. Nutrition risk (NR) screening allows the early identification of patients at risk of malnutrition. This study aimed to evaluate the feasibility and predictive validity of five different tools in EDs: Nutritional Risk Screening 2002 (NRS-2002), Nutritional Risk Emergency 2017 (NRE-2017), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), Malnutrition Universal Screening (MUST), and Malnutrition Screening Tool (MST)., Methods: Patients with scores ≥3 according to the NRS-2002, ≥1.5 according to the NRE-2017, and ≥2 according to the MUST, RFH-NPT, or MST were classified with NR. Prolonged length of stay (LOS) and 1-year mortality were evaluated., Results: 431 patients were evaluated (57.31 ± 15.6 years of age; 54.4% women) in a public hospital in southern Brazil. The prevalence of NR was: 35% according to the NRS-2002, 43% according to the MST, 45% according to the NRE-2017 and MUST, and 49% according to the RFH-NPT. Patients with NR, had a greater risk of prolonged LOS (P < 0.001). The presence of NR was associated with an increased risk of 1-year mortality according to the NRS-2002 (hazard ratio [HR]: 4.04; 95% CI, 2.513-6.503), MST (HR: 2.60; 95% CI, 1.701-3.996), NRE-2017 (HR: 4.82; 95% CI, 2.753-8.443), MUST (HR: 4.00; 95% CI, 2.385-6.710), and RFH-NPT (HR: 5.43; 95% CI, 2.984-9.907)., Conclusions: NRE-2017 does not require objective data and presented predictive validity for all outcomes assessed, regardless of the severity of the disease, and thus appears to be the most appropriate tool for carrying out NR screening in the ED., (© 2024 American Society for Parenteral and Enteral Nutrition.)

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., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Individuals receiving hemodialysis are at increased risk of malnutrition; however, regular diagnosis of malnutrition using subjective global assessment (SGA) is time-consuming. This study aimed to determine whether the Canadian Nutrition Screening Tool (CNST) or the Geriatric Nutrition Risk Index (GNRI) screening tools could accurately identify hemodialysis patients at risk for malnutrition. A retrospective medical chart review was conducted for in-centre day shift hemodialysis patients (n = 95) to obtain the results of the SGA assessment and the CNST screener and to calculate the GNRI score. Sensitivity and specificity analyses showed only a fair agreement between the SGA and CNST (sensitivity = 20%; specificity 96%; κ = .210 (95% CI, -0.015 to .435), p  < .05) and between the SGA and GNRI (sensitivity = 35%; specificity = 88%; κ = .248 (95% CI, .017 to .479), p  < .05). There was no significant statistical difference between the accuracy of either tool in identifying patients at risk of malnutrition ( p  = .50). The CNST and GNRI do not accurately screen for risk of malnutrition in the hemodialysis population; therefore, further studies are needed to determine an effective malnutrition screening tool in this population.

Objectives: Many existing malnutrition screening and diagnostic tools require body mass index (BMI) and quantification of weight change to detect malnutrition or risk thereof. This is often a challenge in South African public hospitals due to missing data, including patient records. This study investigated the extent to which hospitalised patients can gauge their current and usual body size from a validated BMI-based figure rating scale (FRS). It also ascertained whether a relationship exists between a change in clothing size and a change in perceived BMI, derived from the FRS. Methods: A total of 196 adult patients participated in a cross-sectional study, in three Eastern Cape public hospitals. Data were collected by consulting medical files, patients and taking anthropometric measurements. Validated FRSs were used to determine patients’ accuracy of actual and usual BMI. Data were analysed with Statistica® and Microsoft Excel 2016. Results: Some 66% (n = 131) of participants were accurate in selecting an image representative of their BMI, which was statistically significant (r2 = 0.80; p

This study aimed to determine four-year outcomes of community-living older adults identified at 'nutrition risk' in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49–87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time. [ABSTRACT FROM AUTHOR]

