IntroductionTo stimulate early recognition and treatment of malnutrition, the Dutch Healthcare Inspectorate obliged all hospitals from 2008–2019 to report the number of malnourished patients with an adequate protein intake on the fourth day of hospital admission. In this article we present results over the past 11 years and discuss success factors and barriers for adequate treatment of malnourished patients in hospitals.MethodsThe annual reports of hospitals on the numbers of patients with a screening result ‘malnourished’ and an adequate protein intake on the fourth day of admission were analysed. Hospitals were categorized based on the percentage of malnourished patients with an adequate protein intake on the fourth day of admission as ‘poor’ (<40% of patients in a hospital achieve an adequate protein intake), ‘moderate’ 40–60% of patients in a hospital achieve an adequate protein intake), and ‘good’ (>60% of patients in a hospital achieve an adequate protein intake). To identify success factors and barriers for adequate treatment and registration of malnourished patients in hospitals, three focus groups were held in June and July 2020. Participants were dietitians and quality employees or nurses who were involved in data collection for malnutrition indicators in their hospitals.ResultsBetween 2008–2019, data were reported of 339,720 malnourished patients. The relative number of patients with adequate intake of protein on the fourth day in hospital ranges from 44%-53% between 2011 and 2019. Before 2013, the number of hospitals that reported data was too small to draw conclusions about results of treatment of malnutrition. Data from 2013 to 2019, show a decline in the number of hospitals with a ‘poor’ score. The number of hospitals with a moderate score increased between 2015 and 2019 and the number of hospitals with a good score remained more or less stable, except for 2018 where more hospitals reached a ‘good’ score. Sixteen professionals from ten different hospitals participated in the focus groups and revealed several determinants of adequate treatment of malnourished patients in hospitals such as awareness, feeling responsible and the need of clear instructions and good collaboration.ConclusionThis inventory of the protein intake of 339,720 hospital malnourished patients over 11 years shows that in one out of five Dutch hospitals >60% of malnourished patients had an adequate protein intake on the fourth day of admission. This shows that meeting protein requirements remains a difficult challenge. Early recognition of malnutrition, optimal multidisciplinary treatment and continuous evaluation is necessary to provide optimal nutritional care in the hospital and beyond.
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Trends in eiwittransitie kunnen regionaal verschillen. In groeiende economieën verschuiven diëten wereldwijd van plantaardige naar dierlijke eiwitten. In veel economisch ontwikkelde regio's gebeurt echter het tegenovergestelde vanwege de zorg voor milieu en gezondheid. Wij onderzochten de relatie tussen vijf drijvende krachten en eiwittransitietrends zoals deze worden ervaren door jongvolwassenen in ontwikkelde regio's in China (Shanghai) en Nederland (Amsterdam, lees: de Randstad). De onderzochte drijvende krachten waren: milieubewustzijn; het beleid; cultuur; geld; en gezondheid. De gegevens zijn verkregen door 200 vragenlijsten te laten beantwoorden in beide regio's. De resultaten geven aan dat jongvolwassenen in Shanghai meer dierlijke eiwitten consumeren dan plantaardige eiwitten, maar dat er een verandering naar plantaardige eiwitten is ingezet, terwijl de trend van jongvolwassenen in Amsterdam om plantaardig eiwit te consumeren al verder ontwikkeld is. De rangschikking van de drijvende krachten in Shanghai was Geld＞ Milieubewustzijn＞ Gezondheid＞ Cultuur＞ Beleid, en in Amsterdam Gezondheid＞ Milieubewustzijn＞ Geld＞ Beleid＞ Cultuur. Eiwitkeuzes in de voeding van jongvolwassenen worden dus in Shanghai door andere drijvende krachten bepaald dan in Amsterdam
MULTIFILE
In this review, we present the growing scientific evidence showing the importance of protein and amino acid provision in nutritional support and their impact on preservation of muscle mass and patient outcomes.
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