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PubMed2001

The Mini Nutritional Assessment-Short Form for preoperative nutritional evaluation of elderly patients.

The Mini Nutritional Assessment (MNA) is a clinical tool designed for assessing nutritional status of elderly patients. Used in preoperative evaluation of ambulatory patients over 60 years of age seen on anesthesia consultation in a previous study, it identified 6.9% patients with overt malnutrition out of a group of 408. However, four-fifths of 291 ASA 1-2 patients were well nourished, and underwent needless, non-contributory and time-consuming test. The MNA-Short Form (MNA-SF) has recently been devised as the first step of a two-step process: if negative, there would be no need to complete "full" MNA. Therefore, the base data of 408 MNA forms completed during the above-mentioned study was used for the purpose of comparing the MNA-SF to the MNA, to test whether the MNA-SF could have been the first step of a two-step nutritional evaluation of anesthesia patients. Median (range) age, and BMI were 72 (60-98) years, and 25.2 (12.8-40.4) kg x m(-2), respectively. There were equal numbers of men and women. In 144 cases, the MNA-SF was found positive (35.3%) with a median MNA of 21.5 (1.5-27) points. The MNA-SF predicted absence of overt malnutrition revealed by the MNA, with 100% sensitivity and negative predictive value (NPV). It was found less efficient for predicting absence of "possible" nutritional problems detected by the MNA (sensitivity 85.6% and NPV 92.8%). However, none of the 19 borderline patients would have had overt malnutrition, being only found "at risk of malnutrition" by the MNA. On the studied sample, the MNA-SF would have correctly sorted out 69.5% of the patients without severe malnutrition. We believe the MNA-SF should be used as the first step of an efficient preoperative nutritional evaluation of ambulatory elderly patients.

Aged↗
PubMed2004

[School nutrition and nutrition lessons].

Nutrition behavior usually becomes manifest during childhood and once learned food patterns and eating habits are often maintained for the rest of life. Therefore, imparting knowledge early about food composition, food habits, nutritional physiology, and connections between health and nutrition as well as instilling competence in dealing with food are of particular importance. In the EiS project, it was recently shown that fewer students than ever obtain less and less nutrition education in German schools. Promoting healthy eating is not only a matter of nutritional knowledge. It is also very much about creating a healthy environment and providing proper food, drinks, and meal service in schools. Therefore, both aspects will be discussed in the following article.

Adolescent↗
PubMed2002

Position paper of the ESICM Working Group on Nutrition and Metabolism. Metabolic basis of nutrition in intensive care unit patients: ten critical questions.

The metabolic changes associated with critical illness involve several pathways acting at different steps of the utilization of nutritive substrates. The understanding of the role of these pathways and of their complex regulation has led to the development of new strategies for the metabolic and nutritional management of critically ill patients, including the development of new products for nutritional support. The rationale for changing the profile of nutritional support solutions by adding novel substrates is also discussed. This review focuses on the metabolic specificities of critically ill patients and also includes an analysis of the adequacy of tools to monitor the metabolic status and the adequacy of the nutritional support.

Critical Care↗
PubMed1990

Effect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease.

The effect of IV nutrition on protein nutriture and physiological function in 19 patients who were clinically malnourished and had acute exacerbations of inflammatory bowel disease was studied. Total body protein, plasma proteins, respiratory muscle function, and skeletal muscle function were measured at the commencement of a 14-day course of IV nutrition and 7 and 14 days later. Final measurements were made after recovery approximately 200 days later. Compared with a group of matched controls, the patients had lost approximately 35% of their body protein stores with accompanying physiological impairments of 20%-40%. After 4 days of IV nutrition, there were improvements in all the physiological measurements (approximately 12%) but no significant change in total body protein. During convalescence, there were further improvements in physiological function, which were accompanied by an increase in body stores of protein. We conclude that there is an early and rapid improvement in physiological function with IV nutrition in patients hospitalised for exacerbations of inflammatory bowel disease even though this is not accompanied by significant protein gain. Later during anabolic recovery, physiological improvements occur in association with repletion of total body protein. Short courses of IV nutrition in these patients prevent protein loss and result in significant improvements in skeletal muscle function and respiratory muscle function.

