Tina Beermann

Multi-modal intervention improved oral intake in hospitalized patients. A one year follow-up study

BACKGROUND Good nutritional practice (GNP) includes screening, nutrition plan and monitoring, and is mandatory for targeted treatment of malnourished patients in hospital. AIMS To optimize energy- and protein-intake in patients at nutritional risk and to improve GNP in a hospital setting. METHODS A 12-months observational multi-modal intervention study was done, using the top-down and bottom-up principle. All hospitalized patients (>3 days) were included. SETTING A university hospital with 758 beds and all specialities. MEASUREMENTS Record audit of GNP, energy- and protein-intake by 24-h recall, patient interviews and staff questionnaire before and after the intervention. INTERVENTIONS Based on pre-measurements, nutrition support teams in each department made targeted action plans, supervised by an expert team. Education, diagnose-specific nutrition plans, improved menus and eating environment, and awareness were initiated. STATISTICS Mann-Whitney and Kruskal-Wallis test was used for ordinal data, and Pearson Chi square test for nominative data. RESULTS Overall 545 patients participated (287 before/258 after) from 26/22 departments. There were no significant differences regarding sex, age, BMI or previous weight loss before and after the intervention. Result-indicators: Energy intake improved from 52% to 68% (p < 0.007), and protein intake from 33% to 52% (p < 0.001) (>75% of requirements). Intake of less than 50% of requirements decreased with 50%. Process-indicators: Screening improved from 56% to 77% (p < 0.001), nutrition plans from 21% to 56% (p < 0.0001), and monitoring food intake from 29% to 58% (p < 0.0001). CONCLUSIONS Intake of energy and protein as well as GNP improved using a multi-modal top-down and bottom-up approach.

Ability of different screening tools to predict positive effect on nutritional intervention among the elderly in primary health care.

OBJECTIVE Routine identification of nutritional risk screening is paramount as the first stage in nutritional treatment of the elderly. The major focus of former validation studies of screening tools has been on the ability to predict undernutrition. The aim of this study was to validate Mini Nutritional Assessment-Short Form (MNA-SF), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening 2002 (NRS-2002), Body Mass Index (BMI) <24, and the Eating Validation Scheme (EVS), using published randomized controlled trials of nutritional intervention among old people in primary health care, in order to evaluate whether they were capable of distinguishing those with a positive benefit from those that showed no benefit of nutritional intervention. METHODS The methods used were a literature search; classification of participants with respect to nutritional risk according to the different nutritional screening tools; and validation (i.e., evaluation of whether the different tools were capable of distinguishing those with a positive benefit from those that showed no benefit of nutritional intervention by assessing the positive [PPV] and negative [NPV] predictive values). RESULTS MNA-SF, NRS-2002, BMI <24 and EVS had the highest PPV (0.75) and EVS the highest NPV (0.74) with regard to function-the primary clinical outcome. CONCLUSION Overall EVS seemed most capable of distinguishing those clients and residents with a positive benefit from those that showed no benefit of nutritional intervention. The findings should be confirmed in further validation and intervention studies.