Background Nutrition screening is paramount for the detection of malnutrition, allowing for improved patient care and timely nutrition management. Despite the well-documented prevalence of malnutrition in patients with traumatic brain injury (TBI) and spinal cord injury (SCI), no studies have assessed the validity of the malnutrition screening tool (MST) in these patient populations. Objective The primary aim of this study was to explore health professionals' perspectives on nutrition screening in patients with TBI and SCI in specialist inpatient rehabilitation. Furthermore, this study aimed to elucidate health professionals' views on the barriers and enablers of nutrition management as directed by the MST score. Methods Seven health professionals who used the MST in patients with TBI and SCI at a specialist rehabilitation centre participated in semi-structured, face-to-face interviews. Resultant transcripts were analysed thematically using the six-phase technique in QSR NVivo software. Results Thematic analysis identified four main themes highlighting the barriers and enablers of the MST in patients with TBI and SCI: population-specific influencers (e.g., patient cognition and enteral feeding); the impact of the MST on staff resources; participant identification that additional resources were required to effectively administer the MST; and the importance of MST score-directed patient care. Conclusions This study highlights challenges associated with the reliability of MST to direct nutrition care in patients with TBI and SCI, while recognising opportunities for improvement. This new knowledge underscores the importance of individualised patient care whilst identifying the need for sensitive, population-specific nutrition screening tools (NSTs). [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to assess the nutritional status and the most commonly reported nutrition-related factors contributing to nutritional risk in people living with HIV/AIDS (PLWHA) in Ghana and the specificity and sensitivity of the Rapid Nutrition Screening for HIV disease tool (RNS-H) in this population. Design: A cross-sectional design was utilised. Patients were screened for nutritional status during a one-week period by clinic nurses using the RNS-H. Results were compared with a comprehensive nutritional assessment by a dietitian. Setting: The research was conducted in a public health clinic at the University of Ghana Hospital, Legon. Subjects Patients receiving care at the clinic were asked to participate. Outcome measures: The nutritional screening and nutritional assessment both resulted in participants being assigned to one of three nutritional statuses: ‘low risk’, ‘at risk’ and ‘high risk’. The association between the nutritional screening and nutritional assessment was measured. Results: The results of the nutritional status assigned by the RNS-H and nutritional assessment were compared. A total of 51 patients participated. A high prevalence of nutritional risk based on the RNS-S (54.9%) was found with 33.3% of the sample being malnourished. The most common nutrition-related complications were food insecurity, poor appetite, weight loss and diarrhoea. Conclusions: The RNS-H was found to have a strong specificity and sensitivity in a sample of Ghanaian PLWHA. Because of the nutritional risk and complexity of HIV in Ghana, nutritional screening using the RNS-H and nutrition care by a dietitian should be a standard of care.

Robert D Murray,1 Kirk W Kerr,2 Cory Brunton,2 Jennifer A Williams,2 Tiffany DeWitt,2 Karyn L Wulf2,3 1The Ohio State University College of Medicine, Columbus, OH, USA; 2Abbott Nutrition, Columbus, OH, USA; 3Nationwide Children’s Hospital Division of Emergency Medicine, Columbus, OH, USACorrespondence: Karyn L WulfAbbott Nutrition, 2900 Easton Square Place, Columbus, OH, 43219, USATel +1 614-370-4491Email Karyn.wulf@abbott.comBackground: Childhood malnutrition remains far too common around the world today. In this paper, we discuss pediatric malnutrition in the context of protein-energy undernutrition and hidden hunger (single or multiple micronutrient deficiencies). Recent growth statistics show that nearly 150 million children under 5 years are stunted, and 50 million are wasted. At the same time, millions more children experience undernutrition of lesser severity but with negative effects on growth nonetheless. Beyond poor growth, such nutrient shortfalls can predispose children to impaired physical and mental development, which may have lifelong consequences. The World Health Organization recently set an aspirational goal “to end all forms of childhood malnutrition by 2030.”Plan of Action: Our paper proposes a stepwise strategy to raise awareness of childhood malnutrition risk and to work toward building a consensus on pediatric malnutrition screening as a pathway to ending childhood malnutrition. In a full plan for action, we propose to convene an expert Working Consensus Group on Pediatric Nutrition Screening (WCG-PNS). We propose that this group will work to (1) identify malnutrition screening tools specific for universal screening of children in hospital and community settings, (2) plan and lead healthcare professional training on how to screen for malnutrition risk, then take appropriate follow-up steps, (3) guide and advise quality improvement programs (QIPs) to facilitate incorporation of nutrition screening and interventions into everyday practice, and (4) measure and communicate potential findings in terms of health and financial outcomes.Conclusion: We recognize an urgent need for universal screening of infants and children for nutritional risk—around the world and across the continuum of care. Such screening is expected to promote early identification of children who can benefit from nutrition interventions, then ensure that these children get needed nutritional support. In this way, we aim to prevent growth impairment, which has also been associated with adverse effects on mental and physical development.Keywords: malnutrition, pediatrics, nutrition screening, nutritional interventions, undernutrition, clinical outcomes