Acute Disease↗
PubMedDate not supplied

[Preoperative screening and nutritional support of nutritional deficiencies].

Nutritional deficiencies have to be considered as an independent risk factor for postoperative morbidity. Peri-operative nutritional support reduce this risk in elective abdominal surgery for cancer and cardiac surgery. Preoperative nutritional support for 7-10 days reduce postoperative complications in undernourished patients by 10% but is not operant when administered after surgery. Enteral route is as effective. Recent studies using immunonutrients conclude that a short preoperative oral intake is able to reduce complications even in well-nourished patients. Then, a preoperative nutritional screening must be routinely performed leading to a nutritional programme.

Abdominal Neoplasms↗
PubMed2005

Mini nutritional assessment and screening scores are associated with nutritional indicators in elderly people with pressure ulcers.

OBJECTIVE: To determine the association between the Mini Nutritional Assessment (MNA) or MNA Screening Form and standard indicators of nutritional status in male elders with pressure ulcers. DESIGN: Cross-sectional study. MNA and MNA Screening Form scores were related to nutritional indicators using the Pearson correlation. SUBJECTS/SETTING: Residents (79+/-1 years, N=23 men) of Veterans Affairs medical center nursing home care units with stage I to IV pressure ulcers were enrolled. MAIN OUTCOME MEASURES: Correlation coefficients were obtained from correlations between the MNA or MNA Screening Form scores and biochemical and anthropometric indices of nutritional status or measures of body composition normalized for height by dividing by height in meters(2). RESULTS: Hemoglobin (106+/-4 g/L; r=0.43, P=.0409, mean, standard error of the mean, Pearson's r, P value), hematocrit (0.32+/-0.01; r=0.44, P=.0358), body mass index (23.1+/-1.0; r=0.66, P=.0006), calf circumference (30.4+/-1.1 cm; r=0.46, P=.0286), fat-free mass index (18.3+/-0; r=0.60, P=.0063), body cell mass index (8.3+/-0.5; r=0.64, P=.0033), and fat mass index (3.7+/-0.4; r=0.50, P=.0275) positively correlated with MNA score. Serum albumin (31+/-1 g/L) and prealbumin (180+/-17 mg/L) did not correlate with MNA, but prealbumin inversely correlated with erythrocyte sedimentation rate (r=-0.52, P=.0134), a marker of inflammation. The inverse correlation between albumin and erythrocyte sedimentation rate approached statistical significance (r=-0.42, P=.0542). The MNA Screening Form showed similar correlations or lack of correlations observed with the MNA with the exception of hemoglobin and hematocrit. CONCLUSIONS: The MNA and MNA Screening Form provide advantages over using visceral proteins in screening and assessing nutritional status of elderly people with pressure ulcers.

Aged↗
PubMed2005

Home parenteral nutrition registry: a five-year retrospective evaluation of outcomes of patients receiving home parenteral nutrition support.

OBJECTIVE: Few data are currently reported on home parenteral nutrition (HPN) patient outcomes, which makes evaluating comparative outcomes in HPN difficult. This study describes outcomes of consecutive HPN patients collected retrospectively over a 5-y period by one HPN support provider. METHODS: Retrospective data from the HPN support provider was aggregated yearly from 1997 to 2001. Length of therapy, demographics, diagnosis, rehospitalizations, catheter infection rate, catheter occlusion rate, and mechanical complication rate data were reported. RESULTS: The mean age of HPN patients ranged from 42 y to 45 y. The average length of HPN therapy was 100 d. There were more female than male HPN patients. Nutritional deficiency and malabsorption were the most common International Classification of Diseases, Ninth Revision codes for HPN use and reflects a focus on nutritional diagnosis rather than on disease state as the criterion for HPN use. Catheter infection rates ranged from 0.44 to 0.84 per 1000 catheter days, a lower than anticipated number. Mean catheter occlusion rates were lower than 7% and mean mechanical complication rates were approximately 5%. Known termination of therapy was secondary to completion of therapy (50% to 56%) or death (17.3% to 22%). CONCLUSIONS: Overall, time on HPN therapy in the United States has increased. Nutritional diagnoses are currently used to justify HPN. Catheter infection and occlusion rates, in general, are low. Termination of therapy and death are the most common reasons for HPN discontinuation. Standardization of HPN data collection is necessary to obtain a historical snapshot of the efficacy and safety of patients treated outside the hospital with nutritional support.

