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Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Objectives: To investigate associations between nutrition risk (determined by SCREEN-II) and malnutrition (diagnosed by the GLIM criteria) with five-year mortality in Māori and non-Māori of advanced age. Design: A longitudinal cohort study. Setting: Bay of Plenty and Lakes regions of New Zealand. Participants: 255 Māori; 400 non-Māori octogenarians. Measurements: All participants were screened for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). Those at high nutrition risk (SCREEN-II score <49) had the Global Leadership Initiative in Malnutrition (GLIM) criteria applied to diagnose malnutrition or not. Demographic, physical and health characteristics were obtained by trained research nurses using a standardised questionnaire. Five-year mortality was calculated from Government data. The association of nutrition risk (SCREEN-II) and a malnutrition diagnosis (GLIM) with five-year mortality was examined using logistic regression and cox proportional hazard models of increasing complexity. Results: 56% of Māori and 46% of non-Māori participants had low SCREEN-II scores indicative of nutrition risk. The prevalence of GLIM diagnosed malnutrition was lower for both Māori and non-Māori (15% and 19% of all participants). Approximately one-third of participants (37% Māori and 32% non-Māori) died within the five-year follow-up period. The odds of death for both Māori and non-Māori was significantly lower with greater SCREEN II scores (better nutrition status), (OR (95% CI); 0.58 (0.38, 0.88), P < 0.05 and 0.53 (0.38, 0.75), P < 0.001, respectively). GLIM diagnosed malnutrition was not significantly associated with five-year mortality for Māori (OR (95% CI); 0.88 (0.41, 1.91), P >0.05) but was for non-Māori. This association remained significant after adjustment for other predictors of death (OR (95% CI); 0.50 (0.29, 0.86), P< 0.05). Reduced food intake was the only GLIM criterion predictive of five-year mortality for Māori (HR (95% CI); 10.77 (4.76, 24.38), P <0.001). For non-Māori, both aetiologic and phenotypic GLIM criteria were associated with five-year mortality. Conclusion: Nutrition risk, but not malnutrition diagnosed by the GLIM criteria was significantly associated with mortality for Māori. Conversely, both nutrition risk and malnutrition were significantly associated with mortality for non-Māori. Appropriate phenotypic criteria for diverse populations are needed within the GLIM framework. [ABSTRACT FROM AUTHOR]