Medical nutrition therapy has been widely applied in various diseases as a fundamental or even a first-line treatment. Patient who undergoes a disease state especially at the perioperative period can be much improved with the help of nutrition therapy. Precise nutrition diagnosis should be conducted before applying any nutrition therapy. Traditional malnutrition diagnostic process, however, is a two-stage process (nutrition screening and nutrition assessment) which cannot precisely assess nutritional status of surgical patients or the consequences of being malnourished. This article systematically introduced a new nutrition diagnostic process – Three-Stage Diagnosis (nutrition screening, nutrition assessment, and comprehensive evaluation) and discussed its applications during perioperative period. [ABSTRACT FROM AUTHOR]

(1) Background: Prevalence studies on hospital malnutrition are still scarce in the Middle East region despite recent global recognition of clinical malnutrition as a healthcare priority. The aim of this study is to measure the prevalence of malnutrition in adult hospitalized patients in Lebanon using the newly developed Global Leadership Initiative on Malnutrition tool (GLIM), and explore the association between malnutrition and the length of hospital stay (LOS) as a clinical outcome. (2) Methods: A representative cross-sectional sample of hospitalized patients was selected from a random sample of hospitals in the five districts in Lebanon. Malnutrition was screened and assessed using the Nutrition Risk Screening tool (NRS-2002) and GLIM criteria. Mid-upper arm muscle circumference (MUAC) and handgrip strength were used to measure and assess muscle mass. Length of stay was recorded upon discharge. (3) Results: A total of 343 adult patients were enrolled in this study. The prevalence of malnutrition risk according to NRS-2002 was 31.2%, and the prevalence of malnutrition according to the GLIM criteria was 35.6%. The most frequent malnutrition-associated criteria were weight loss and low food intake. Malnourished patients had a significantly longer LOS compared to patients with adequate nutritional status (11 days versus 4 days). Handgrip strength and MUAC measurements were negatively correlated with the length of hospital stay. (4) Conclusion and recommendations: the study documented the valid and practical use of GLIM for assessing the prevalence and magnitude of malnutrition in hospitalized patients in Lebanon, and highlighted the need for evidence-based interventions to address the underlying causes of malnutrition in Lebanese hospitals.