Adult↗
PubMed2004

Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature.

OBJECTIVE: Nutritional support is part of the standard of care for the critically ill adult patient. In the average patient in the intensive care unit who has no contraindications to enteral nutrition (EN) or parenteral nutrition (PN), the choice of route for nutritional support may be influenced by several factors. Because EN and PN are associated with risks and benefits, we systematically reviewed and critically appraised the literature to compare EN with PN the critically ill patient. METHODS: We searched computerized bibliographic databases, personal files, and relevant reference lists to identify potentially eligible studies. Only randomized clinical trials that compared EN with PN in critically ill patients with respect to clinically important outcomes were included in this review. In an independent fashion, relevant data on the methodology and outcomes of primary studies were abstracted in duplicate. The studies were subsequently aggregated statistically. RESULTS: There were 13 studies that met the inclusion criteria and, hence, were included in our meta-analysis. The use of EN as opposed to PN was associated with a significant decrease in infectious complications (relative risk = 0.64, 95% confidence interval = 0.47 to 0.87, P = 0.004) but not with any difference in mortality rate (relative risk = 1.08, 95% confidence interval = 0.70 to 1.65, P = 0.7). There was no difference in the number of days on a ventilator or length of stay in the hospital between groups receiving EN or PN (Standardized Mean Difference [SMD] = 0.07, 95% confidence interval = -0.2 to 0.33, P = 0.6). PN was associated with a higher incidence of hyperglycemia. Data that compared days on a ventilator and the development of diarrhea in patients who received EN versus PN were inconclusive. In the EN and PN groups, complications with enteral and parenteral access were seen. Four studies documented cost savings with EN as opposed to PN. CONCLUSION: The use of EN as opposed to PN results in an important decrease in the incidence of infectious complications in the critically ill and may be less costly. EN should be the first choice for nutritional support in the critically ill.

Costs and Cost Analysis↗
PubMed2001

Dietary intake and nutritional status of US adult marijuana users: results from the Third National Health and Nutrition Examination Survey.

OBJECTIVES: This study examined dietary intakes and nutritional status of marijuana users and non-current marijuana users in US adults aged 20 to 59 years. METHODS: We used data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994. Information on self-reported drug use, including marijuana, was obtained as part of the NHANES III physical examination component. Nutritional status was assessed using height and weight, and blood biochemistries. Dietary intake was assessed using a 24-hour recall and a food-frequency questionnaire. RESULTS: Among adults 20-59 years of age, 45% reported ever having used marijuana in their lifetime. A total of 8.7% reported using marijuana in the past month. Current marijuana users had higher intakes of energy and nutrients than non-current marijuana users; however, body mass index (BMI) was slightly lower. We found higher cigarette-smoking rates and higher consumption of sodas and alcohol, specifically beer, among marijuana users than among non-current marijuana users. Marijuana users also consumed more sodium, fewer fruits, and more pork, cheese, and salty snacks. Nutritional status, using indicators of serum nutrients, serum albumin, haematocrit and haemoglobin, was similar between marijuana users and non-current marijuana users. Serum carotenoid levels were lower among marijuana users, independent of cigarette smoking. CONCLUSION: Dietary intake was different among marijuana users than among non-current marijuana users. Although overall nutritional status was similar, serum carotenoid levels were lower in marijuana users. The long-term health effects of these differences in marijuana users deserve careful consideration in future research.

