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Clinical Nutrition Management in Healthcare

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (1 February 2024) | Viewed by 12023

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Special Issue Editor

Dr. Shelley Roberts

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Guest Editor

School of Health Sciences and Social Work, Gold Coast Campus, Griffith University, Gold Coast, QLD 4222, Australia
Interests: nutrition; malnutrition; patient participation; patient-centred care

Special Issue Information

Dear Colleagues,

Nutrition is central to health and well-being. In clinical settings, adequate nutritional intake (i.e., of energy, protein, and other nutrients) is vital for patient recovery and for the prevention or correction of disease-related malnutrition, which affects up to 50% of adult inpatients and results in severe consequences to patients (e.g., increased risk of mortality and complications such as falls, infections, and pressure injuries) and hospitals (e.g., higher costs). Nutrition also plays an integral role in managing acute and chronic health conditions through Medical Nutrition Therapy, an evidence-based and personalized approach dietitians use to improve patients’ health outcomes by changing dietary behaviors. Healthcare professionals (HCPs) are responsible for the delivery of safe and quality nutrition care in hospitals, ideally following the Nutrition Care Process, which includes the precursor steps of nutrition risk screening and referral (which can be performed by any HCP), and dietitian-led steps of nutrition assessment, diagnosis, intervention, and monitoring/evaluation. Despite the clear benefits of appropriate nutrition care among hospital patients, malnutrition remains prevalent in this setting. Thus, research is required to highlight the many opportunities for the delivery of improved nutritional care at both patient and organizational levels.

This Special Issue welcomes innovative works of research aimed at improving nutrition care practices such as screening, referral, assessment, diagnosis, intervention, and monitoring/evaluation in adult clinical populations. Multidisciplinary involvement, patient-centered care approaches (including patient or family engagement/participation in care), and healthcare technologies have been proven to optimize nutrition care delivery in clinical settings; hence, papers incorporating these aspects will be prioritized. Practice-based research and studies using knowledge translation or implementation science approaches (including findings from these methods) will also be welcomed.

The aim of this Special Issue is to broaden the scientific knowledge on how clinical nutrition care may be optimized by learning from others’ experiences, and to advocate for HCPs of all disciplines to be aware of, and involved in, the nutrition care of their patients.

Dr. Shelley Roberts
Guest Editor

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Keywords

clinical nutrition
nutrition care
malnutrition
medical nutrition therapy
nutrition screening
nutrition assessment
nutrition intervention
patient-centred care
nutrition practice

Published Papers (9 papers)

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Research

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14 pages, 1818 KiB

Open AccessArticle

Influence of Sugar-Sweetened Beverages Intake on Sarcopenic Obesity, Visceral Obesity, and Sarcopenia in Lebanese Patients with MASLD: A Case-Control Study

by Maha Hoteit, Myriam Dagher, Nikolaos Tzenios, Najat Al Kaaki, Ghadir Rkein, Abdul Rahman Chahine, Yonna Sacre, Samer Hotayt, Rami Matar, Mahmoud Hallal, Micheal Maitar and Bilal Hotayt

Healthcare 2024, 12(5), 591; https://doi.org/10.3390/healthcare12050591 - 05 Mar 2024

Viewed by 979

Abstract

Chronic liver diseases are a major global health concern. Aims: this study investigated the links between medical, clinical, anthropometric, and dietary factors with dysfunction-associated steatotic liver disease (MASLD) in the Lebanese population using a case-control approach to uncover factors influencing visceral obesity, sarcopenia, and sarcopenic obesity. Methods and Materials: a total of 120 participants (20–70 years old) were divided into case and control groups based on liver disease diagnosis. Patient information was gathered through a questionnaire encompassing demographics, medical history, and beverage consumption. Anthropometric and body composition data were collected in a clinical setting. Results: our findings indicated a clear association between the presence of MASLD and obesity, hypertension, and diabetes. The positive association with higher body mass index and all three conditions remained consistent even when data was stratified by case and control groups. A greater proportion of MASLD patients exhibited sarcopenic obesity. Furthermore, MASLD cases showed higher consumption of sugary beverages and a reduced intake of milk and water in their diets. Conclusions: this study shed light on the health attributes and diets of the Lebanese population with liver diseases and suggested more research in this area and in a more ethnically diverse population. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

