According to BAPEN 2014
Comparing the result of malnutrition screening in winter and summer by autumn and spring presenting a significant variation. winter and summer malnutrition risk counted around 27% and 29 %, respectively while in spring and autumn it dropped to 21% and 23% respectively. However, it can be risen in winter due to cold weather isolation which result in reluctance of people to go out for any activity or shoppingvisit their GP to discuss about their health issues
- severe accidents on icy surfaces
- severe hypothermia
- long-term chest infectious
- immunosuppression
- lethargy and fatigue
Incidence:
Malnutrition can be a Cause and Consequence of diseases. it may be led to worsen the health and clinical outcomes in society as well as NHS care settings. However, Most Patient, care giver, healthcare providers, commissioners and senior managers do not realise how frequent it is in UK so it remains undiagnosed and untreated. According to BAPEN there are around 3 Million of malnourished cases over the UK which can be result on sever health problems, this while WHO has been reported around 1.9 billion adults are overweight while 462 million are underweight world widely. (BAPEN,2010)(WHO,2016 )
Reasons behind malnutrition:
- Poor access and high cost of to Nutritious Food such fresh fruits and vegetables, legumes, meat and dairy
- Easy access to cheaper prices high calories dense food (high sugar, fat and salt)
The two above reasons can lead to both conditions of under and over weight in poor as well as rich countries . (WHO,2016)
Introduction:
World Health Organization defines malnutrition as “deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition covers 2 broad groups of conditions. One is ‘undernutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). The other is overweight, obesity and diet-related no communicable diseases (such as heart disease, stroke, diabetes and cancer)” (WHO,2016)
The result of this condition has a significant negative impact on health: Malnutrition in hospital will increase the hospital stay duration, at the same time it increase the risk of complication such nosocomial infection , impaired wound healing , depression and falls
Economic cost: in December 2005, the BAPEN calculated the average cost of malnutrition per year to the UK national health services (NHS) of £7•3 billion which is about two times higher than the cost of obesity related morbidities.
(Lamb, Parr et al. 2009)
Nutrition Assessment VS Screening ?
Screening :
It is the first line of identifying patient who are already malnourished or at risk of being malnourished. there are many tools and methods to detecting the nutrition status level.according to European Society for Clinical Nutrition and Metabolism (ESPEN)suggest the following tools to reduce the unfavorable medical conditions:
- Nutritional Risk Screening 2002 (NRS 2002) suitable for hospital sites
- Subjective Global Assessment (SGA) suitable for hospital sites
- Malnutrition Universal Screening Tool (MUST) suitable for both hospital and community use
- Mini-Nutritional Assessment (MNA) mostly use for elderly patients
However the most commonly use in the UK is “MUST” tool.
MUST (Malnutrition Universal Screening tool)
It is suitable for acute adult individual and community use. It works based on BMI and presence of acute illness and It can predict the mortality risk as well
Can be graded 0-3 for each parameter.
- >2 categories as high risk of malnutrition
- =1 means medium risk of malnutrition
- =0 means low risk
it should be repeated regularly specially for patient at high risk .it can be done by all the medical team.
(Health.qld.gov.au, 2017)
Health.qld.gov.au. (2017). Cite a Website – Cite This For Me. [online] Available at: https://www.health.qld.gov.au/__data/assets/pdf_file/0021/152454/hphe_scrn_tools.pdf [Accessed 23 Nov. 2017].
It is available in English, French, German, Italian , Portuguese and Spanish languages
(BAPEN,2016)
Bapen. (2016). The ‘MUST’ Itself. [online] Available at: http://www.bapen.org.uk/screening-and-must/must/must-toolkit/the-must-itself [Accessed 23 Nov. 2017].
Type the following link on your computer to screen yourself:
http://www.bapen.org.uk/screening-and-must/must-calculator
other examples of
Nutrition Assessment:
systematic stages of collecting and analyzing data in order to make decision about the patient nutrition and health status that can be effected on individual, a group of people or people of the society.
It is the next step after screening to identify the stage of malnutrition. To reach the goal which is optimum health of the patient, the healthcare providers need some health relevant information that help them to identify the problem, monitor and intervene .