Adult↗
PubMed2006

The evolution of Nutrition in Medicine, a computer-assisted nutrition curriculum.

The primary mission of the Nutrition in Medicine (NIM) project is to provide tools to facilitate the nutrition training of undergraduate medical students. NIM has developed and distributed a CD-ROM-based nutrition curriculum to medical schools since 1995. However, the medical school environment is changing rapidly; there is pressure to do more in less time, and many schools are emphasizing independent and integrated learning. The need for a nutrition curriculum that is more flexible and more accessible has driven the evolution of the NIM curriculum from CD-ROM-based delivery into a more modular curriculum with Web delivery. Such changes facilitate access and eliminate the need for installation of CD-ROMs and the associated technical support issues. In addition, the instructional units are smaller and more modular. Eventually, the authoring system will allow instructors to put together a course to meet their specific instructional needs. Our future plans also include custom-tailoring that will allow students to opt out of learning material on the basis of pretest scores if they are already proficient in the content. In this update, we provide a detailed description of the new system and the rationale for the modifications we made. Furthermore, we describe how each change addresses barriers to nutrition education as identified from our surveys and others and from direct user feedback. These innovative strategies should allow a better fit of NIM within diverse medical school environments and help to promote incorporation of the curriculum into more medical schools.

Computer-Assisted Instruction↗
PubMed1989

Use of fibronectin and somatomedin-C as nutritional markers in the enteral nutrition support of traumatized patients.

Enteral nutrition support was provided to 12 critically ill, traumatized patients by continuous NG infusion with a nutritionally complete formula for at least 7 consecutive days. Serum for fibronectin (Fn) and somatomedin-C (Sm-C) was collected and nitrogen balance (NB) was measured on days 1, 4, 7, 14, 21, and 28 of the study period. Estimated energy and protein requirements were based, respectively, on the patient's calculated basal energy expenditure multiplied by a stress factor and urea nitrogen excretion (plus 4) during 24-h urine collections. Enteral feedings were started 5.3 +/- 3.8 days after injury; patients received an average of 33.2 +/- 3.9 kcal/kg.day and 1.5 +/- 0.4 g protein/kg.day. Fn concentrations increased significantly (p less than .05) from baseline on study days 7, 14, 21, and 28, whereas NB increased significantly (p less than .05) on study days 4, 7, 14, 21, and 28. Significant correlations were found between Fn and NB (r = .52, p less than .005), Fn and cumulative caloric intake (r = .54, p less than .005), and Fn and cumulative nitrogen intake (r = .62, p less than .005). There were no significant changes observed with Sm-C concentrations during the study period. Measurement of Fn concentrations appears to have potential as a nutrition support marker in traumatized patients, particularly in monitoring short courses of nutrition support. The role of Sm-C as a nutrition marker requires further investigation.

Adolescent↗
PubMed1996

Physical growth, infant nutrition, breastfeeding, and general nutrition.

A constant in the practice of general pediatrics is an emphasis on infant nutrition and monitoring of growth. These topics are the focus of this issue's "Office pediatrics" section. Much of the new research and publication concerning nutrition in childhood in the past year continues to focus on breastfeeding-its short-term and long-term benefits and strategies to increase the number of women who successfully nurse their infants. The documentation of breastfeeding's benefits is becoming increasingly strong, even in developed countries such as the United States. At the same time, the many weaknesses in the health care system's support of this important health-promoting behavior continue to be documented. Separate from breastfeeding per se, additional articles examining the state of nutrition among children in the United States show that despite our relative affluence, malnutrition remains prevalent. The poor and the chronically ill appear particularly vulnerable to inadequate nutrition and should remain a focus of our efforts at nutritional monitoring and support.

Breast Feeding↗
PubMedDate not supplied

Parenteral nutrition focus. Nutrition assessment and formula composition.

The infusion therapy nurse often is in a position to intervene by assessing and helping to treat the nutritional status of the patients she or he serves. This article provides an overview of the nutritional assessment process. Tips are offered for estimating patient-specific nutritional needs. Basic components of parenteral nutrition solutions are highlighted, and general guidelines for initiating parenteral nutrition are included. A case study guides the reader through application of some principles offered in the article.