Background: Routine malnutrition risk screening of patients is critical for optimal care and comprises part of the National Australian Hospital Standards. Identification of malnutrition also ensures reimbursement for hospitals to adequately treat these high‐risk patients. However, timely, accurate screening, assessment and coding of malnutrition remains suboptimal. The present study aimed to investigate manual and digital interventions to overcome barriers to malnutrition identification for improvements in the hospital setting. Methods: Retrospective reporting on malnutrition identification processes was conducted through two stages: (1) manual auditing intervention and (2) development of a digital solution – the electronic malnutrition management solution (eMS). Repeated process audits were completed at approximately 6‐monthly intervals through both stages between 2016 and 2019 and the results were analysed. In Stage 2, time investment and staff adoption of the digital solution were measured. Results: Overall, the combined effect of both regular auditing and use of the eMS resulted in statistically significant improvements across all six key measures: patients identified (97%–100%; p < 0.001), screened (68%–95%; p < 0.001), screened within 24 h (51%–89%; p < 0.001), assessed (72%–95%; p < 0.001), assessed within 24 h (66%–93%; p < 0.001) and coded (81%–100%; p = 0.017). The eMS demonstrated a reduction in screening time by over 60% with user adoption 100%. Data analytics enabled automated, real‐time auditing with a 95% reduction in time taken to audit. Conclusions: A single digital solution for management of malnutrition and automation of auditing demonstrated significant improvements where manual or combinations of manual and electronic systems continue to fall short. Key points: Timely and accurate screening for malnutrition remains suboptimal.Regular quality improvement cycle auditing demonstrates improvements in malnutrition identification.A single digital solution demonstrates further improvements, allows automation of routine auditing and provides analytics capability to facilitate dietitian workload management and resource allocation. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a major global health challenge. Worldwide, approximately 390 million adults are underweight, while 2.5 billion are overweight. The Malnutrition Universal Screening Tool (MUST) has been implemented successfully in the United Kingdom to assess the nutritional status of patients in health care settings. Currently, MUST is available as a web-based tool or as a paper-based version, However, the paper tool can lead to calculation errors, and web-based tools require internet access, limiting use in some communities. The MUST app uses clear and simple navigation and processes information precisely, so could potentially improve the accuracy and accessibility of malnutrition screening for health care professionals (HCP) in all settings., Objective: This study aimed to explore the views of HCPs on the content, functionality, and usability of a newly developed mobile app for MUST., Methods: We performed a qualitative study using deductive and inductive framework analysis. A series of online focus groups (~1 hour each) were conducted, exploring potential users' views on the app's content design, functionality, and usefulness, which was set in demonstration mode and not available for direct use with patients. Each focus group used a semistructured approach and predefined topic guide. Participants were recruited consecutively and United Kingdom-wide using advertisements through emails, newsletters, and on social media across appropriate local and national networks. Participants had the opportunity to look at the app on their phones before giving feedback and an on-screen demonstration of the app was provided during the focus group. Data were analyzed using deductive and inductive framework analysis., Results: In total, 8 online focus groups were conducted between August 2022 and January 2023. Participants (n=32) were dietetic and nutrition HCPs or educators with experience in using MUST in clinical or community settings. Data analysis revealed three broad themes: (1) improving the app for better use in practice, (2) user experience of design, and (3) barriers and facilitators in different settings. Overall feedback for the app was positive with potential users considering it to be very useful for improving routine and accurate screening, particularly in the community, and mainly because of the automatic calculation feature, which may help with improving discrepancies. Participants generally considered the app to be for professional use only, stating that patients may find it too clinical or technical. Participants also made suggestions for app sustainability and improvements, such as incentives to complete the demographics section or the option to skip questions, and the addition of more subjective measures and instructions on measuring ulna length., Conclusions: The MUST app was positively evaluated by potential users, who reported it was user-friendly and an accessible way to screen for malnutrition risk, whilst improving the accuracy of screening and availability in community settings., (©Debra Jones, Anne Marie Sowerbutts, Sorrel Burden. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.12.2024.)

(1) Background: Malnutrition in hospitalized patients is prevalent worldwide, but the severity of the issue is often underestimated by practitioners. The purpose of this study is to investigate the prevalence of malnutrition and inadequate eating behaviour in a geriatric sample. (2) Methods: Two hospitals participated with six wards on nutritionDay in 2017, 2018 and 2019. Nutritional status, food intake, and nutritional interventions were analyzed for all patients ≥ 65 years (n = 156), using the official nutritionDay questionnaires. Malnutrition risk is identified by Malnutrition Universal Screening Tool (MUST), malnutrition by the ESPEN criteria (European Society of Clinical Nutrition and Metabolism). (3) Results: According to MUST (n = 136) 16.9% (n = 23) were at medium risk of malnutrition, 33.8% (n = 46) at high risk of malnutrition, 28.1% (n = 38) were malnourished. Overall, 62.8% (n = 98) showed an inadequate eating behaviour during hospital stay. Moreover, patients with inadequate nutrition had significantly worse self-reported health statuses (p = 0.001; r = −0.276), were less able to walk on nutritionDay (p = 0.002; r = −0.255), had eaten little in the week before admission to hospital (p < 0.001; r = −0.313), and had an increased length of stay (p = 0.036; r = −0.174). (4) Conclusion: To identify malnourished patients is a significant barrier for practitioners seeking to administer specific, tailored interventions. Malnutrition screening protocols must be improved, just as nutrition monitoring in general.

