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PubMed2005

Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients.

The Mini Nutritional Assessment (MNA), the Subjective Global Assessment (SGA) and the Nutritional Risk Screening (NRS) are screening and assessment tools aimed at detecting malnourished individuals and those at risk for malnutrition. In our study we tested their applicability in geriatric hospital patients and compared the results of the three tools. We examined prospectively all patients of two acute geriatric wards by the MNA, the SGA and the NRS. 121 patients were included in the study. The MNA could be completed in 66.1% of all patients, the SGA in 99.2% and the NRS in 98.3%. There was a significant association of all three tools with the BMI (p<0.01). With regard to serum albumin and to length of hospital stay (p<0.05), only a significant association could be shown for the MNA (p<0.05). Although the categories of the results were not completely identical for the three tools there were more patients at risk or malnourished according to the MNA (70%) than according to the SGA (45%) or the NRS (40.3%). The direct comparison of the NRS with the MNA and the SGA demonstrated significant differences, especially for the latter (p<0.001). In a relevant percentage of those tested, MNA, SGA, and NRS identify different individuals as malnourished or at risk for malnutrition. Because of its association with relevant prognostic parameters, the MNA is still the first choice for geriatric hospital patients. For those patients to whom the MNA cannot be applied, the NRS is recommended.

Aged↗
PubMed1992

[Problems in child nutrition. 1. Nutrition in children with low-birth weight. Nutrition of normal neonates and infants].

The author recommends to change the system of enteral nutrition of low-birth-weight infants. These infants should be fed according to recent findings as follows: 1. by their mother's partly fortified milk, 2. by fully fortified human milk of another woman, 3. by adapted milk suitable for the given age group. The author recommends to adhere to the valid system of infant nutrition. In bottle-fed infants with a allergological case-history or severe atopic eczema it is possible to use hypoallergic milk.

Breast Feeding↗
PubMed1993

[Recommendations of the Council for Nutrition on infant nutrition. Norwegian National Nutrition Council].

Because of the high frequency of nursing mothers there is concensus that, in general, the diet of Norwegian newborns is good for the first six months of life. However, several publications have questioned the recommendations concerning the babies' diet from the age of six to 12 months with respect to time of weaning and introduction of cow's milk, and intake of energy, fat-soluble vitamins, iron and essential fatty acids. The Norwegian National Nutrition Council has therefore evaluated the available data, and has adjusted some of the recommendations, including the recommendations for energy intake, energy percent from fat and essential polyunsaturated fatty acids.

Breast Feeding↗
PubMed1977

[Nutritional condition, food consumption and nutritional intake in students in Saudi Arabia. II. Food consumption and nutritional intake].

In field surveys in 13 schools in different regions of Saudi-Arabia, energy expenditure, food consumption, and nutrient intake were studied. Cereal products, especially bread, have the greatest significance in nutrition. Many students do not eat other foodstuffs regularly. A certain dependency of food consumption from the region was found in regard to the schools. The frequency of foodstuffs was generally low, but lowest in remote villages. In some age groups, the sufficient energy intake leaves much to be desired, 70 % do not reach recommended dietary allowances of animal protein and 100 % in fat. Intake of carbohydrates was too high, while intake of linoleic acid, minerals and vitamins is too low of nearly all test persons. To secure regularly a sufficient intake of essential nutrients, a school lunch program for the Saudi-Arabian boys is to be recommended.

Adolescent↗
PubMed1997

[Monitoring food consumption and nutritional status of Moscow schoolchildren in 1992-1994. 2. Anthropometric evaluation of nutritional status, effect of social factors on the character and status of nutrition].