Food, Formulated↗
PubMed2006

Solutions to nutrition-related health problems of preschool children: education and nutritional policies for children.

OBJECTIVE: By reviewing the literature, lessons learned and experience regarding the nutrition-related health problems of preschool children, draw conclusions and make recommendations on education and nutrition policies for young children. RESULTS: The most common causes of under-5 mortality in low-income countries have been identified as neonatal disorders, diarrhoea, respiratory infections, malaria, measles, and in some developing countries, AIDS. More than half (56%) of all child deaths have underlying malnutrition and undernutrition as a contributing factor. Children must have optimal growth and physical and intellectual development to learn and achieve their potential in society. Solutions include both preventive and curative interventions at all levels and include both improved health and education systems. Recent focus has been on health systems interventions that address averting deaths by cause for the 42 countries that account for 90% of worldwide under-5 deaths (the majority in sub-Saharan Africa). However, parallel or multisectoral interventions must be addressed to all children at risk for death, poor health and compromised growth and development. Adequate health care and nutrition is a human right, legally established in the Convention on the Rights of the Child. CONCLUSIONS: Improved health and nutrition will lead to enhanced economic development, but having a poverty focus appears to be essential, if poor people are not to be marginalized further. The HIV/AIDS pandemic illustrates this challenge clearly. The role of education, especially girls' education, in improved health and nutrition status of children and birth-spacing is now clear, as is improving women's status. Increases in female status and education have been estimated to account for half of the reduction in child malnutrition rates during the past 25 years.

Adult↗
PubMedDate not supplied

Nutritional and cognitive status in elderly subjects living in service flats, and the effect of nutrition education on personnel.

BACKGROUND: There is limited knowledge about the nutritional and cognitive status in elderly and chronically ill subjects living in sheltered housing. OBJECTIVE: To perform a 6-month follow-up study in order to investigate (1) nutritional status and its relationship to cognitive function in elderly people living in service flats, and (2) the effect of a 9-hour educational program given to personnel working in the service flats. METHODS: Of 93 eligible subjects, 28 agreed to participate (age 81 +/- 7 years, 75% women). Body mass index (BMI), triceps skin fold (TSF), arm muscle circumference (AMC), appetite, Subjective Global Assessment (SGA), serum albumin, serum insulin-like growth factor-1 (IGF-1) and Mini Mental Test (MMT) were assessed on two occasions with a 6-month interval. The staff of the service flats answered a questionnaire before and 6 months after an educational program. RESULTS: At the start, BMI, TSF and AMC were within the normal ranges, e.g. BMI 26.6 +/- 3.1 for men and 25.6 +/- 3.2 for women. Three subjects were suspected to be malnourished and 2 were malnourished according to SGA. Among 20 randomly selected subjects who chose not to participate in the investigation, age, sex, BMI, weight loss and appetite were not significantly different from those values in participants. However, none of the latter had a BMI <20 compared to 10% in non-participants. The MMT results suggested cognitive dysfunction in 41% of the subjects. On the first test occasion, MMT correlated with BMI (r = 0.43, p < 0.03), weight loss (r = 0.4, p < 0.05) and age (r = -0.38, p < 0.05). The ability of the personnel to suggest suitable nutrition for fictitious patient cases appeared to have improved after the educational program. At the 6-month follow-up, the BMI in men rose to 27.0 +/- 3.4 (p < 0. 05), while other anthropometric measurements remained unchanged. Serum IGF-1 lay within the normal range, as did serum albumin which, however, rose from 39.1 +/- 2.9 to 41.2 +/- 3.5 g/l (p < 0.01). CONCLUSION: Fifteen to twenty percent of the individuals studied in the service flats displayed definite or possible signs of malnutrition. Cognitive function correlated with BMI, weight loss and age. The educational program appeared to increase the nutritional knowledge in personnel working in the service flats. At the 6-month follow-up, the nutritional status of the residents had not deteriorated.