This systematic process start by Assessing the patient by following below steps :
Anthropometry: weight ,hight , BMI, Waist hip ratio , mid Upper arm Circumference
Biochemistry: laboratory result
Clinical/physical: presence of any diseases such as cancer, neurological diseases, mental and psychological disease
Dietary Assessment: an estimation of calories and nutrient intake through different approaches of diet diary, food frequency questionnaire or 24 hours diet recall.
Environmental, behavioral and social: able to go for shopping or mobility , physical assistance , social and economic status
(BAPEN,2016)
Bapen. (2016). Nutritional Assessment. [online] Available at: http://www.bapen.org.uk/nutrition-support/assessment-and-planning/nutritional-assessment?showall=&start=1 [Accessed 23 Nov. 2017].
(BDA,2016)
BDA. (2016). Cite a Website – Cite This For Me. [online] Available at: https://www.bda.uk.com/publications/professional/model_and_process_for_nutrition_and_dietetic_practice_ [Accessed 23 Nov. 2017].
The early detection of malnutrition can minimise the detrimental effect of diseases-related malnutrition such as
- faster wound and injuries healing
- decrease risk factor which causing infection
- shorter hospital stays
- faster mobilization and stay less inactive
- increase the quality of life
however, all the mentioned factors need proper nutritional care from health care team such as :
- receiving suitable nutrition screening
- proper nutrition strategies and policies
- exact calculation of energy and nutrient needs
- desirable rout of administration
- well-stablished monitoring system
- expert management organization
https://www.unitedforclinicalnutrition.com/en/why-are-screening-and-assessment-important
Progression of nutritional support:
Nutritional support team:
Nurses have a vital role in managing and assessing nutritional needs of the patients and help them with appropriate decision in feeding. they also can cooperate with other medical professions such as occupational therapist or physiotherapist if need. The medical team should be informed about patient’s digestion, absorption and excretion which can be done by nurses evaluation. Qualified dietitian can be effective by providing dietary assessment and advices on type of food and supervise the therapeutic diet .they also collaborate with catering services, medical and nurses team. The multi professional team of medical doctors, nurses, pharmacists and dietitian can do much to work together .
Providing nutrition support can be illustrate as a inverted triangle. most of hospital patients can meet the nutritional support by normal food in hospital. Smaller number of patient may need oral supplement and sips of feed or enteral feeding. A minority of patients require parenteral nutrition support. the following figure shows the rule of medical team in nutrition support at hospital.
for delivering and implementing nutritional support to the complex and large hospital, Standard should be set and examined, the education and training team and equipment that have been chosen, all must collaborate with other authorities such infection control and risk management. Therefor, Nutrition Steering Committee who brings senior manager of different discipline such as nurses, dietitian, food catering, pharmacist, medicine and surgery http://www.bapen.org.uk/ofnsh/page4.html) is needed. The diagram below shows how health care system should work together for optimum nutrition support of a patient.
http://www.bapen.org.uk/ofnsh/OrganizationOfNutritionalSupportWithinHospitals.pdf
Figure 1 http://www.bapen.org.uk/ofnsh/_wp_generated/wp5369f55e.png
Evidenced Based Practice
Does nutrition support(Oral,parentral,entral) decrease the complications of liver disease patients?
Nutrition support for hepatic disorders:
According Koretz, Avenell et al., (2012) the study liver related diseases (specially Cirrhosis ), commonly contribute to weight and muscle reduction. Comparing hepatic patient who has muscle and weight loss with the one who does not developed weight change explain the poor clinical outcomes. “If the problem is just deprivation of nutrients, it would be expected that the provision of some type of nutrition should result in better outcomes.” thus, it can be provided by adding extra nutrients to their diet, or replace it for with food if patient cannot consume enough food in a voluntary eating process. In involuntary food manner the enteral, parenteral and nutrient solution can be delivered as well to minimised the negative clinical outcomes. The high cost and other medical complication such as Gastrointestinal problem, for altered metabolic function can happened due to nutritionally supplementation process. Furthermore , it is vital to know how effective are supplementation or adding extra nutrient rather than their normal food. The following randomized trial compared the impact of nutrients which received orally ,parenterally or enteral on liver patients and patient with same problem but did not receive nutritional intervention . The patients categorized and analyzed in six different group according to their condition. “medical patients receiving or not receiving parenteral nutrition, surgical patients receiving or not receiving parenteral nutrition, medical patients receiving or not receiving enteral nutrition, surgical patients receiving or not receiving enteral nutrition, medical patients receiving or not receiving supplements by mouth, and surgical patients receiving or not receiving supplements by mouth”. The aim of this practice was to detect the positive and negative effect of the nutrients intervention on the mortality and morbidity of hepatic related disorders.