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14 pages, 300 KiB

Open AccessArticle

Assessment of Nutrient Levels Provided by General Hospital Patient Menus: A Cross-Sectional Study Carried Out in the Region of Murcia (Spain)

by Pablo Barcina-Pérez, Carmen Lucas-Abellán, Oriol Abellán-Aynés, María Teresa Mercader-Ros, Desirée Victoria-Montesinos, Pilar Hernández-Sánchez and Ana Serrano-Martínez

Healthcare 2023, 11(16), 2304; https://doi.org/10.3390/healthcare11162304 - 15 Aug 2023

Cited by 1 | Viewed by 857

Abstract

Disease-related malnutrition remains a health problem with a high prevalence that increases the risk of poor patient outcomes, in addition to an elevation of healthcare costs. The aim of this study was to evaluate the nutritional quality of the menus at Ribera Molina Hospital, including their adequacy regarding recommended daily nutrient intakes and the agreement with the theoretical nutrition information provided by catering. The mean levels of energy, macronutrients, vitamins, and minerals provided by the basal, diabetic, and soft diets were calculated through the weighing of plated food served throughout the first 14 days of February 2020. A nutritional overestimation was seen in the nutrition information provided by the catering compared to the values derived from weighing foods (p < 0.01). Despite this, the nutritional content calculated by weighing satisfied the energy and protein requirements of 203 hospitalized patients previously studied in the internal medicine area of the hospital. The mean age of these patients was 62 years, and the main causes of admission were lung, cardiovascular, renal, and digestive diseases. There seems to be an insufficient amount of vitamins E and D, as well as magnesium, on all the menus. A possible insufficient amount of calcium, potassium, zinc, and copper was observed in some of the menus studied. It is necessary to update the hospital prescription manual so the nutritional contents of the diets are accurate and based on the weighted and calculated values to improve the adequacy of diets prescribed to patients. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

11 pages, 619 KiB

Open AccessArticle

Are Malnourished Inpatients Treated by Dietitians Active Participants in Their Nutrition Care? Findings of an Exploratory Study of Patient-Reported Measures across Nine Australian Hospitals

by Jack J. Bell, Alita Rushton, Kai Elmas, Merrilyn D. Banks, Rhiannon Barnes and Adrienne M. Young

Healthcare 2023, 11(8), 1172; https://doi.org/10.3390/healthcare11081172 - 19 Apr 2023

Viewed by 1008

Abstract

Background: Inpatient malnutrition is a key determinant of adverse patient and healthcare outcomes. The engagement of patients as active participants in nutrition care processes that support informed consent, care planning and shared decision making is recommended and has expected benefits. This study applied patient-reported measures to identify the proportion of malnourished inpatients seen by dietitians that reported engagement in key nutrition care processes. Methods: A subset analysis of a multisite malnutrition audit limited to patients with diagnosed malnutrition who had at least one dietitian chart entry and were able to respond to patient-reported measurement questions. Results: Data were available for 71 patients across nine Queensland hospitals. Patients were predominantly older adults (median 81 years, IQR 15) and female (n = 46) with mild/moderate (n = 50) versus severe (n = 17) or unspecified severity (n = 4) malnutrition. The median length of stay at the time of audit was 7 days (IQR 13). More than half of the patients included had two or more documented dietitian reviews. Nearly all patients (n = 68) received at least one form of nutrition support. A substantial number of patients reported not receiving a malnutrition diagnosis (n = 37), not being provided information about malnutrition (n = 30), or not having a plan for ongoing nutrition care or follow-up (n = 31). There were no clinically relevant trends between patient-reported measures and the number of dietitian reviews or severity of malnutrition. Conclusions: Malnourished inpatients seen by dietitians across multiple hospitals almost always receive nutritional support. Urgent attention is required to identify why these same patients do not routinely report receiving malnutrition diagnostic advice, receiving information about being at risk of malnutrition, and having a plan for ongoing nutrition care, regardless of how many times they are seen by dietitians. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

