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3Need for quantifying malnutrition awareness among community-dwelling older adults and identifying factors associated with malnutrition awareness.
DOCUMENT
Objectives: The aim of this study was to determine how diagnosing and coding of malnutrition in an internal medicine ward setting influences potential hospital reimbursement. Methods: Patients admitted to the internal medicine ward of Centro Hospitalar do Médio Ave between April 24 and May 22, 2018 were screened by Nutritional Risk Screening 2002, and patients classified as at “risk for malnutrition” were assessed by the Patient-Generated Subjective Global Assessment (PG-SGA). For each patient, medical coders simulated coding, taking into account the malnutrition diagnosis by PG-SGA, and compared it with the real coding as retrieved from the medical records. For the coding, the Diagnosis-Related Group and Severity of Illness were determined, allowing the calculation of hospitalization cost (HC) according to Portuguese Ministerial Directive number 207/2017. The increase of HC in this subsample was extrapolated to the number of patients admitted during 2018, to obtain the estimated unreported annual HC. Results: Of the 71% (92/129) participants having malnutrition risk according to Nutritional Risk Screening 2002, 86% were malnourished. Including malnutrition diagnosis in the coding of malnourished patients increased the level of Severity of Illness in 39% of cases and increased HC for this subsample, resulting in €52 000. Extrapolating for the annual HC, total HC reached €1.3 million. Conclusions: Identifying malnourished patients and including this highly prevalent diagnosis in medical records allows malnutrition coding and consequent increase of HC. This can improve the potential hospital reimbursement, which could contribute to the quality of patient care and economic sustainability of hospitals.
DOCUMENT
Objectives: Malnutrition is associated with a twofold higher risk of dying in patients with tuberculosis (TB) and considered an important potentially reversible risk factor for failure of TB treatment. The construct of malnutrition has three domains: intake or uptake of nutrition; body composition and physical and cognitive function. The objectives of this systematic review are to identify malnutrition assessment methods, and to quantify how malnutrition assessment methods capture the international consensus definition for malnutrition, in patients with TB.
Design: Different assessment methods were identified. We determined the extent of capturing of the three domains of malnutrition, that is, intake or uptake of nutrition, body composition and physical and cognitive function.
Results: Seventeen malnutrition assessment methods were identified in 69 included studies. In 53/69 (77%) of studies, body mass index was used as the only malnutrition assessment method. Three out of 69 studies (4%) used a method that captured all three domains of malnutrition.
Conclusions: Our study focused on published articles. Implementation of new criteria takes time, which may take longer than the period covered by this review. Most patients with TB are assessed for only one aspect of the conceptual definition of malnutrition. The use of international consensus criteria is recommended to establish uniform diagnostics and treatment of malnutrition.
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Rationale: Inadequate operationalisation of the multidimensial concept of malnutrition may result in inadequate evaluation of nutritional status. In this review we aimed to assess content validity of methods used to assess malnutrition in cancer patients, according to domains directly derived from European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) definitions for malnutrition.
Methods: Studies on malnutrition in adult cancer patients published between 1999 and 2013 were considered eligible. Methods to assess malnutrition were classified using 13 indicators within three domains that the malnutrition definitions of ESPEN and ASPEN have in common: A) Nutrient balance; B) Changes in body shape, body area and body composition; and C) Body function.
Content validity index per method (M-CVIA-C) was calculated by averaging indicator scores weighted per domain, quantifying to what extent the methods covered the construct of malnutrition. Acceptable content validity was defined as M-CVIA-C ≥0.80.
Results: 40 Different methods within 166 articles were identified. Median M-CVIA-C was 0.22 (interquartile range: 0.08-0.53). None of the methods reached M-CVIA-C=0.80. Mini Nutritional Assessment (MNA; M-CVIA-C=0.75), Nutritional Screening Questionnaire (NSQ; M-CVIA-C=0.56) and Scored Patient-Generated Subjective Global Assessment (PG-SGA; M-CVIA-C=0.53) were responsible for the top 25% of M-CVIA-C scores.
Conclusion: Content validity of methods that assess malnutrition in cancer patients varies widely and is unacceptable in terms of M-CVIA-C. MNA, NSQ and PG-SGA showed highest scores in terms of content validity.
Conflict of interest: None.
DOCUMENT
Background: The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 that comprised screening followed by assessment of three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden). This planned update reconsiders the GLIM framework based on published knowledge and experience over the past 5 years. Methods: A working group (n = 43 members) conducted a literature search spanning 2019–2024 using the keywords “Global Leadership Initiative on Malnutrition or GLIM.” Prior GLIM guidance activities for using the criteria on muscle mass and inflammation were reviewed. Successive rounds of revision and review were used to achieve consensus. Results: More than 400 scientific reports were published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgment may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. After two rounds of review and revision, the working group secured 100% agreement with the conclusions reported in the 5-year update. Conclusion: Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.
