Efficacy and Efficiency of Nutritional Support Teams

Reber, Emilie; Strahm, Rachel; Bally, Lia; Schuetz, Philipp; Stanga, Zeno

doi:10.3390/jcm8091281

Cited by 53 publications

(57 citation statements)

References 71 publications

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“…Appropriate nutrition care should be continued after discharge to prevent further deterioration in patient's autonomy, quality of life and poor outcome. A systematic approach to DRM in hospitals and an adequate continuity of care may lead to better outcomes [11,12,26]. nutritionDay in this regard has served and it will keep serving as a tool to monitor changes in clinical practice and associated outcome.…”

Section: Discussionmentioning

confidence: 99%

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Hospital Malnutrition, a Call for Political Action: A Public Health and NutritionDay Perspective

Hiesmayr

Tarantino

Moick

et al. 2019

JCM

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Disease-related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analysed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical, surgical, long-term care and other patients (n = 153,470). In 59,126 medical patients included between 2006 and 2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. A similar pattern is found in all four patient groups. Nutrition care processes increase slightly with the presence of risk factors but are never done in more than 50% of the patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM.

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Section: Discussionmentioning

confidence: 99%

“…Food costs are to be added to the overall malnutrition related costs. Patients with malnutrition usually stay longer in hospitals, are more often re-hospitalized or transferred to long-term care [9][10][11][12]. Each of these, together with the reimbursement schemes, do create additional costs for the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

Hospital Malnutrition, a Call for Political Action: A Public Health and NutritionDay Perspective

Hiesmayr

Tarantino

Moick

et al. 2019

JCM

View full text Add to dashboard Cite

show abstract

“…Appropriate nutrition care should be continued after discharge to prevent further deterioration in patient's autonomy, quality of life and poor outcome. A systematic approach to DRM in hospitals and an adequate continuity of care may lead to better outcomes [11,12,27]. nutritionDay in this regard has served and it will keep serving as a tool to monitor changes in clinical practice and associated outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Food costs are to be added to the overall malnutrition related costs. Patients with malnutrition usually stay longer in hospitals, are more often rehospitalized or transferred to long-term care [9][10][11][12]. Each of these, together with the reimbursement schemes, do create additional costs for the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

Hospital Malnutrition, A Call for Political Action: A Public Health and nutritionDay Perspective

Hiesmayr¹,

Tarantino²,

Moick³

et al. 2019

Preprint

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Disease related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analyzed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical patients. In 59126 medical patients included between 2006-2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. Nutrition care processes increases slightly with presence of risk factors but never done in more than 50% of patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM.

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“…The articles included cover the process of nutritional care, including screening tools to identify nutritional risk (Nutritional risk screening and assessment [11]), patient muscle mass assessment including bioimpedance analysis (Clinical value of muscle mass assessment in clinical conditions associated with malnutrition [12]; Decreased bioelectrical impedance phase angle in hospitalized children and adolescents with newly diagnosed type 1 diabetes: a case-control study [13]), nutritional biomarkers (Nutritional laboratory markers in malnutrition [14]), nutritional therapy planning (Indirect calorimetry in clinical practice [15]; Micronutrient deficiencies in medical and surgical inpatients [16]), use of nutritional support overall (Efficacy and efficiency of nutritional support teams [17]; Challenges and perspectives in nutritional counselling and nursing: a narrative review [18]) and in specific patient populations (e.g., medical patients, critical care patients, geriatric patients, oncologic patients, patients after allogenic stem cell transplantation, patients with dysphagia or eating disorders, as well as the nutritional challenges associated with metabolic disorders) (Nutritional management of medical inpatients [19]; Medical nutrition therapy in critically ill patients treated on intensive and intermediate care units: a literature review [20]; Metabolic and nutritional characteristics of long-stay critically ill patients [21]; Protein intake, nutritional status, and outcomes in intensive care unit survivors: a single-center cohort study [22]; Early supplemental parenteral nutrition in critically ill children: an update [23]; Management of malnutrition in older patients-current approaches, evidence, and open questions [24]; Nutrition in cancer patients [25]; Management of dehydration in patients suffering swallowing difficulties [26]; Nutrition in gastrointestinal diseases: liver, pancreatic, and inflammatory bowel diseases [27]; Nutritional management and outcomes in malnourished medical inpatients: anorexia nervosa [28]; Nutritional challenges in metabolic syndrome [29]; Nutritional challenges in patients with advanced liver cirrhosis [30]). Potential complications of nutritional interventions, such as refeeding syndrome (Management of refeeding syndrome in medical inpatients [31]), and treatment challenges posed by gastric motility disorders are discussed (Gastroparesis and dumping syndrome: current concepts and management [32]).…”

mentioning

confidence: 99%

Nutritional Management and Outcomes in Malnourished Medical Inpatients in 2020: The Evidence Is Growing!

Schuetz

Stanga

2019

JCM

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Access to adequate food is a fundamental human right. There is no doubt that nutrition is essential in maintaining health and preventing or treating disease. Particularly when patients are affected by disease-related malnutrition, their risk of adverse clinical outcomes increases significantly and optimizing nutritional support becomes mandatory [1,2].There is ongoing debate about what constitutes an optimal nutritional care process in terms of screening, assessment, and use of nutritional support in different patient populations. Issues include dose and quality of proteins and total energy, route of delivery, and whether or how nutritional support needs to be adjusted for specific medical and metabolic conditions. As we move toward personalized medicine, which is based on patients' individual needs, an understanding of these different factors is important. Well-planned clinical studies of high methodological quality are needed to develop the best approach to providing individualized nutritional support [3].Historically, much of the evidence regarding effects of nutritional support has come from small interventional trials and observational studies with cross-sectional or cohort-study designs, whereas there was an important lack of large-scale randomized interventional research, which is needed to establish causal effects rather than just statistical associations [4,5]. As a consequence, the medical community has struggled to design efficient, evidence-based approaches for the prevention and treatment of malnutrition [4].Recently, however, the results of several high-quality trials have provided important new insights that advance nutritional science significantly and translate nutrition research into practice [6]. Regarding prevention of cardiovascular disease through nutrition, the PREDIMED (Prevención con Dieta Mediterránea) trial provided strong evidence that a Mediterranean diet supplemented with extra-virgin olive oil or with mixed nuts reduces the risk of cardiovascular and metabolic disease by about 30% over five years [7]. Regarding the use of clinical nutrition in patients at nutritional risk or with established malnutrition, two trials found nutritional support to be highly effective. First, the multicenter, randomized, placebo-controlled NOURISH trial (Nutrition effect On Unplanned ReadmIssions and Survival in Hospitalized patients) including 652 older adults affected by malnutrition found that a high-protein oral nutritional supplement containing beta-hydroxy-beta-methylbutyrate was associated with a significant reduction in 90 day mortality, with a number needed to treat (NNT) of 20 [8]. Second, the EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial) including 2028 medical inpatients at nutritional risk in eight Swiss hospitals showed that protocol-guided individualized nutritional support designed to achieve protein and energy targets results in significantly lower rates of severe complications

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Efficacy and Efficiency of Nutritional Support Teams

Cited by 53 publications

References 71 publications

Hospital Malnutrition, a Call for Political Action: A Public Health and NutritionDay Perspective

Hospital Malnutrition, a Call for Political Action: A Public Health and NutritionDay Perspective

Hospital Malnutrition, A Call for Political Action: A Public Health and nutritionDay Perspective

Nutritional Management and Outcomes in Malnourished Medical Inpatients in 2020: The Evidence Is Growing!

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