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12 pages, 1380 KiB

Open AccessArticle

Importance of Asprosin for Changes of M. Rectus Femoris Area during the Acute Phase of Medical Critical Illness: A Prospective Observational Study

by Hilal Sipahioglu, Hatice Kubra Zenger Ilik, Nurhayat Tugra Ozer, Sevda Onuk, Sumeyra Koyuncu, Sibel Kuzuguden and Gulseren Elay

Healthcare 2023, 11(5), 732; https://doi.org/10.3390/healthcare11050732 - 02 Mar 2023

Cited by 1 | Viewed by 1108

Abstract

Asprosin, a new adipokine, is secreted by subcutaneous white adipose tissue and causes rapid glucose release. The skeletal muscle mass gradually diminishes with aging. The combination of decreased skeletal muscle mass and critical illness may cause poor clinical outcomes in critically ill older adults. To determine the relationship between the serum asprosin level, fat-free mass, and nutritional status of critically ill older adult patients, critically ill patients over the age of 65 receiving enteral nutrition via feeding tube were included in the study. The patients’ cross-sectional area of the rectus femoris (RF) of the lower extremity quadriceps muscle was evaluated by serial measurements. The mean age of the patients was 72 ± 6 years. The median (IQR) serum asprosin level was 31.8 (27.4–38.1) ng/mL on the first study day and 26.1 (23.4–32.3) ng/mL on the fourth study day. Serum asprosin level was high in 96% of the patients on the first day, and it was high in 74% on the fourth day after initiation of enteral feeding. The patients achieved 65.9 ± 34.1% of the daily energy requirement for four study days. A significant moderate correlation between delta serum asprosin level and delta RF was found (Rho = −0.369, p = 0.013). In critically ill older adult patients, a significant negative correlation was determined between serum asprosin level with energy adequacy and lean muscle mass. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

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12 pages, 795 KiB

Open AccessArticle

Prevalence of Malnutrition in Hospitalized Patients in Lebanon Using Nutrition Risk Screening (NRS-2002) and Global Leadership Initiative on Malnutrition (GLIM) Criteria and Its Association with Length of Stay

by Krystel Ouaijan, Nahla Hwalla, Ngianga-Bakwin Kandala and Emmanuel Kabengele Mpinga

Healthcare 2023, 11(5), 730; https://doi.org/10.3390/healthcare11050730 - 02 Mar 2023

Cited by 1 | Viewed by 1967

Abstract

(1) Background: Prevalence studies on hospital malnutrition are still scarce in the Middle East region despite recent global recognition of clinical malnutrition as a healthcare priority. The aim of this study is to measure the prevalence of malnutrition in adult hospitalized patients in Lebanon using the newly developed Global Leadership Initiative on Malnutrition tool (GLIM), and explore the association between malnutrition and the length of hospital stay (LOS) as a clinical outcome. (2) Methods: A representative cross-sectional sample of hospitalized patients was selected from a random sample of hospitals in the five districts in Lebanon. Malnutrition was screened and assessed using the Nutrition Risk Screening tool (NRS-2002) and GLIM criteria. Mid-upper arm muscle circumference (MUAC) and handgrip strength were used to measure and assess muscle mass. Length of stay was recorded upon discharge. (3) Results: A total of 343 adult patients were enrolled in this study. The prevalence of malnutrition risk according to NRS-2002 was 31.2%, and the prevalence of malnutrition according to the GLIM criteria was 35.6%. The most frequent malnutrition-associated criteria were weight loss and low food intake. Malnourished patients had a significantly longer LOS compared to patients with adequate nutritional status (11 days versus 4 days). Handgrip strength and MUAC measurements were negatively correlated with the length of hospital stay. (4) Conclusion and recommendations: the study documented the valid and practical use of GLIM for assessing the prevalence and magnitude of malnutrition in hospitalized patients in Lebanon, and highlighted the need for evidence-based interventions to address the underlying causes of malnutrition in Lebanese hospitals. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