Background: Oropharyngeal dysphagia (OD) and malnutrition are associated with poor clinical outcomes after stroke. The present study evaluated (1) malnutrition risk and OD-related characteristics in patients with chronic post-stroke OD, and (2) the relationship between on the one hand OD severity and on the other hand functional oral intake and dysphagia-specific quality of life. Methods: A cross-sectional study was conducted in a Dutch interdisciplinary outpatient clinic for OD. The standardized examination protocol comprised: clinical ear, nose, and throat examination, body mass index, the short nutritional assessment questionnaire (SNAQ), a standardized fiberoptic endoscopic evaluation of swallowing (FEES), the functional oral intake scale (FOIS), and the MD Anderson dysphagia inventory (MDADI). Results: Forty-two consecutive patients with chronic post-stroke OD were included. Mean (±SD) age and BMI of the population were 69.1 (±8.7) years and 26.8 (±4.1) kg/m2 respectively. Seventeen (40.4%) patients presented a moderate to high risk of malnutrition (SNAQ score>2). The FEES examination showed moderate to severe OD in 28 (66.7%) patients. The severity of OD was significantly related to the FOIS score but not to the MDADI scores. Conclusion: In this specific sample of referred stroke patients, moderate to severe OD and moderate to high risk of malnutrition were common. Despite the use of clinical practice guidelines on stroke and a normal nutritional status at first sight, repeated screening for malnutrition and monitoring the severity and management of OD remain important elements in the care of patients with chronic post-stroke OD. [ABSTRACT FROM AUTHOR]

BackgroundOropharyngeal dysphagia (OD) and malnutrition are associated with poor clinical outcomes after stroke. The present study evaluated (1) malnutrition risk and OD-related characteristics in patients with chronic post-stroke OD, and (2) the relationship between on the one hand OD severity and on the other hand functional oral intake and dysphagia-specific quality of life.MethodsA cross-sectional study was conducted in a Dutch interdisciplinary outpatient clinic for OD. The standardized examination protocol comprised: clinical ear, nose, and throat examination, body mass index, the short nutritional assessment questionnaire (SNAQ), a standardized fiberoptic endoscopic evaluation of swallowing (FEES), the functional oral intake scale (FOIS), and the MD Anderson dysphagia inventory (MDADI).ResultsForty-two consecutive patients with chronic post-stroke OD were included. Mean (±SD) age and BMI of the population were 69.1 (±8.7) years and 26.8 (±4.1) kg/m2 respectively. Seventeen (40.4%) patients presented a moderate to high risk of malnutrition (SNAQ score≥2). The FEES examination showed moderate to severe OD in 28 (66.7%) patients. The severity of OD was significantly related to the FOIS score but not to the MDADI scores.ConclusionIn this specific sample of referred stroke patients, moderate to severe OD and moderate to high risk of malnutrition were common. Despite the use of clinical practice guidelines on stroke and a normal nutritional status at first sight, repeated screening for malnutrition and monitoring the severity and management of OD remain important elements in the care of patients with chronic post-stroke OD.

COVID-19 symptoms range from severe respiratory failure to mild anorexia, cough and smell and taste alterations, adversely impacting nutritional intake. The aim of this paper was to establish malnutrition risk, Nutrition Impact Symptoms (NIS) and associations with reduced oral intake. A retrospective observational cohort of all people testing positive for COVID-19 was conducted. Malnutrition risk, nutritional status, weight, reduced oral intake and NIS on and during admission were collected. Dietetic consultation frequency and mode were captured. Some 80% (48/60) of participants reported at least one NIS, and 58% (25/60) reported two or more. Most frequent reported symptoms were cough (60%), sore throat (35%) and reduced appetite (28%). Significant associations existed between ≥2 NIS (p=0.006), reduced appetite (p=0.000) and reduced oral intake, with 20% requiring ongoing nutrition support and consultation. High NIS prevalence confirms systematised nutrition support pathways are indicated through incorporation into standard care across the healthcare continuum, including community care. [ABSTRACT FROM AUTHOR]

