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BMC Family Practice Jul 2019Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies... (Review)
Review
BACKGROUND
Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions.
METHOD
A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers.
RESULTS
Of a total of 2182 studies identified, 21 were included (6 qualitative, 12 quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals' reservations about prescribing oral nutritional supplements.
CONCLUSION
The studies reviewed identified several barriers and facilitators and addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face.
REVIEW REGISTRATIONS
PROSPERO: CRD42017071398 . The review protocol was registered retrospectively.
Topics: Aged; Humans; Independent Living; Malnutrition; Mass Screening; Primary Health Care
PubMed: 31307402
DOI: 10.1186/s12875-019-0983-y -
Frontiers in Endocrinology 2020We propose the use of the analytic frame of "nutrition justice" to reconcile the separate imperatives of Global Health for nutritional sufficiency for all, the... (Review)
Review
We propose the use of the analytic frame of "nutrition justice" to reconcile the separate imperatives of Global Health for nutritional sufficiency for all, the requirement to eradicate childhood malnutrition, and the need for strategies to check the emerging pandemic of the double burden of malnutrition in the Global South. Malnutrition and its consequences of growth stunting are the result of disruption to the nutritional ecology of childhood from structural violence. This is mediated through loss of food security and perturbation to the cultural status of food, and on the prerequisites for nurture during infancy and early childhood. These socio-political factors obscure the role of biological adaptation to nutritional constraint on growth and hence the causal pathway to the double burden of malnutrition. In this paper we describe how the effects of historical and contemporary structural violence on the nutritional ecology of childhood are mediated using the examples of remote Aboriginal Australia and the Lao PDR. Both populations live by force of circumstance in a "metabolic ghetto" that has disrupted the prerequisites for parental nurturing through loss of food security and of traditional sources of transitional staple foods for weaning. Growth faltering and stunting of stature are markers of adaptation to nutritional constraint yet are also the first steps on the track to the double burden. We discuss the implications of these observations for strategies for global food sufficiency by mean of a thought-experiment of the effect of food and nutrient sufficiency for growth on future health and metabolic adaptation.
Topics: Global Health; Humans; Malnutrition; Nutritional Physiological Phenomena; Nutritional Status
PubMed: 32265841
DOI: 10.3389/fendo.2020.00150 -
Methodist DeBakey Cardiovascular Journal 2023In patients undergoing elective cardiovascular and thoracic surgery, malnutrition and the deterioration of nutritional status are associated with negative outcomes.... (Review)
Review
In patients undergoing elective cardiovascular and thoracic surgery, malnutrition and the deterioration of nutritional status are associated with negative outcomes. Recognition of the contributory factors and the complications stemming from surgical stress is important for the prevention and management of these patients. We have reviewed the literature available and focused on the nutritional and metabolic aspects affecting surgical patients, with emphasis on the recommendations of enhanced recovery protocols. The implementation of enhanced recovery protocols and nutritional support guidelines focusing on the surgical patient as part of a multidisciplinary approach would improve the nutritional status of surgical patients at risk for negative outcomes.
Topics: Humans; Nutritional Status; Perioperative Care; Postoperative Complications; Nutritional Support; Malnutrition
PubMed: 37547903
DOI: 10.14797/mdcvj.1248 -
Renal Failure Dec 2024The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal...
The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population. We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model. According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, < 0.001). The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.
Topics: Humans; Female; Aged; Adult; Middle Aged; Male; Nutrition Assessment; Leadership; Retrospective Studies; Malnutrition; Peritoneal Dialysis; Nutritional Status
PubMed: 38575339
DOI: 10.1080/0886022X.2024.2337290 -
PLoS Neglected Tropical Diseases Mar 2022Malnutrition, anemia, micronutrient deficiency and parasitic infections continue to impact the nutritional status and health of children in lower-income countries....
BACKGROUND
Malnutrition, anemia, micronutrient deficiency and parasitic infections continue to impact the nutritional status and health of children in lower-income countries. However, not enough data concerning this issue is available. The aim of this study was to assess the distribution of nutritional indicators, anemia and micronutrient deficiency and their underlying risk factors among schoolchildren in south-eastern Tanzania.