In this part of the study the nutritional status of Moscow's schoolchildren was assessed by height and weight. The anthropometric data were compared with the CDC/WHO international growth references standards by ANTHRO version 1.01 software. The prevalence of low weight-for-age (Z-score < -2) was more frequent in boys of 15 years of age. Low height-for-age was more prevalent in the group of boys of 15 and girls of 10 years of age. In the period under study there was a slight decrease in height and weight of schoolchildren, but this was within the limits of expected normal variation. A few selected socio-economic variables such as parental education, family size, participation in organized sports and use of school breakfast/lunch options were included. The size of the family or whether it is a one- or two-parent household does not seem to influence energy or nutrient intake, nor are the anthropometric variables significantly affected. The more size of family and the lower the father's education than lower the children's total fat intake and intake of energy from fat.

Adolescent↗
PubMed2006

Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU.

AIM: To test whether a feeding algorithm could improve the nutritional support of intensive care patients. BACKGROUND: Numerous factors may impede delivery of both enteral and parenteral nutrition to patients in the intensive care unit. Often there is a discrepancy between what is prescribed and actual delivery of nutrients. The purpose of this study was to test the effect of a nutritional support algorithm in an intensive care unit mainly by using the enteral route and if necessary by combining enteral and parenteral nutrition. METHODS: In this prospective study, nutritional data were collected from routinely fed critically ill patients (controls, n=21) during the first three days following admission to the intensive care unit. A nutritional support algorithm was then implemented and nutritional data were collected from critically ill patients who participated in this intervention (intervention group, n=21). Data collected included the total amount of calories prescribed vs. received, onset of delivery of enteral nutrition, enteral vs. parenteral nutrition, and the use and size of enteral feeding tubes. RESULTS: Patients in the intervention group were both prescribed and actually received significantly larger amounts of nutrients than patients in the control group. They also received a larger proportion of their nutrients in the form of enteral nutrition. In addition, the nutritional support algorithm led to greater consistency in nursing practices with respect to aspiration of gastric content and rate of increment in enteral feeding. CONCLUSION: The study confirms that a nutritional support algorithm improved the delivery of nutrients to critically ill patients. The algorithm was most effective with respect to the delivery of enteral nutrition. The effect was primarily because of early and more rapid increment in the delivery of enteral nutrition administered by nurses based on improved physician orders. The combination of enteral and parenteral nutrition may contribute to meeting adequate nutritional requirements. RELEVANCE TO CLINICAL PRACTICE: By using a nutritional algorithm focused on enteral nutrition, but including parenteral nutrition as a supplement, it is possible to improve the delivery of clinical nutrition in the intensive care unit patients.

Algorithms↗
PubMed1997

The role of nutrition support dietitians as viewed by chief clinical and nutrition support dietitians: implications for training.

OBJECTIVES: To determine current and ideal frequencies with which nutrition support dietitians perform each item on a list of 15 tasks and evaluate dietitian preparation for the practice of nutrition support. DESIGN: Data were collected using two questionnaires, one completed by the chief clinical dietitian and the other completed by the nutrition support dietitian at each hospital surveyed. Both versions of the questionnaires contained a list of 15 tasks that had been validated as being related to advanced nutrition support by a panel of 20 nutrition support experts using a modified Delphi method. Follow-up telephone calls were made to increase the number of responses. SAMPLE: Questionnaires were mailed to the chief clinical dietitian at 300 randomly selected, general medical/surgical hospitals with 300 or more beds in the United States and Puerto Rico. A total of 134 chief clinical dietitians (45%) and 129 nutrition support dietitians (43%) responded to the surveys; 124 (41%) and 120 (40%) questionnaires, respectively, were usable for statistical analyses. STATISTICAL ANALYSES: The Wilcoxon matched-pairs signed-ranks test was used to determine differences between nutrition support dietitian actual and ideal frequencies and between chief clinical dietitian actual and ideal frequencies for each of the 15 tasks. The Mann-Whitney U-Wilcoxon rank sum W test was used to determine differences between nutrition support dietitian and chief clinical dietitian actual frequencies and between nutrition support dietitian and chief clinical dietitian ideal frequencies for each of the 15 tasks. Descriptive statistics were used to analyze the questions regarding educational preparation for nutrition support practice and demographic data. RESULTS: The ideal frequency for each of the 15 tasks was significantly greater (P < .0001) than the actual frequency reported by nutrition support dietitians and chief clinical dietitians. Whereas chief clinical dietitians and nutrition support dietitians agreed on the ideal frequency for most tasks, the nutrition support dietitian ideal frequency indicated for the tasks "determines macronutrient composition of parenteral nutrition" and "performs physical examinations related to nutritional status, fluid status, and gastrointestinal function" was significantly greater (P < .001, P < .05), respectively) than the ideal frequency indicated by chief clinical dietitians. Of the nutrition support dietitians, 79% agreed and 16% somewhat agreed that experiences beyond those required for becoming a registered dietitian are needed to provide nutrition support dietitians with specialized clinical skills. APPLICATIONS/CONCLUSIONS: Nutrition support dietitians desire increased responsibility for delivering nutrition support to their patients and this desire is largely supported by chief clinical dietitians. Nutrition support dietitians appear to have a strong interest in postregistration qualifying experiences that would provide a foundation for expanding their roles. According to the results of this study, programs designed to provide practical, clinical experience in nutrition support are needed.

