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Nutrients Jun 2022Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of... (Review)
Review
Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of hospital stay, mortality, and health spending. Early identification is fundamental to implement the necessary therapeutic actions, involving adequate nutritional support to prevent or reverse malnutrition. This review presents two complementary methods of fighting malnutrition: nutritional screening and nutritional assessment. Nutritional risk screening is conducted using simple, quick-to-perform tools, and is the first line of action in detecting at-risk patients. It should be implemented systematically and periodically on admission to hospital or residential care, as well as on an outpatient basis for patients with chronic conditions. Once patients with a nutritional risk are detected, they should undergo a more detailed nutritional assessment to identify and quantify the type and degree of malnutrition. This should include health history and clinical examination, dietary history, anthropometric measurements, evaluation of the degree of aggression determined by the disease, functional assessment, and, whenever possible, some method of measuring body composition.
Topics: Humans; Malnutrition; Nutrition Assessment; Nutritional Status; Nutritional Support; Quality of Life
PubMed: 35745121
DOI: 10.3390/nu14122392 -
Lancet (London, England) Mar 2023Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to... (Review)
Review
Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.
Topics: Humans; Aged; Malnutrition; Nutritional Support; Nutrition Assessment; Parenteral Nutrition; Risk Factors; Nutritional Status
PubMed: 36716756
DOI: 10.1016/S0140-6736(22)02612-5 -
Nature Reviews. Disease Primers Sep 2017The main forms of childhood malnutrition occur predominantly in children <5 years of age living in low-income and middle-income countries and include stunting, wasting... (Review)
Review
The main forms of childhood malnutrition occur predominantly in children <5 years of age living in low-income and middle-income countries and include stunting, wasting and kwashiorkor, of which severe wasting and kwashiorkor are commonly referred to as severe acute malnutrition. Here, we use the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.
Topics: Child; Humans; Malnutrition; Severity of Illness Index
PubMed: 28933421
DOI: 10.1038/nrdp.2017.67 -
Nutrients Dec 2017Malnutrition in children and adults with advanced liver disease represents a tremendous challenge as the nutritional problems are multifactorial. This Editorial comments...
Malnutrition in children and adults with advanced liver disease represents a tremendous challenge as the nutritional problems are multifactorial. This Editorial comments the articles appearing in this special issue of , "Nutrition and Liver disease" dealing with multiple diagnostic and therapeutic features that relate the outcomes of liver disease to nutrition. To improve quality of life and prevent nutrition-related medical complications, patients diagnosed with advanced liver disease should have their nutritional status promptly assessed and be supported by appropriate dietary interventions. Furthermore specific food supplements and/or restriction diets are often necessary for those with hepatic conditions associated with an underlying metabolic or nutritional or intestinal disease.
Topics: Body Composition; Humans; Liver Diseases; Malnutrition; Nutrition Assessment; Nutritional Status; Nutritional Support; Prognosis; Risk Factors
PubMed: 29295475
DOI: 10.3390/nu10010009 -
JNMA; Journal of the Nepal Medical... Jan 2022Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin,... (Review)
Review
Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin, etc. Enterocutaneous fistula can occur after any gastrointestinal surgery where there is some trauma during surgery or other associated causes such as malignancy, inflammatory bowel disease, foreign body, etc. Enterocutaneous fistula needs a multidisciplinary approach as its management is a very tedious and complex process. Sepsis, malnutrition, and dyselectrolytemia are three key factors during the management of enterocutaneous fistula, so these should be properly addressed for better and efficient outcomes. There is excess fistula effluent which should be replaced adequately in high output fistula. The nutrition of the patient plays a vital role in the success of enterocutaneous fistula management so if the patient can tolerate oral or enteral feeding should be commenced as soon as possible otherwise parenteral nutrition should be advised. Wound care should be done aggressively, proper skincare, timely drainage of any localised abscesses should be done. Patients should be properly resuscitated and stabilised before any definitive investigations and management. Surgical therapy can be staged and should not be rushed which results in failure of this complex disease process.
Topics: Drainage; Enteral Nutrition; Humans; Intestinal Fistula; Malnutrition; Sepsis
PubMed: 35199684
DOI: 10.31729/jnma.5780 -
Nutrients Feb 2022Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care... (Review)
Review
Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care in up to 90% of old populations. However, malnutrition frequently remains underdiagnosed and undertreated in the hospital. Thus, an accurate screening to identify patients at risk of malnutrition or malnourishment is determinant to elaborate a personal nutritional intervention. Several definitions of malnutrition were proposed in the last years, affecting the real frequency of nutritional disorders and the timing of intervention. Diagnosis of malnutrition needs a complete nutritional assessment, which is often challenging to perform during a hospital stay. For this purpose, various screening tools were proposed, allowing patients to be stratified according to the risk of malnutrition. The present review aims to summarize the actual evidence in terms of diagnosis, association with clinical outcomes, and management of malnutrition in a hospital setting.