METHODOLOGY/PRINCIPAL FINDINGS
This cross-sectional study enrolled primary schoolchildren aged 6-12 years from Kikwawila and Kiberege wards, Tanzania. In total, 471 schoolchildren underwent a physical examination and provided blood, stool and urine samples for an assessment of the levels of different micronutrients, nutritional and anemia status, and parasitic infection status. We employed bivariate and multivariate logistic regression to determine the association between nutritional statuses, anemia, micronutrient deficiency and parasitic infections. We found that 23.90%, 12.60% and 16.20% of schoolchildren were stunted, underweight and wasted, respectively. About 14.0% of schoolchildren were found to be anemic. Children diagnosed with Plasmodium falciparum infection were more likely to have low levels of ferritin (aOR: 10.40, 95% CI: 2.88-40.53) and elevated levels of serum soluble transferrin receptor (aOR: 3.59, 95% CI: 1.27-11.23), respectively. Vitamin A (34.71%) and vitamin B12 (8.79%) were the most prevalent micronutrients found to be deficient in diagnosed children. Finally, we found that schoolchildren attending the most rural schools were five times more likely to be diagnosed with at least one micronutrient deficiency (aOR: 5.04, 95% CI: 2.38-11.44).
CONCLUSIONS/SIGNIFICANCE
Malnutrition, anemia and micronutrient deficiency still pose a significant health burden among schoolchildren living in rural Tanzania. To effectively tackle this burden, health interventions such as deworming, micronutrient supplementation, vector control, health education and access to clean water and improved sanitation should be strengthened and made sustainable.
Topics: Anemia; Child; Cross-Sectional Studies; Humans; Malaria, Falciparum; Malnutrition; Micronutrients; Nutritional Status; Prevalence; Tanzania
PubMed: 35245314
DOI: 10.1371/journal.pntd.0010261 -
Nutrients Feb 2022Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital...
Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital inpatients with or at risk of malnutrition remains primarily individually delivered by dietitians-an approach that is not considered sustainable. This study aimed to identify barriers and enablers to delegating malnutrition care activities to dietitian assistants. This qualitative descriptive study was nested within a broader quality assurance activity to scale and spread systematised and interdisciplinary malnutrition models of care. Twenty-three individual semi-structured interviews were completed with nutrition and dietetic team members across seven hospitals. Inductive thematic analysis was undertaken, and barriers and enablers to delegation of malnutrition care to dietitian assistants were grouped into four themes: working with the human factors; balancing value and risk of delegation; creating competence, capability, and capacity; and recognizing contextual factors. This study highlights novel insights into barriers and enablers to delegating malnutrition care to dietitian assistants. Successful delegation to dietitian assistants requires the unique perspectives of humans as individuals and in their collective healthcare roles, moving from words to actions that value delegation; engaging in processes to improve competency, capability, and capacity of all; and being responsive to climate and contextual factors.
Topics: Dietetics; Humans; Malnutrition; Nutritional Status; Nutritionists; Qualitative Research
PubMed: 35268008
DOI: 10.3390/nu14051037 -
Nutrients May 2021Malnutrition is highly prevalent in inflammatory bowel disease (IBD) patients and disproportionately affects those admitted to hospital. Malnutrition is a risk factor... (Review)
Review
Malnutrition is highly prevalent in inflammatory bowel disease (IBD) patients and disproportionately affects those admitted to hospital. Malnutrition is a risk factor for many complications in IBD, including prolonged hospitalization, infection, greater need for surgery, development of venous thromboembolism, post-operative complications, and mortality. Early screening for malnutrition and prompt nutrition intervention if indicated has been shown to prevent or mitigate many of these outlined risk factors. There are many causes of malnutrition in IBD including reduced oral food intake, medications, active inflammation, and prior surgical resections. Hospitalization can further compound pre-existing malnutrition through inappropriate diet restrictions, nil per os (NPO) for endoscopy and imaging, or partial bowel obstruction, resulting in "post-hospital syndrome" after discharge and readmission. The aim of this article is to inform clinicians of the prevalence and consequences of malnutrition in IBD, as well as available screening and assessment tools for diagnosis, and to offer an organized approach to the nutritional care of hospitalized adult IBD patients.