Malnutrition is common among older adults and is associated with a progressive decline in overall health and increased mortality. With a rapidly ageing population, the detection, prevention and management of malnutrition require urgent attention within health service planning and delivery. Routine screening for malnutrition among older adults in community settings, which addresses aetiological as well as phenotypic factors, is considered an important step for prevention and early intervention. The aim of this review is to summarise current malnutrition screening literature and highlight research that seeks to understand and address community-based approaches to malnutrition screening and management. Key healthcare professionals (HCPs) that encounter community-dwelling older adults include general practitioners (GPs), community-based nurses, community pharmacists and a range of other health and social care professionals including dietitians, physiotherapists, speech and language therapists, and occupational therapists. The key barriers to implementing screening in primary care include lack of knowledge about malnutrition among non-dietetic HCPs, lack of resources allocated to managing malnutrition, lack of access to dietetic services, and poor GP knowledge about oral nutritional supplement prescribing. In addition, older adults have poor insight into the clinical condition and the associated negative health implications. Investment in education among HCPs and public awareness is required, as well as accompanying resources to successfully implement malnutrition screening programmes for community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Abstract Background Malnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. Methods Secondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis. Results Among 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and ‘risk of malnutrition’ was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant. Conclusion Over one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days. Trial registration Protocol registered in ClinicalTrials.gov, ID: NCT03739515 , first posted November 13, 2018.

Background: Critically ill patients who are mechanically ventilated are at a high risk for malnutrition, which is associated with poor clinical outcomes. Aim: The aim of this study was to determine whether the modified version of Nutrition Risk in the Critically Ill (mNUTRIC) score predicts patients' clinical and functional outcomes in intensive care units (ICUs) in Jordan. Methods: A prospective, observational, quantitative research design was used. A convenience sample of 129 mechanically ventilated patients was recruited from ICUs in 7 hospitals across the different Jordanian health care sectors. Each patient was assessed and scored by the mNUTRIC tool. Results: Of the total 129 mechanically ventilated patients, themean (SD) age of critically ill participants was 66.38 (17.46) years, 69.8% of the participants were male (n = 90), and 30.2% were female (n = 39). Approximately 88.4%ofmechanical ventilator patients were at a high risk of malnutrition at the time of ICU admission. Overall, high mNUTRIC score (≥5) was significantly associated with MV duration (P = .004), ICU length of stay (P = .002), mortality (odds ratio, 5.43; P = .005), and functional outcomes (odds ratio, 0.184; P = .009). Relevance to Clinical Practice: Using nutrition risk screening tools such as the mNUTRIC score will add great benefits to nursing practice through identifying patients who are at a high risk of malnutrition within the first 48 hours of their admission in the ICU. [ABSTRACT FROM AUTHOR]

(1) Background: Malnutrition in hospitalized patients is prevalent worldwide, but the severity of the issue is often underestimated by practitioners. The purpose of this study is to investigate the prevalence of malnutrition and inadequate eating behaviour in a geriatric sample. (2) Methods: Two hospitals participated with six wards on nutritionDay in 2017, 2018 and 2019. Nutritional status, food intake, and nutritional interventions were analyzed for all patients ≥ 65 years (n = 156), using the official nutritionDay questionnaires. Malnutrition risk is identified by Malnutrition Universal Screening Tool (MUST), malnutrition by the ESPEN criteria (European Society of Clinical Nutrition and Metabolism). (3) Results: According to MUST (n = 136) 16.9% (n = 23) were at medium risk of malnutrition, 33.8% (n = 46) at high risk of malnutrition, 28.1% (n = 38) were malnourished. Overall, 62.8% (n = 98) showed an inadequate eating behaviour during hospital stay. Moreover, patients with inadequate nutrition had significantly worse self-reported health statuses (p = 0.001; r = -0.276), were less able to walk on nutritionDay (p = 0.002; r = -0.255), had eaten little in the week before admission to hospital (p < 0.001; r = -0.313), and had an increased length of stay (p = 0.036; r = -0.174). (4) Conclusion: To identify malnourished patients is a significant barrier for practitioners seeking to administer specific, tailored interventions. Malnutrition screening protocols must be improved, just as nutrition monitoring in general. [ABSTRACT FROM AUTHOR]