Attitude of Health Personnel↗
PubMed1981

Federally-supported human nutrition research, training, and education: update for the 1980s. I. Human nutrition research and training. Prepared by the Joint Subcommittee on Human Nutrition Research of the Committee on Health and Medicine and the Committee on Food and Renewable Resources. Federal Coordinating Council on Science, Engineering, and Technology. Office of Science and Technology Policy. Executive Office of the President.

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Adult↗
PubMedDate not supplied

Grains or veins: is enteral nutrition really better than parenteral nutrition? A look at the evidence.

BACKGROUND: Enteral nutrition is said to be better than parenteral nutrition for providing nutrition support to humans. PURPOSE: To assess the literature documenting the assertions that enteral nutrition is superior to parenteral nutrition with respect to cost, safety, physiology, intestinal structure and function, bacterial translocation, and outcome. DATA IDENTIFICATION: Sources included MEDLINE search, personal files, and references from human comparative studies of enteral vs parenteral nutrition. STUDY SELECTION: The goal was to include all human studies directly addressing questions of comparative efficacy of enteral and parenteral nutrition. Emphasis was given to prospective randomized controlled studies where available. Retrospective comparisons were not included. DATA EXTRACTION: An attempt was made to briefly summarize methodology and findings of relevant studies. No general attempt was made to assess quality of individual studies. RESULTS OF DATA SYNTHESIS: Enteral nutrition appears to be less expensive than parenteral nutrition, but new economic analyses are needed given the newer aggressive access techniques for enteral nutrition. Enteral nutrition is associated with meaningful morbidity and mortality. The little comparative data existent suggest no differences in safety. Comparative studies of physiology and metabolism as well as comparative and noncomparative studies of intestinal function and structure do not support putative advantages of enteral nutrition. There is no evidence that enteral nutrition prevents bacterial translocation in humans. Enteral nutrition probably reduces septic morbidity compared with parenteral nutrition in abdominal trauma. Otherwise, there is no evidence that enteral nutrition consistently improves patient outcome compared with parenteral nutrition. CONCLUSIONS: With the exception of decreased cost and probable reduced septic morbidity in acute abdominal trauma, the available literature does not support the thesis that enteral nutrition is better than parenteral nutrition in humans.

Bacterial Translocation↗
PubMed2000

Nutritional support for head-injured patients.