DOCUMENT
The aim of this systematic review was to examine the association between malnutrition and oral health in older people (≥ 60 years of age). A comprehensive systematic literature search was performed in four databases (PubMed, CINAHL, Dentistry and Oral Sciences Source, and Embase) for literature from January 2000 to May 2020. Both observational and intervention studies were screened for eligibility. Two reviewers independently screened the search results to identify potential eligible studies, and assessed the methodological quality of the full-text studies. A total of 3240 potential studies were identified. After judgement for relevance, 10 studies (cross-sectional (n = 9), prospective cohort (n = 1)) met the inclusion criteria. Three studies described malnourished participants as having fewer teeth, or functional (tooth) units (FTUs), compared to well-nourished participants. Four studies reported soft tissue problems in malnourished participants, including red tongue with blisters, and dry or cracked lips. Subjective oral health was the topic in six studies, with poorer oral health and negative self-perception of oral health in malnourished elderly participants. There are associations between (at risk of) malnutrition and oral health in older people, categorized in hard and soft tissue conditions of the mouth, and subjective oral health. Future research should be focused on longitudinal cohort studies with proper determination of malnutrition and oral health assessments, in order to evaluate the actual association between malnutrition and oral health in older people.
DOCUMENT
Adequate distinction between malnutrition, starvation, cachexia and sarcopenia is important in clinical care. Despite the overlap in physical characteristics, differences in etiology have therapeutical and prognostic implications. We aimed to determine whether dietitians in selected European countries have ‘proper knowledge’ of malnutrition, starvation, cachexia and sarcopenia, and use terminology accordingly.
DOCUMENT
As the population ages, the risk of becoming malnourished increases. Research has shown that poor oral health can be a risk factor for malnutrition in institutionalized elderly. However, it remains unclear whether oral health problems, edentulousness and health-related quality of life also pose a risk for malnutrition in community-dwelling older adults. In this cross-sectional observational study, 1325 community-living elderly (≥75 years) were asked to complete questionnaires regarding nutritional status, oral status (edentulous, remaining teeth, or implant-supported overdentures), oral health problems, health-related quality of life (HRQoL), frailty, activities of daily living (ADL) and complexity of care needs. Univariate and multivariate logistic regression analyses were performed with nutritional status as dependent variable. Of the respondents, 51% (n = 521) were edentulous, 38.8% (n = 397) had remaining teeth and 10.2% (n = 104) had an implant-supported overdenture. Elderly with complex care needs were malnourished most frequently, followed by frail and robust elderly (10%, 4.5% and 2.9%, respectively). Malnourished elderly reported more frequent problems with chewing and speech when compared with well-nourished elderly (univariate analysis). However, multivariate analysis did not show an association between malnutrition and oral health problems and edentulousness, although HRQoL was associated with malnutrition (odds ratio (OR) 0.972, confidence interval (CI) 0.951–0.955). Based on the results of this cross-sectional study, it can be concluded that poor HRQoL is significantly associated with malnutrition; however, edentulousness and oral health problems are not.
DOCUMENT
Rationale: In this study, we aimed to explore how dietitians’ history-taking questions function during dietary counseling of clients with malnutrition (risk). Fruitful functioning of history-taking questions during the problem identification phase is crucial for dietitians to develop a client-centered dietary treatment plan.
Methods: Using discursive psychology, we analyzed the problem identification phase of recorded dietitian-client conversations of 7 dietitians and 17 clients. Discursive psychology is a qualitative, inductive methodology that is used to analyze real-life conversations. Discursive psychology focuses on how descriptions in talk (including wording, intonation, pauses, non-verbal behavior) accomplish actions such as presenting oneself in a particular way.
Results: Our analysis shows how, in response to dietitians’ history-taking questions, clients repeatedly demonstrate that they have already made some effort to self-help. Typically, these history-taking questions presume some biopsychosocial factor as the cause of the dietary problems discussed. In response, clients show they already started to eat extra, closely monitored their body weight, and tried to eat despite having no appetite. In addition, clients account for the absence of efforts by claiming various kinds of inability, such as facing difficulties in preparing food for oneself or by questioning whether their underlying medical condition caused the diet-related problem in the first place.
Conclusion: This study shows that history-taking questions not only elicit answers with factual information but also evoke clients’ self-presentations. Responses from dietitians show little attention to the relevance of these self-presentations,
while clients treat self-help as a normative requirement to demonstrate they have done everything they can before they sought professional help. To optimize the problem identification phase, we suggest that in addition to conversational
techniques dietitians could increase their attention to clients’ actions performed.
DOCUMENT
Aim: The prevalence of age‐related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals. Methods: In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using ‘dietitian’, ‘elderly’ and ‘malnutrition’ as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach. Results: Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries. Conclusions: The role of dietitians in managing age‐related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate. https://doi.org/10.1111/1747-0080.12546 LinkedIn: https://www.linkedin.com/in/matthijs-fleurke-66279110/ https://www.linkedin.com/in/dorien-voskuil-9b27b115/
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