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BACKGROUND Malnutrition is a substantial issue in hospitals, leading to prolonged length of hospital stay, increased perioperative morbidity and increased mortality. There are several validated screening tools for malnutrition, one of which is the Nutritional Risk Screening 2002 (NRS). It screens patients based on recent weight loss, reduction of recent food intake, body mass index (BMI), severity of disease and age. Higher NRS scores have been shown to be negatively associated with patients’ outcomes such as increased morbidity and mortality. OBJECTIVES The aim of the study was to evaluate how the two NRS components Nutritional Score (NS) and Severity of Disease Score (SDS) are associated with patients’ length of hospital stay and mortality. METHODS All patients admitted to the medical department of a large community hospital in Switzerland were screened for malnutrition using the nutrition screening NRS during the years 2014 to 2017. Data on patients’ NRS, primary diagnosis, number of secondary diagnoses, mortality, length of stay (LOS), discharge, sex and age were collected. The association between the NRS components and LOS/mortality was estimated using a linear mixed-effects regression model and a logistic regression model, respectively, with adjustment for confounders (age, sex, comorbidity, diagnosis group, mode of discharge and year of hospitalisation). RESULTS The evaluation of the outcomes of 21,855 hospitalisations demonstrated that the NS was associated with an increment in the LOS of 5.5–12.3% per score point, depending on the diagnosis group. An increase in the SDS by one point was associated with an increase in the LOS of 2.2–11.3%. The odds for all-cause in-hospital mortality were increased by 44.1% (95% confidence interval [CI] 33.7–55.2%) per point in the NS, and by 73% (95% CI 57.5–90.1%) per point in the SDS. CONCLUSIONS Increases in both components of the NRS are associated with longer LOS. The NS has a slightly stronger impact on LOS compared to the SDS and its effect is dependent on the patient’s diagnosis group. Increases in the SDS are linked to a higher mortality than increases in the NS.

Introduction: Malnutrition remains a critical risk factor for morbidity and mortality among CKD patients. However, malnutrition is preventable and treatable. Thus, early malnutrition screening of CKD patients is crucial. The present paper is a narrative review of the several studies related the use, sensitivity and specificity of developed malnutrition screening tools for CKD patients. Material and Method: Articles were searched from five electronic databases i.e., PubMed, PMC, Semanticscholar, Science-direct, and Google scholar. Several keywords used for literature searching including “malnutrition screening tools CKD”; “malnutrition CKD”; “malnutrition screening CKD”. Inclusion criteria of this narrative review was the subject of intervention should be an aged 1 – 64 years old with experimental randomized control trial (RCT) or non-RCT study design. The exclusion criteria for this literature study were research published before 1990, literature studies, meta-analysis, comments, short communication, and editorial letters. Data then narratively described. Result and Conclusion: Twelve publication were narratively described in final analysis. Development of malnutrition screening tools for CKD patient had been done since 1992 and still counting until 2020. At least thirteen screening tools had been tested for its use, sensitivity and specificity. Among 13 tools we analyzed, Simple Nutrition Screening Tool (SNST) and The Renal Nutrition Screening Tool (R-NST) revealed the highest sensitivity and specificity value which suitable to be used in adult population, while in children, only Pediatric Digital Scaled MAlnutrition Risk Screening Tool (PeDiSMART) showed a good sensitivity and specificity. Further study should be focusing to look for sensitivity and specificity in other specific population to ensure the right use of malnutrition screening tool. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED.Methods: Secondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis.Results: Among 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and 'risk of malnutrition' was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant.Conclusion: Over one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days.Trial Registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515 , first posted November 13, 2018. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis assesses the prevalence of protein-energy malnutrition risk across different health-care settings in European older adults, using 22 malnutrition screening tools recently validated for use in older adults. Systematic searches were performed in six electronic databases (2006 through 2017). Included were studies which reported malnutrition risk in adults aged ≥65y in Europe. Frequency of high and moderate malnutrition risk for each malnutrition screening tool was collated. Meta-analyses of malnutrition risk using a random-effects model were performed where data from at least 10 study samples were available. Of 21,465 studies, 196 studies were available for data extraction, representing 223 study samples from 24 European countries and 583,972 older adults. Pooled prevalence rates of high malnutrition risk across all countries and malnutrition screening tools were 28.0% (n = 127 study samples), 17.5% (n = 30), and 8.5% (n = 32), for the hospital, residential care and community settings respectively. Using meta-regression, prevalence rates were higher in adults aged >80y (p < 0.0001), in women (p = 0.03) and in patients with one or multiple comorbidities (p < 0.0001). Prevalence rates differed by country, from 15.2% in Spain to 37.7% in Switzerland, and by screening tool, from 14.9% using MNA-SF to 40.6% using NRS-2002. In conclusion, the prevalence of high malnutrition risk in European older adults varies widely between countries and across health-care settings. Malnutrition risk is associated with older age, gender and presence of disease. As prevalence rates differ depending on the screening tool used, the use of one preferred malnutrition screening tool per setting is strongly recommended. [ABSTRACT FROM AUTHOR]