Although because of small sample size (n=37)analysis did not show the significant difference but some noteworthy differences has been observed.
- In parenteral nutrition serum bilirubin has been reduced faster and Nitrogen Balance in medical patient with jaundice disease has been improved as well.
- enteral nutrition caused an progression in nitrogen balance and decrease long-term complications in surgical patients.
- the number of patient with ascites and infection have been reduced by having supplements. it shows some of supplements (mostly branched chain amino acid) might be effective in management of hepatic encephalopathy .
KORETZ, R.L., AVENELL, A. and LIPMAN, T.O., 2012. Nutritional support for liver disease. The Cochrane database of systematic reviews, (5), pp. CD008344.
Question and answer
Starvation and emergency
“Starvation is a severe lack of food which can result in death”
how big is malnutrition?
in serious emergency condition people are mainly are at risk of being undernourished or facing food nutrients deficiencies. It can be worsen for chronic cases oever in acute phase the immunity can be weaken and become more susceptible to different disease such as infection .
who are more susceptible?
- it can be very common among refugees and homeless peoples
- older adult
- people with eating disorders such as anorexia nervosa and bulimia
- people in poverty
- social isolated such person having depression
https://www.nursingtimes.net/malnutrition/5001811.article
who are the priorities in emergency cases?
Children, pregnant and breastfeed women are most vulnerable to be undernutrition. The need for micronutrient such as vitamin and mineral are higher in them comparing to normal adult.
Do infants need breastfeeding in sever cases?
“breastfeeding can be life-saving for young children in emergencies”
mother milk contains all the nutrient as well as antibodies which can prevent the risk of serious illness such as infection in emergency situations. infant formula can be used as a substitution with breast milk in emergencies however it is important to note in this situation , the access to clean water and bottle may not be limited .
http://www.who.int/features/qa/malnutrition-emergencies/en/
Further readings:
to know more about malnutrition the following websites can help you:
Malnutrition Self Screening tool: www.malnutritionselfscreening.org
Maternal and child undernutrition: www.who.int/nutrition/topics/Lancetseries_Undernutrition1.pdf
conclusion :
References :
RASLAN, M., GONZALEZ, M.C., DIAS, M.C.G., NASCIMENTO, M., CASTRO, M., MARQUES, P., SEGATTO, S., TORRINHAS, R.S., CECCONELLO, I. and WAITZBERG, D.L., 2010. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition, 26(7), pp. 721-726.
Feldblum, I., German, L., Castel, H., Harman-Boehm, I., Bilenko, N., Eisinger, M., Fraser, D. and Shahar, D.R., 2007. Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutrition journal, 6(1), p.37.
Persson, M.D., Brismar, K.E., Katzarski, K.S., Nordenström, J. and Cederholm, T.E., 2002. Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. Journal of the American Geriatrics Society, 50(12), pp.1996-2002.
Kyle, U.G., Kossovsky, M.P., Karsegard, V.L. and Pichard, C., 2006. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clinical Nutrition, 25(3), pp.409-417.
Bapen, (2014). BAPEN Publishes Results of Biggest Malnutrition Survey Ever Undertaken (Scotland). [online] Available at: http://www.bapen.org.uk/media-centre/press-releases/377-bapen-publishes-results-of-biggest-malnutrition-survey-ever-undertaken-scotland [Accessed 21 Nov. 2017].
World Health Organization. (2016). What is malnutrition?. [online] Available at: http://www.who.int/features/qa/malnutrition/en/ [Accessed 22 Nov. 2017].
LAMB, C.A., PARR, J., LAMB, E.I.M. and WARREN, M.D., 2009. Adult malnutrition screening, prevalence and management in a United Kingdom hospital: cross-sectional study. British journal of nutrition, 102, pp. 571-575.