Activities of Daily Living↗
PubMedDate not supplied

Total parenteral nutrition by a nutrition support team: improved quality of care.

Most of the studies that have examined the effect of nutrition support teams (NST) on the quality of total parenteral nutrition (TPN) have found reductions in the frequency of metabolic and central venous catheter related complications. Previous studies have not examined the patterns of nutrient delivery (eg, calories and protein) when TPN is provided either by a primary physician or by a NST. We compared the quality of TPN care provided by our NST or by primary physicians utilizing nonspecialized hospital personnel and resources. As expected, catheter complications were significantly less frequent in NST patients. Assessment of nutritional status and nutrient requirements as well as nitrogen balance were performed and documented significantly more often in NST patients. In addition, nutritional goals for calories and protein were achieved and positive nitrogen balance documented more often in NST patients. The need to consult the NST physician to utilize the NST was not well received by primary attending and resident physicians and resulted in nonuse of the team. In the future, modification of NST policies will be explored to encourage greater utilization of the NST without compromising the high standard of nutrition care delivered by the NST.

Catheterization↗
PubMedDate not supplied

Nutrition support practice: a study of factors inherent in the delivery of nutrition support services.

The purpose of this study was to determine the degree of intercorrelation among dietitian, physician, and team nutrition support functions. Eight hundred and eighty dietitians and physicians were asked to respond to a questionnaire describing nutrition support functions as reported in the literature and validated by a panel of nutrition support physicians and dietitians. Two hundred and fifty-four completed questionnaires were included in the study, 84 from physicians and 170 from dietitians. Intercorrelations among function statements were subjected to factor analysis. The magnitude and consistency of factor loadings suggest that nutrition support is not perceived as independent components, but as a comprehensive pattern or structure. However, there was one important difference in perception. The sample tended to have an "enteral" orientation to the dietitian role and a "parenteral" orientation to the physician and team roles. The data support the contention that all members of nutrition support teams need a common core of knowledge and a set of highly developed process skills which can best be attained through an integrated, rather than segmented, approach to team training.

Dietetics↗
PubMed2006

Agricultural biodiversity, nutrition, and health: making a difference to hunger and nutrition in the developing world.

BACKGROUND: In spite of the strides made globally in reducing hunger, the problems of micronutrient deficiencies and coexisting obesity and related cardiovascular and degenerative diseases constitute a formidable challenge for the future. Attempts to reverse this trend with single-nutrient intervention strategies have met with limited success, resulting in renewed calls for food-based approaches. The deployment of agricultural biodiversity is an approach that entails greater use of local biodiversity to ensure dietary diversity. OBJECTIVE: To outline a new strategy proposed by the International Plant Genetic Resources Institute (IPGRI) that employs agricultural biodiversity as the primary resource for food security and health. METHODS: The authors carried out a meta-analysis to review and assemble existing information on the nutritional and healthful properties of traditional foods based on a diverse set of case studies and food composition and nutritional analysis studies. The methods highlight particular examples of foods where analysis of nutrient and non-nutrient composition reveals important traits to address the growing problems of malnutrition associated with the rise of chronic diseases. Finally, the authors analyze social, economic, and cultural changes that undermine the healthful components of traditional diets. RESULTS: Based on this multidisciplinary and comparative approach, the authors suggest a holistic food-based approach that combines research to assess and document nutritional and healthful properties of traditional foods, investigating options in which nutritionally valuable traditional foods can contribute to better livelihoods, and ways that awareness and promotional campaigns can identify healthful components of traditional diets that fit the needs of urban and market-oriented consumers. CONCLUSIONS: There is an urgent need for agricultural research centers, national agricultural research systems, universities, and community-based organizations to work together under a shared policy framework with the aim of developing a strong evidence base linking biodiversity, nutrition, and health. Although these initiatives are still ongoing, the gains realized in small-scale and local pilot efforts have encouraged IPGRI to work with local partners toward the implementation of scale-up efforts in various regions.

Biodiversity↗