Many malnutrition screening tools are used to screen for risk of malnutrition in older adults. An aim of the Joint Programming Initiative (JPI) 'A Healthy Diet for a Healthy Life' (HDHL) MalNutrition in the ELderly Knowledge hub (MaNuEL) is to devise recommendations on the best tools to screen for risk of malnutrition in older adults in community and healthcare settings across Europe. The aim of this paper was to develop and apply a scoring system to rate malnutrition screening tools. Using a targeted literature search strategy, 48 malnutrition screening tools used to screen for risk of malnutrition in older adults were identified across community, rehabilitation, residential care and hospital settings. Criteria to rate each tool were developed; these were based on published evidence and expert opinion. These criteria were translated into a scoring system. The scoring system had three equally weighted sections; validation, parameters and practicability, and was applied to all 48 tools. Overall, the highest scoring tools per setting for screening for risk of malnutrition in older adults were i) DETERMINE your health checklist for the community setting; ii) the Nutritional Form for the Elderly (NUFFE) for the rehabilitation setting; iii) the Short Nutritional Assessment Questionnaire-Residential Care (SNAQRC) for residential care and iv) both the Malnutrition Screening Tool (MST) and the Mini Nutritional Assessment Short Form Version 1 (MNA-SF-V1) for the hospital setting. Setting-specific tools are more appropriate for use with older adults. These findings will inform recommendations for the optimal screening of geriatric malnutrition across Europe. [ABSTRACT FROM AUTHOR]

Background: Overnutrition and undernutrition can affect patients with inflammatory bowel disease (IBD). Although all IBD outpatients should be screened for nutrition risk, screening is not routinely performed, potentially leading to reduced identification and treatment. This study aimed to estimate the prevalence of nutrition risk in adult IBD outpatients and the proportion of cases who discussed diet and/or nutrition during their routine clinical appointment. Methods: Adults with IBD attending outpatient clinics at 4 hospitals in Greece and in UK were recruited. Demographic and anthropometric data were collected using face-to-face patient interviews and clinical records. Patients were classified as high (i.e., body mass index [BMI] < 18.5 or 18.5–20 kg/m2 and weight loss > 5%), moderate (i.e., BMI 20–25 kg/m2 and weight loss > 5%) or low risk of undernutrition and high risk of obesity (i.e., BMI 25–30% and weight gain > 5%). The proportion of patients who discussed diet and/or nutrition during their clinical appointment was calculated. Results: In total, 390 IBD patients participated. Sixteen (4%) patients were underweight, 113 (29%) were overweight and 71 (18%) were obese. Twenty-one (5%) patients were at high risk of undernutrition; of these 4 (19%) were under dietetic care. Of those at high risk of undernutrition, 11 (52%) had discussed diet and/or nutrition during their routine clinical appointment. Fifty-six (14%) patients had gained more than 5% weight since their last recorded/reported weight and 19 (5%) were at high risk of obesity. Conclusions: Few patients were identified to be at high risk of undernutrition and less than a fifth of these were under dietetic care. Overnutrition is a growing problem in IBD with almost half of adult patients being overweight or obese. Diet and/or nutrition were not routinely discussed in this group of IBD outpatients. [ABSTRACT FROM AUTHOR]