Background: Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status. Methods: We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross‐sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores. Results: A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87). Conclusions: This is the first large‐scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in‐hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this implementation project was to improve nutritional screening and nutritional interventions for patients scheduled for gastrointestinal surgery in a general surgical ward. Introduction: Malnutrition is common in hospitalized surgical patients and has many adverse outcomes affecting the patients' quality of life. Improving nutritional risk screening and nutritional support could reduce the incidence of malnutrition and its adverse outcomes. Methods: The project used the JBI audit and feedback method to implement evidence into practice. JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for promoting change in general surgical wards. Six audit criteria were created based on an evidence summary, including using screening tool, patients' and caregivers' education, nurses' education on nutritional screening and support, preoperative nutrition support and postoperative early food intake. A baseline audit was conducted, followed by nursing information system improvement, education, multidisciplinary meetings targeted at clinicians and two cycles of follow-up audits. Results: Results from the baseline and follow-up audits showed improvement for all the criteria. Compliance for criteria 1-3 increased from 0 to 100%, and that for criterion 4 increased from 32 to 100%. These four criteria sustained 100% in follow-up cycle 2. Compliance for criterion 5 increased from 8 to 50% in follow-up cycle 1 audit, but decreased to 0% in follow-up cycle 2 audit, and similarly for criterion 6, compliance increased from 45 to 56% in follow-up cycle 1 audit, but decreased to 48% in follow-up cycle 2 audit. Conclusion: The objectives related to nutritional risk screening, nurse knowledge, patients and families were successfully realized and sustained positive results. This project demonstrated that a nursing information system and long-term patient education are essential strategies to achieve and sustain positive results. The objectives related to preoperative nutritional support and postoperative early enteral food intake were challenges and represented barriers. In future, a multiple-pronged strategy will be implemented to achieve overall success and change according to best practice. [ABSTRACT FROM AUTHOR]

This article reviews the prevalence of loss of muscle mass and function, (sarcopenia) alongside malnutrition in the older population (>65 years). It outlines what is meant by both sarcopenia and malnutrition and looks at how these conditions can interact to cause detrimental outcomes in both underweight and overweight older adults. It also details some of the potential consequences of loss of muscle mass on the effective functioning of the human body and clinical outcomes and includes tips for nurses on how they can incorporate simple strategies into everyday care to both identify and treat patients at risk of sarcopenia and malnutrition. [ABSTRACT FROM AUTHOR]

Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition identification through nutrition screening needs to be performed routinely in health clinics. However, the nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim. Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years) attending the sampled health clinics. Both data from the interviews and observations were analysed thematically using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6), medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty- one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition screening guideline may facilitate healthcare staff in performing nutrition screening. [ABSTRACT FROM AUTHOR]

The presence and impact of malnutrition in adult hospitalized patients has been well documented by a significant body of literature. However, current malnutrition care practices often vary widely and frequently lack standardization. The Global Malnutrition Composite Score (GMCS), the first nutrition-related electronic clinical quality measure, is intended to evaluate the quality of malnutrition care provided to inpatient adults. This measure aims to aid in standardizing malnutrition care through performance measurement. The four components of the measure (nutrition screening, nutrition assessment, malnutrition diagnosis, and nutrition care plans) follow the well-established Nutrition Care Process and encourage the use of standardized terminology. Facilities with high-performance scores on the GMCS are likely to experience improved outcomes associated with high-quality malnutrition care., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Background: Ambulatory cancer patients are at high risk of malnutrition. Multiple nutrition screening and assessment tools are used in the outpatient setting. This study aimed to evaluate the efficacy of different nutrition screening tools as the first step of the Global Leadership Initiative on Malnutrition (GLIM) framework in Chinese ambulatory cancer patients., Methods: A cross-sectional study was conducted in a tertiary hospital in China. Malnutrition diagnoses made by the GLIM framework using Malnutrition Screening Tool, Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, or short-form of Patient-Gernerated Subjective Global Assessment (PG-SGA) as the first step were compared with PG-SGA separately., Results: Of the 562 included patients, 31.0% were diagnosed with malnutrition (PG-SGA: B + C), and 12.6% were diagnosed with severe malnutrition (PG-SGA: C). As the screening tool in the first step of the GLIM framework, the short form of PG-SGA (PG-SGA SF) with a cutoff value of ≥2 performed best in diagnosing malnutrition, with good sensitivity (SE) (80.5% [73.6-85.9]) and specificity (SP) (98.4% [96.5-99.4]) and substantial accordance (κ = 0.826), whereas PG-SGA SF with a cutoff value of ≥4 performed best in diagnosing severe malnutrition, with fair SE (62.0% [49.6-73.0]), good SP (96.7% [94.6-98.1]) and moderate accordance (κ = 0.629)., Conclusion: Using PG-SGA as the standard, the GLIM framework using PG-SGA SF as the screening tool has good accordance with the PG-SGA regardless of severity grading. PG-SGA SF can be used as a valid screening tool in the GLIM framework., (© 2023 American Society for Parenteral and Enteral Nutrition.)

