Increasing the Awareness and Identification of Malnutrition in Hospitalized Patients: By Dr. Jessica Noelting
George, Philip, MSc Candidate, Translational Medicine Graduate Program
Malnutrition is a significantly prevalent and devitalizing condition. It is characterized by the deficiency or imbalance of energy, proteins and vital nutrients, and has been associated with increased morbidity in both acute and chronic illnesses. Furthermore, malnutrition has been related to an increase in hospital length of stay, cost of care, and risk of re-admission. As a result, malnutrition not only affects a patient’s health and quality of life, but also generates a financial burden on the health care system.
Unlike Canada, countries such as the United Kingdom, United States, Denmark, and the Netherlands have developed unique programs and national guidelines based on their prevalence data. According to the Dieticians of Canada (2014), these nations have been on the forefront of systematically elucidating the malnutrition epidemic. The lack of comprehensive Canadian data, awareness, and knowledge led to the establishment of the Canadian Malnutrition Task Force (CMTF). In 2013, the CMTF launched and conducted the Nutrition Care in Canadian Hospitals study, enrolling 1022 patients from 18 hospitals across the country. A first of its kind investigating the estimated prevalence of nutritional risk within hospitalized settings. Moreover, the study’s objective was to also describe the state of nutrition care found in Canadian hospitals, and to reveal the significant negative outcomes on overall health and health care systems. A nutrition risk screening tool was performed on the patients enrolled in the CMTF study in order to compare its predictive value to the gold standard Subjective Global Assessment (SGA). Results indicated the prevalence of malnutrition upon hospital admission was 45% based on SGA. This is a profound proportion which is paradoxically similar to that of various developing countries, where malnutrition prevalence’s range from 20% to 50% (Agarwal et al., 2010; Sorensen et al., 2008).
The heterogeneity and occurrence of malnutrition among hospitalized patients has guided Dr. Jessica Noelting’s journey in the field of nutrition. As a Gastroenterologist and an Assistant Professor at Queen’s University, Kingston, Ontario, Dr. Noelting’s research focuses on increasing the awareness and identification of malnutrition within health care settings. During this week’s Medical Grand Rounds, Dr. Noelting presented on the importance of a standardized inter-professional malnutrition care program, that focuses on identification, prevention, and treatment. The program’s fundamental principles comprise of SGA, screening, nutrition assessment, discharge planning, liberalization of diets, protected mealtimes, adequate food, and standardized documentation. Its implementation could ultimately prevent, detect, and alter the practice of nutrition care. Additionally, dependence on referrals from other physicians would be minimized since they are often based on erroneous beliefs and subjective assessment. Dr. Noelting encouraged all physicians present at Medical Grand Rounds to recognize the importance of nutritional status, and for them to create an awareness among health care professionals through presentations, conferences, and practice.
Malnutrition remains overlooked and untreated for many hospitalized patients, and addressing its importance requires a collaborative effort between all health care professionals, not just dieticians alone. The lack of knowledge and awareness of the condition further contributes to patient and economic burdens. Therefore, further advocacy on malnutrition and the development of an inter-professional team will increase overall awareness and reduce prevalence rates. From a translational perspective, additional research observing nutritional behaviour prior to hospital admission, and analysis of the effects of hospital communal dining, will contribute to the further understanding of malnutrition.