Malnutrition and nutritional screening in patients undergoing surgery in low and middle income countries: A systematic review

Jones, David; Knight, Stephen R; Sremanakova, Jana; Lapitan, Marie Carmela; Qureshi, Ahmad Uzair; Drake, Thomas M; Tabiri, Stephen; Ghosh, Dhruva; Thomas, Maria; Kingsley, Pamela Alice; Sundar, Sudha; Maimbo, Mayaba; Yenli, Edwin Mwintiereh Ta‐ang; Shaw, Catherine; Valparaiso, Apple P.; Bhangu, Aneel; Magill, Laura; Norrie, John; Roberts, Tracey; Τheodoratou, Evropi; Weiser, Thomas G.; Burden, Sorrel

doi:10.1002/crt2.55

Cited by 4 publications

References 48 publications

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Overall mortality for community‐dwelling adults over 50 years at risk of malnutrition

Gittins,

AlMohaisen,

Todd

et al. 2024

J cachexia sarcopenia muscle

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BackgroundIt is well reported that malnutrition in acute care is associated with poorer health outcomes including increased mortality. However, the consequences of malnutrition on survival in community settings is uncertain. Malnutrition in people 65 years or over is often cited. Nevertheless, this study includes both middle‐aged and older adults as current public health policy is highlighting the need to increase disease‐free life years and is moving away from just extending life to increase overall longevity. The aim of this study is to describe the association of the risk of malnutrition using the Malnutrition Universal Screening Tool (MUST) with mortality in community‐dwelling middle‐aged and older adults.MethodsWe used the UK Biobank to investigate the association between those at risk of malnutrition and mortality in participants aged ≥50 years. MUST identified risk of malnutrition and linked data to national death registries confirmed mortality. Years of life lost (YLL) and Cox proportional hazard models with hazard ratios (HR) and confidence intervals (CI) described risk associated with all‐cause mortality.ResultsThere were 502 408 participants recruited, 117 830 were ≤50 years leaving 384 578 eligible participants. Based on MUST scores 63 495 (16.5%) were at risk of malnutrition with 401 missing some data and excluded. Incidence of mortality for at risk participants was 755 per 100 000 person‐years, corresponding to 153 476 YLL. Of those at risk of malnutrition, 9.5% died versus 7.8% at low risk. Initial survival analysis reported an increased risk of mortality (HR 1.29, 95% CI: 1.25 to 1.33) that decreased after adjusting for confounders (HR 1.14, 95% CI: 1.11 to 1.18) in those at risk of malnutrition versus those at low risk.ConclusionsRisk of malnutrition was associated with increased overall mortality. Modest effect sizes are demonstrated but are supportive of public health policies, which advocate wide‐scale community, based nutritional screening for middle‐aged and older adults.

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Overall mortality for community‐dwelling adults over 50 years at risk of malnutrition

Gittins,

AlMohaisen,

Todd

et al. 2024

J cachexia sarcopenia muscle

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Revolução nos cuidados cirúrgicos: explorando os componentes essenciais dos programas de recuperação melhorados após a cirurgia

Hekal,

Eskandar

2024

Rev. salud. bosque.

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Background: Surgical care has evolved significantly over the years, with the introduction of Enhanced Recovery After Surgery (ERAS) programs emerging as a transformative approach. This literature review delves into the essential elements of ERAS, aiming to provide a comprehensive understanding of its impact on perioperative care and patient outcomes. Main Body: The preoperative phase of ERAS involves meticulous patient preparation, encompassing strategies such as preoperative counseling, carbohydrate loading, and minimizing bowel preparation. These components collectively contribute to reducing preoperative anxiety, enhancing nutritional status, and mitigating the adverse effects of fasting, ultimately facilitating a smoother transition to surgery. Intraoperative considerations within ERAS focus on techniques that minimize surgical stress, optimize fluid management, and implement pain control protocols. These critical interventions help to reduce surgical complications, accelerate postoperative recovery, and lessen the duration of hospital stays. The postoperative phase is a cornerstone of ERAS, emphasizing early mobilization, optimized nutrition, and multimodal pain management. By incorporating these elements, ERAS programs aim to expedite recovery, decrease the risk of complications, and enhance patient satisfaction. However, despite the evident benefits, implementing ERAS programs in clinical practice is not without challenges. This review discusses the barriers to ERAS adoption, including resistance to change, resource allocation, and the need for multidisciplinary collaboration. Conclusion: Thence, ERAS represents a revolution in surgical care, offering a holistic approach to enhance patient outcomes, reduce complications, and shorten hospital stays. By exploring the key components of ERAS, this literature review provides valuable insights into the potential for widespread adoption and the imperative need to overcome implementation barriers. Ultimately, ERAS holds the promise of revolutionizing the future of surgical care, redefining standards, and improving the overall quality of patient experiences.

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Exploring Individuals’ Views and Feedback on a Nutritional Screening Mobile App: Qualitative Focus Group Study

Jones,

Sowerbutts,

Burden

2024

JMIR Form Res

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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.

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Malnutrition and nutritional screening in patients undergoing surgery in low and middle income countries: A systematic review

Cited by 4 publications

References 48 publications

Overall mortality for community‐dwelling adults over 50 years at risk of malnutrition

Overall mortality for community‐dwelling adults over 50 years at risk of malnutrition

Revolução nos cuidados cirúrgicos: explorando os componentes essenciais dos programas de recuperação melhorados após a cirurgia

Exploring Individuals’ Views and Feedback on a Nutritional Screening Mobile App: Qualitative Focus Group Study

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