Topics: Adult; Female; Hospitalization; Humans; Inflammatory Bowel Diseases; Male; Malnutrition; Nutrition Assessment; Nutrition Therapy; Nutritional Status; Risk Factors
PubMed: 34065070
DOI: 10.3390/nu13051581 -
How the Covid-19 epidemic is challenging our practice in clinical nutrition-feedback from the field.European Journal of Clinical Nutrition Mar 2021The viral epidemic caused by the new Coronavirus SARS-CoV-2 is responsible for the new Coronavirus disease-2019 (Covid-19). Fifteen percent of the Covid-19 patients will... (Review)
Review
The viral epidemic caused by the new Coronavirus SARS-CoV-2 is responsible for the new Coronavirus disease-2019 (Covid-19). Fifteen percent of the Covid-19 patients will require hospital stay, and 10% of them will need urgent respiratory and hemodynamic support in the intensive care unit (ICU). Covid-19 is an infectious disease characterized by inflammatory syndrome, itself leading to reduced food intake and increased muscle catabolism. Therefore Covid-19 patients are at high risk of being malnourished, making the prevention of malnutrition and the nutritional management key aspects of care. Urgent, brutal and massive arrivals of patients needing urgent respiratory care and artificial ventilation lead to the necessity to reorganize hospital care, wards and staff. In that context, nutritional screening and care may not be considered a priority. Moreover, at the start of the epidemic, due to mask and other protecting material shortage, the risk of healthcare givers contamination have led to not using enteral nutrition, although indicated, because nasogastric tube insertion is an aerosol-generating procedure. Clinical nutrition practice based on the international guidelines should therefore adapt and the use of degraded procedures could unfortunately be the only way. Based on the experience from the first weeks of the epidemic in France, we emphasize ten challenges for clinical nutrition practice. The objective is to bring objective answers to the most frequently met issues to help the clinical nutrition caregivers to promote nutritional care in the hospitalized Covid-19 patient. We propose a flow chart for optimizing the nutrition management of the Covid-19 patients in the non-ICU wards.
Topics: COVID-19; Critical Care; France; Humans; Malnutrition; Nutrition Assessment; Nutritional Support; SARS-CoV-2
PubMed: 32939042
DOI: 10.1038/s41430-020-00757-6 -
Journal of Diabetes Research 2023The relationship between malnutrition and diabetic retinopathy (DR) is still unclear. The purpose of this study is to investigate the relationship between malnutrition...
BACKGROUND
The relationship between malnutrition and diabetic retinopathy (DR) is still unclear. The purpose of this study is to investigate the relationship between malnutrition and DR in type 2 diabetic patients.
METHODS
A cross-sectional study was conducted on 612 patients with type 2 diabetes mellitus. Four malnutrition assessment tools: Global Leadership Initiative on Malnutrition (GLIM) criteria, controlling nutritional status (CONUT), nutritional risk index (NRI), and prognostic nutritional index (PNI), were applied to assess the nutritional status of the study population. The association between malnutrition and DR was examined using multivariable logistic regression and ordered logistic regression.
RESULTS
The proportion of malnutrition varied from 10.0% to 34.3% in total patients and from 16.3% to 45.1% in DR patients across the assessment tools. DR patients were more likely to be malnourished than patients without DR. The adjusted odds ratios (aOR) and 95% confidence interval (CI) for DR of malnutrition defined by different tools were 1.86 (1.01-3.14) for GLIM criteria, 1.67 (1.04-2.70) for NRI, and 2.24 (1.07-4.69) for PNI. The aOR and 95% CI for the severity of DR of malnutrition defined by different tools were 1.99 (1.12-3.51) for GLIM criteria, 1.65 (1.06-2.58) for NRI, and 2.51 (1.31-4.79) for PNI.
CONCLUSIONS
Malnutrition was common in DR patients, and it was closely linked to the presence and severity of DR. Diabetic patients with DR should undergo nutritional assessment and early treatment of malnutrition to prevent the onset or progression of DR.
Topics: Humans; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Cross-Sectional Studies; Malnutrition; Nutritional Status
PubMed: 38020197
DOI: 10.1155/2023/1613727 -
Acta Bio-medica : Atenei Parmensis Mar 2022Nutrition is one of the most important factors affecting pubertal development. Increasing demands for energy proteins and micronutrients are necessary to cope with the... (Review)
Review
Nutrition is one of the most important factors affecting pubertal development. Increasing demands for energy proteins and micronutrients are necessary to cope with the rapid linear pubertal growth and development, change in body composition, and increased physical activity. Adequate nutrition is a key permissive factor for the normal timing and tempo of pubertal development. Severe primary or secondary malnutrition also can adversely delay the onset and progression of puberty. The higher incidence of anorexia nervosa and bulimia in adolescents imposes a nutritional risk on pubertal development. Here we provide an overview of nutritional requirements (macronutrients and micronutrients) necessary to cope with these changes. In addition, we discuss possible nutritional interventions trials and their effects on several aspects of growth and development in undernourished and stunted adolescents, in low- and middle-income countries (LMIC), who require nutritional rehabilitation. This mini-review sums up some important findings in this important complex that links between nutrition, nutritional interventions, and pubertal development.
Topics: Adolescent; Humans; Malnutrition; Micronutrients; Nutritional Requirements; Puberty
PubMed: 35315384
DOI: 10.23750/abm.v93i1.12789