Topics: Hospitalization; Humans; Length of Stay; Malnutrition; Mass Screening; Nutrition Assessment; Nutritional Status; Prevalence
PubMed: 35215559
DOI: 10.3390/nu14040910 -
Nutrition in Clinical Practice :... Feb 2022Nutrition assessment is used to describe nutrition status-related nutrition problems and their causes, one of which includes malnutrition. Four malnutrition diagnostic... (Review)
Review
Nutrition assessment is used to describe nutrition status-related nutrition problems and their causes, one of which includes malnutrition. Four malnutrition diagnostic tools are currently in use today in adults: Subjective Global Assessment, the Mini Nutritional Assessment, the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition malnutrition consensus characteristics, and the Global Leadership Initiative on Malnutrition criteria. The aim of this article is to provide sufficient background of these methodologies to assist clinicians in choosing their approach in diagnosing malnutrition. There is substantial overlap between the criteria included in these malnutrition diagnostic approaches. A desired goal is to identify a core data set in order to evaluate malnutrition prevalence globally and to assess the impact of nutrition interventions on nutrition and clinical outcomes.
Topics: Adult; Dietetics; Humans; Malnutrition; Nutrition Assessment; Nutritional Status; Parenteral Nutrition
PubMed: 34936131
DOI: 10.1002/ncp.10810 -
The Proceedings of the Nutrition Society Aug 2019Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally impacts on health, cognitive and physical functioning and quality of life. Given these... (Review)
Review
Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally impacts on health, cognitive and physical functioning and quality of life. Given these negative health outcomes in the context of an ageing global population, the Healthy Diet for a Healthy Life Joint Programming Initiative Malnutrition in the Elderly (MaNuEL) sought to create a knowledge hub on malnutrition in older adults. This review summarises the findings related to the screening and determinants of malnutrition. Based on a scoring system that incorporated validity, parameters used and practicability, recommendations on setting-specific screening tools for use with older adults were made. These are: DETERMINE your health checklist for the community, Nutritional Form for the Elderly for rehabilitation, Short Nutritional Assessment Questionnaire-Residential Care for residential care and Malnutrition Screening Tool or Mini Nutritional Assessment-Short Form for hospitals. A meta-analysis was conducted on six longitudinal studies from MaNuEL partner countries to identify the determinants of malnutrition. Increasing age, unmarried/separated/divorced status (vs. married but not widowed), difficulties walking 100 m or climbing stairs and hospitalisation in the year prior to baseline or during follow-up predicted malnutrition. The sex-specific predictors of malnutrition were explored within The Irish Longitudinal Study of Ageing dataset. For females, cognitive impairment or receiving social support predicted malnutrition. The predictors for males were falling in the previous 2 years, hospitalisation in the past year and self-reported difficulties in climbing stairs. Incorporation of these findings into public health policy and clinical practice would support the early identification and management of malnutrition.
Topics: Aged; Aged, 80 and over; Geriatric Assessment; Humans; Malnutrition; Nutrition Assessment
PubMed: 30501651
DOI: 10.1017/S0029665118002628 -
Lancet (London, England) Nov 2021Disease-related malnutrition in adult patients who have been admitted to hospital is a syndrome associated with substantially increased morbidity, disability, short-term... (Review)
Review
Disease-related malnutrition in adult patients who have been admitted to hospital is a syndrome associated with substantially increased morbidity, disability, short-term and long-term mortality, impaired recovery from illness, and cost of care. There is uncertainty regarding optimal diagnostic criteria, definitions for malnutrition, and how to identify patients who would benefit from nutritional intervention. Malnutrition has become the focus of research aimed at translating current knowledge of its pathophysiology into improved diagnosis and treatment. Researchers are particularly interested in developing nutritional interventions that reverse the negative effects of disease-related malnutrition in the hospital setting. High-quality randomised trials have provided evidence that nutritional therapy can reduce morbidity and other complications associated with malnutrition in some patients. Screening of patients for risk of malnutrition at hospital admission, followed by nutritional assessment and individualised nutritional interventions for malnourished patients, should become part of routine clinical care and multimodal treatment in hospitals worldwide.
Topics: Adult; Hospitalization; Humans; Malnutrition; Nutrition Assessment; Nutrition Therapy
PubMed: 34656286
DOI: 10.1016/S0140-6736(21)01451-3 -
The International Journal of Lower... Dec 2017Although malnutrition is a common health and social care problem, there is no universal agreement about its definition, prevalence, or method of identification and... (Review)
Review
Although malnutrition is a common health and social care problem, there is no universal agreement about its definition, prevalence, or method of identification and report. Fifteen definitions of malnutrition were critically examined to assess their variability. They ranged from descriptions of undernutrition alone to under- and overnutrition, with intakes ranging from dietary protein and energy alone to dietary and nondietary sources of all nutrients and energy. Definitions also varied from non-outcome based to those based on functional, physiological, and/or clinical outcomes. Some definitions relied on the pathways by which malnutrition develops, with one apparently requiring loss of fat-free mass. Also examined were nutrition screening tools, diversely developed for detection of malnutrition, management of malnutrition, and prediction of clinical outcomes or health care usage. Their intended use also varied from specific care settings (hospital, community, care homes) to all settings and from specific age groups to all age groups. With all these definitions and tools, there is considerable scope for confusion and misunderstanding. Therefore, to clarify the burden and significance of malnutrition, guidelines for documenting it in routine practice and reporting it in scientific literature are provided.
Topics: Disease Management; Humans; Malnutrition; Nutrition Assessment; Nutritional Status; Practice Guidelines as Topic
PubMed: 29145755
DOI: 10.1177/1534734617733902