Background: Rapid nutrition screening (NS) is vital for apt management in patients with alcoholic liver cirrhosis (ALC)., Aim: To identify a quick method of NS having high reliability and prognostic significance., Methods: NS of patients with ALC was assessed using mid-upper arm circumference (MUAC), handgrip strength (HGS), fat-free mass index (FFMI), and the Royal Free Hospital-Global Assessment (RFH-GA). Baseline clinical and biochemical information were recorded along with 90-day survival data. The classification and regression tree method was used to classify HGS, MUAC, and FFMI values as well nourished (WN), moderately malnourished (MM), and severely malnourished (SM), and their concordance with RFH-GA categories was assessed using Kendall tau-b coefficient. The prognostic proficiency of each method was tested by Cox regression analysis., Results: According to the RFH-GA, of 140 male patients with ALC, 13 of 140 (9.3%) were WN, 93 of 140 (66.4%) were MM, and 34 of 140 (26.8%) were SM. HGS has the strongest association with the RFH-GA (Kendall tau-b = 0.772; diagnostic accuracy -81.4%). HGS was found to be the independent predictor of 90-day mortality (26 of 140 [18.6%]; hazard ratio, 0.93; 95% CI, 0.88-0.98; P = 0.002) after adjusting for age, body mass index, and disease severity. The hazard of mortality was 8.5-times higher in patients with ALC with HGS < 22 kg as compared with those with HGS > 29., Conclusion: HGS is a reliable tool for rapid NS. HGS < 22 kg suggests a high risk for severe malnutrition and is strongly associated with short-term mortality in male patients with ALC., (© 2022 American Society for Parenteral and Enteral Nutrition.)

The 2020 update to KDOQI Clinical Practice Guidelines for Nutrition in chronic kidney disease (CKD) is a result of the collaboration between the National Kidney Foundation (NKF) and the Academy of Nutrition and Dietetics (Academy). The target population for this guideline is adults with stages 1 through 5 CKD who are not receiving dialysis, end-stage kidney disease including those on dialysis, and individuals with functional kidney transplant. The updated guideline includes 83 recommendations on important nutrition topics in CKD, including nutrition screening and assessment; medical nutrition therapy; dietary protein and energy intake; micronutrients; electrolytes; nutritional supplementation; and dietary patterns. Both Academy and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approaches were used to assess quality of evidence and rate the recommendation statements. Guideline recommendations were the result of a comprehensive systematic review, clinical expertise, and considerations for individualized care. [ABSTRACT FROM AUTHOR]

Background: Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient‐reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient‐reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. Methods: A cross‐sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27‐item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. Results: Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P = 0.01). Conclusions: This survey highlights areas of positive patient‐reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements. [ABSTRACT FROM AUTHOR]