BACKGROUND: Head injury increases the body's metabolic responses, and therefore nutritional demands. Provision of an adequate supply of nutrients is associated with improved outcome. The best route for administering nutrition (parenterally (TPN) or enterally (EN)), and the best timing of administration (e.g early versus late) of nutrients needs to be established. OBJECTIVES: To quantify the effect on mortality and morbidity of alternative strategies of providing nutritional support following head injury. SEARCH STRATEGY: Trials were identified by computerised searches of the Injuries Group specialised register, Cochrane Controlled Trials Register, MEDLINE, EMBASE and BIDS Index to Scientific and Technical Proceedings, and by checking the reference lists of trials and review articles. SELECTION CRITERIA: Randomised controlled trials of nutritional support following acute traumatic brain injury. DATA COLLECTION AND ANALYSIS: Two reviewers independently abstracted data and assessed trial quality. Information was collected on death, disability, and incidence of infection. If trial quality was unclear, or if there were missing outcome data, trialists were contacted in an attempt to get further information. MAIN RESULTS: The timing of support: early versus delayed Of the six trials addressing the timing of support, data on mortality were obtained for all six trials, with a total of 257 patients. The relative risk (RR) for death with early nutritional support was 0.71 (95% CI 0.43 to 1.16). Data on disability were available for three trials. The RR for death or disability at the end of follow-up was 0.75 (0.50 to 1.11). The route of feeding: parenteral versus enteral Six trials compared parenteral versus enteral nutrition. Because early support often involves parenteral nutrition, three of the six trials are also included in the previous analyses. Five trials (207 participants) reported mortality. The RR for mortality at the end of follow-up period was 0.66 (0.41 to 1.07). Two trials provided data on death and disability. The RR was 0.69 (95%Cl 0.40 to 1.19). 3. Enteral nutrition: jejunal versus gastric. There was one trial with no deaths and the RR is not estimable. REVIEWER'S CONCLUSIONS: This review suggests that early feeding may be associated with a trend towards better outcomes in terms of survival and disability. Further trials are required. These trials should report not only nutritional outcomes but also the effect on death and disability.

Craniocerebral Trauma↗
PubMed1997

Nutrition practices of family physicians after education by a physician nutrition specialist.

Although nutrition is an important part of medical care, nutrition education is not provided in most training programs for physicians in the United States, resulting in limited nutrition knowledge among physicians and limited nutritional care of patients. A nutrition education program was provided by a physician nutrition specialist in a family practice residency program. For 6 mo, the nutrition specialist provided the family physicians with recommendations for nutritional care for their patients. The effects of the education program on residents' and faculty physicians' nutrition knowledge and nutritional patient care, patients' perceptions of the importance of nutrition, and physicians' dietary patterns were determined by pre- and post-intervention nutrition exams for physicians and patients, patient questionnaires about attitudes toward nutrition, chart reviews, and physicians' diet records. The nutrition education program resulted in an increase in physicians' nutrition knowledge scores (P < 0.01) and an increase in the frequency with which physicians discussed nutrition and recommended diets for their patients (P < 0.05). This suggests that nutrition education by a physician nutrition specialist within a family practice residency program can be effective in increasing nutritional care provided to patients.

Adolescent↗
PubMed1983

Establishing the need for nutrition education: II. Elementary teachers' nutrition knowledge, attitudes, and practices.

Nutrition knowledge, attitudes, and practices and nutrition education practices of elementary teachers were assessed to provide data for planning a Kansas Nutrition Education and Training Program. Teachers from a random sample of elementary schools throughout the state were surveyed. The nutrition knowledge test scores of the teachers statewide or among the districts and schools did not differ significantly. Teachers who had completed one or more college or continuing education nutrition courses or who were teaching nutrition currently had higher scores on nutrition knowledge, attitudes, and practices and on nutrition education practices than did teachers who had no nutrition training or were not teaching the subject. In general, nutrition knowledge scores correlated positively with scores on nutrition-related attitudes and practices and on nutrition education practices. Kansas elementary teachers tended to have favorable attitudes toward nutrition. Almost all of the teachers indicated that nutrition should be taught in all elementary grades; however, few teachers taught nutrition concepts. Nutrition was integrated in science, health, and social studies more often than in other subjects. Teachers rarely or never used school food service personnel as resource people in the classroom or used the school cafeteria as a laboratory for instruction. However, in those schools with on-premise food production facilities, teachers tended to work with the school food service personnel and use the cafeteria as a laboratory for instruction more frequently than did teachers in schools with only satellite service centers. Attending nutrition workshops during the school year and having access to more nutrition education materials were listed by teachers as the preferred ways to receive additional nutrition training.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