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16 pages, 1359 KiB

Open AccessArticle

Barriers and Facilitators to Intradialytic Parenteral Nutrition Implementation Targeting Protein Energy Wasting in Malaysian Hemodialysis Patients

by Birinder Kaur Sadu Singh, Ban-Hock Khor, Sharmela Sahathevan, Abdul Halim Abdul Gafor, Enrico Fiaccadori, Karuthan Chinna, See-Hoe Ng and Tilakavati Karupaiah

Healthcare 2022, 10(10), 2090; https://doi.org/10.3390/healthcare10102090 - 20 Oct 2022

Viewed by 1681

Abstract

The capacity to deliver intradialytic parenteral nutrition (IDPN) for patients on hemodialysis (HD) diagnosed with protein energy wasting (PEW) in low resource settings is unknown. This study aimed to examine the extent of IDPN practice in HD units in Malaysia, and its implementation to treat PEW. We surveyed pharmacists (n = 56), who are central to parenteral nutrition delivery in Malaysia including IDPN. Seventeen healthcare stakeholders engaging with the Promoting Action on Research Implementation in Health Services (PARIHS) framework used the Likert scale to rate survey outcomes on IDPN implementation to treat PEW, according to the Evidence, Context, and Facilitation elements. IDPN for HD patients was available in 28 of 56 hospitals providing parenteral nutrition services, with only 13 hospitals (23.2%) providing IDPN to outpatients. Outpatient treatment was concentrated to urban locations (12/13) and significantly associated (p < 0.001) with resident nephrologists. The Evidence domain was rated poorly (2.18 ± 0.15) pertaining to IDPN indication when the oral spontaneous intake was ≤20 kcal/kg/day. The Context domain indicated good adherence to international best practice relating to IDPN administration (4.59 ± 0.15) and infusion time (4.59 ± 0.12). Poor adherence was observed in the Facilitation domain on ’Access to pharmacist and dietitian at HD units’ (2.65 ± 0.21) and ’Access to continuous medical education on managing PEW patients on HD’ (2.53 ± 0.15). The IDPN outpatient service was concentrated to urban hospitals with greater manpower resources. The PARIHS evaluation on IDPN implementation to treat PEW revealed facilitators in good practice adherence for prescribing and administration of IDPN but highlighted major barriers relating to IDPN indication and nutrient calculation. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

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8 pages, 857 KiB

Open AccessArticle

Dysbiosis: A Potential Precursor to the Development of a Depressive Disorder

by Seung-Young Chung, Karel Kostev and Christian Tanislav

Healthcare 2022, 10(8), 1503; https://doi.org/10.3390/healthcare10081503 - 10 Aug 2022

Cited by 5 | Viewed by 1620

Abstract

Background: Although previous investigations have indicated that gastrointestinal pathologies facilitate the occurrence of mood disorders, there is a lack of studies based on data from clinical practice. The aim of this study was to investigate the incidence of depression in patients with dysbiosis. Methods: Adult patients (≥18 years) from 1193 general practices in Germany between January 2005 and December 2018 with an initial diagnosis of dysbiosis documented anonymously in the Disease Analyzer database (IQVIA) were analyzed. The incidence of depression diagnoses as a function of dysbiosis was calculated and multivariate regression models were applied. Results: This study included 552 patients with and 552 patients without dysbiosis. Within five years of the index date, 20.5% of patients with dysbiosis and 5.5% of individuals without dysbiosis had been diagnosed with depression (p < 0.001). Dysbiosis was found to be significantly associated with the incidence of depression (HR: 2.85 (95% CI: 2.00–4.04)). This association was slightly stronger in men (HR: 3.54) than in women (HR: 2.61) and was more pronounced in the age group >60 years (HR: 4.43). Conclusions: We identified dysbiosis as a risk factor for developing depression within 5 years after the index date. This risk seems to be higher in male than in female patients. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