Objectives: Many existing malnutrition screening and diagnostic tools require body mass index (BMI) and quantification of weight change to detect malnutrition or risk thereof. This is often a challenge in South African public hospitals due to missing data, including patient records. This study investigated the extent to which hospitalised patients can gauge their current and usual body size from a validated BMI-based figure rating scale (FRS). It also ascertained whether a relationship exists between a change in clothing size and a change in perceived BMI, derived from the FRS. Methods: A total of 196 adult patients participated in a cross-sectional study, in three Eastern Cape public hospitals. Data were collected by consulting medical files, patients and taking anthropometric measurements. Validated FRSs were used to determine patients' accuracy of actual and usual BMI. Data were analysed with Statistica® and Microsoft Excel 2016. Results: Some 66% (n = 131) of participants were accurate in selecting an image representative of their BMI, which was statistically significant (r2 = 0.80; p < 0.001). Female participants were more likely to select the correct corresponding BMI image (p < 0.05; r2 = 0.77 for males; r2 = 0.82 for females). Altogether, 61% (n = 79) of participants with a known previous weight were accurate in selecting an accurate image representative of their usual BMI, also statistically significantly (r2 = 0.71; p < 0.001). Conclusion: An existing FRS may be a useful adjunctive aid in clinical practice to estimate certain anthropometric indices when not otherwise available. This may be especially relevant to nutritional screening practices conducted by frontline healthcare professionals, e.g. nurses and doctors not specifically trained in anthropometry. This in turn may improve malnutrition detection rates and facilitation of appropriate nutrition care pathways. [ABSTRACT FROM AUTHOR]

The objectives of this study were to assess the nutritional status and the most commonly reported nutrition-related factors contributing to nutritional risk in people living with HIV/AIDS (PLWHA) in Ghana and the specificity and sensitivity of the Rapid Nutrition Screening for HIV disease tool (RNS-H) in this population. A cross-sectional design was utilised. Patients were screened for nutritional status during a one-week period by clinic nurses using the RNS-H. Results were compared with a comprehensive nutritional assessment by a dietitian. The research was conducted in a public health clinic at the University of Ghana Hospital, Legon. Patients receiving care at the clinic were asked to participate. The nutritional screening and nutritional assessment both resulted in participants being assigned to one of three nutritional statuses: 'low risk', 'at risk' and 'high risk'. The association between the nutritional screening and nutritional assessment was measured. The results of the nutritional status assigned by the RNS-H and nutritional assessment were compared. A total of 51 patients participated. A high prevalence of nutritional risk based on the RNS-S (54.9%) was found with 33.3% of the sample being malnourished. The most common nutrition-related complications were food insecurity, poor appetite, weight loss and diarrhoea. The RNS-H was found to have a strong specificity and sensitivity in a sample of Ghanaian PLWHA. Because of the nutritional risk and complexity of HIV in Ghana, nutritional screening using the RNS-H and nutrition care by a dietitian should be a standard of care. [ABSTRACT FROM AUTHOR]

Feeding dysfunction is common in children. Efficient processes to identify and treat feeding dysfunction are not commonly known or used among healthcare practitioners. The aim of this study was to develop and validate a survey tool to assess current practice procedures used by Registered Dietitian Nutritionists (RDN) in identifying, diagnosing, and treating feeding dysfunction in children 0–18 years of age. A survey was developed and distributed to gather information on RDN practice procedures, prevalence of pediatric feeding dysfunction, identification of pediatric feeding dysfunction, and method of treatment used to address pediatric feeding dysfunction. Emails were sent to 4449 RDNs in United States. All participants were classified by the Commission on Dietetic Registration (CDR) as clinical dietitians. Distribution and frequency of survey responses were assessed, and in the case of qualitative questions, were categorized according to themes identified. Responses of RDNs from 41 states completed 341 total surveys, 179 surveys were included in data analysis. Eighty percent of participants do not use a specific screening tool to identify feeding dysfunction. Results concerning feeding therapy strategies and terms used by RDNs to describe feeding dysfunction were highly varied or lacking. Increased inclusion of RDNs on interdisciplinary teams was indicated by 80% of participants. The majority of participants indicated they refer patients with feeding dysfunction to other practitioners instead of providing feeding therapy themselves. Standardized screening, diagnostic, and treatment protocols regarding feeding dysfunction are needed to provide consistent and comprehensive care for the pediatric population. Use of these protocols among RDNs would enable them to improve feeding abilities in more patients earlier in individual child development. [ABSTRACT FROM AUTHOR]