Malnutrition risk screening is essential for the adequate identification and treatment of malnourished hospitalised patients. The aim of this study was to determine the effect of the use of an electronic malnutrition screening tool on the knowledge, attitudes and perceived practices (KAP) of a pool of nurses, nurses’ aides and physicians. A controlled study using a pre-test–post-test design was carried out in two Austrian hospitals. The hospital that was assigned to the intervention group used the Graz malnutrition screening tool. The hospital that was assigned to the control group received no intervention. To collect data, a questionnaire was filled out by the study participants at baseline (T0) and 1 month after the implementation (T1) to assess KAP. All data were analysed using descriptive statistics, χ2 tests, Wilcoxon signed-rank tests and Student’s t tests. A total of 269 nurses, nurses’ aides and physicians participated in the study and completed the questionnaires at T0, and 190 people at T1. The sum score for the KAP questionnaire changed significantly after the implementation of the malnutrition screening tool in the intervention group (P<0·001), but not in the control group. The use of a valid and reliable malnutrition screening tool effectively improved the KAP of healthcare staff. The KAP described here are essential for providing successful nutritional care in malnourished patients, and improving these factors may result in improved patient outcomes. To attain these outcomes, stakeholders, as well as members of all professions involved in multidisciplinary nutritional care, must invest significant efforts. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is associated with adverse outcomes for hospital inpatients and is a significant economic burden on hospitals. Malnutrition is frequently under-recognised in this setting and valid screening and early diagnosis are important for timely nutritional management. Aboriginal Australian and/or Torres Strait Islander peoples (Indigenous Australians) are likely to be at increased risk of malnutrition due to their disproportionate burden, pattern and age-distribution of chronic diseases. Despite this increased risk, the burden and impact of malnutrition in Indigenous Australians is poorly understood. Furthermore, a suitable screening tool has not been validated for this vulnerable patient group. The aim of this study is to determine the burden of malnutrition, understand its impact, and validate a malnutrition screening tool for Indigenous Australian inpatients. Methods: This project involves cross-sectional, prospective cohort and diagnostic validation methodologies to assess the burden and impact of malnutrition and to validate a malnutrition screening tool. A target of 752 adult Indigenous and non-Indigenous Australian inpatients will be recruited across three different public hospitals in the Northern Territory and far north Queensland of Australia. Cross-sectional data collection will be used to determine the prevalence of malnutrition using the Subjective Global Assessment and to stratify participants based on the International Consensus Guideline Committee malnutrition aetiology-diagnostic framework. Subjects will then be followed prospectively to measure short and long-term health outcomes such as length of hospital stay, in-hospital mortality, 30-day and 6-month readmission rates. Finally, the utility of a new screening tool, the Australian Nutrition Tool, will be assessed against an existing screening tool, the malnutrition screening tool, used in these settings and the malnutrition reference standard, the Subjective Global Assessment. Discussion: Indigenous Australians continue to experience poorer levels of health than non-Indigenous Australians and issues such as food insecurity, poor diet, and a disproportionate burden of chronic disease play a key contributing role for malnutrition in Indigenous Australians. To improve the health and hospital outcomes of Indigenous and non-Indigenous Australians, it is important that patients are routinely screened using a validated screening tool. It is also imperative that the burden and impact of malnutrition is properly understood, and fully appreciated, so that early and appropriate nutritional management can be provided to this group of hospital patients. [ABSTRACT FROM AUTHOR]