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13 pages, 262 KiB

Open AccessArticle

Patient and Staff Perceptions on Using Bioelectrical Impedance Analysis in an Outpatient Haemodialysis Setting: A Qualitative Descriptive Study

by Kristin Gomes, Ben Desbrow, Chris Irwin and Shelley Roberts

Healthcare 2022, 10(7), 1205; https://doi.org/10.3390/healthcare10071205 - 27 Jun 2022

Cited by 1 | Viewed by 1199

Abstract

Bioelectrical impedance analysis (BIA) is an objective hydration and body composition assessment method recommended for use in haemodialysis patients. Limited research exists on the acceptability and utility of BIA in clinical practice. This qualitative study explored patient and staff acceptability and perceived value of BIA in an outpatient haemodialysis setting at a tertiary public hospital in Queensland, Australia. Participants included five patients receiving outpatient haemodialysis and 12 multidisciplinary clinical staff providing care to these patients. Semi-structured interviews were employed and data were analysed thematically. Patients were satisfied with the BIA measurement process and most thought the BIA data would be useful for monitoring changes in their nutrition status. Clinical staff valued BIA data for improving fluid management, assessing nutrition status and supporting patient care. Staff recommended targeting BIA use to patient groups who would benefit the most to improve its uptake in the haemodialysis setting. Conclusions: BIA use in the outpatient haemodialysis setting is acceptable and provides valuable objective data to support health-related behaviour changes in patients and enhance clinical practice. Implementation of BIA should be tailored to the local context and staff should be supported in its use. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

Other

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11 pages, 815 KiB

Open AccessBrief Report

Short-Term Effects of Dietary Protein Supplementation on Physical Recovery in Older Patients at Risk of Malnutrition during Inpatient Rehabilitation: A Pilot, Randomized, Controlled Trial

by Barbara Strasser, Vincent Grote, Walter Bily, Helena Nics, Patricia Riedl, Ines Jira and Michael J. Fischer

Healthcare 2023, 11(16), 2317; https://doi.org/10.3390/healthcare11162317 - 17 Aug 2023

Cited by 1 | Viewed by 822

Abstract

It is estimated that about 50% of geriatric rehabilitation patients suffer from sarcopenia. Thereby, malnutrition is frequently associated with sarcopenia, and dietary intake is the main modifiable risk factor. During hospitalization, older adults are recommended to consume more dietary protein than the current recommended dietary allowance of 0.8 g/kg body weight per day to optimize the recovery of muscular strength and physical function. This prospective pilot study examined the feasibility and preliminary efficacy of short-term protein supplementation with protein-enriched foods and drinks on the hand-grip strength, nutritional status, and physical function of older patients at risk of malnutrition during a three-week inpatient orthopedic rehabilitation stay. The Mini Nutritional Assessment (MNA) tool was used to assess malnutrition. Patients with an MNA score ≤ 23.5 points were randomly assigned to an intervention group (goal: to consume 1.2–1.5 g protein/kg body weight per day) or a control group (standard care). Both groups carried out the same rehabilitation program. Physical recovery parameters were determined at admission and discharge. A trend was recognized for participants in the intervention group to consume more protein than the control group (p = 0.058): 95.3 (SD 13.2) g/day as compared to 77.2 (SD 24.2) g/day, which corresponds to a mean protein intake of 1.6 (SD 0.3) g/kg/day vs. 1.3 (SD 0.5) g/kg/day. Dietary protein supplementation increased body weight by an average of 0.9 (SD 1.1) kg and fat mass by an average of 0.9 (SD 1.2) kg as compared to the baseline (p = 0.039 and p = 0.050, respectively). No significant change in hand-grip strength, body composition, or physical function was observed. In conclusion, short-term intervention with protein-enriched foods and drinks enabled older patients at risk of malnutrition to increase their protein intake to levels that are higher than their required intake. In these older individuals with appropriate protein intake, dietary protein supplementation did not result in a greater improvement in physical recovery outcomes during short-term inpatient rehabilitation. The intervention improved dietary protein intake, but further research (e.g., a full-scale, randomized, controlled trial with sufficient power) is required to determine the effects on physical function outcomes. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

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