Skip to main content
Patient Care Photo

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.

 

Comments

Name
Asish

Tue, 02/05/2019 - 10:28

A very nice and informative report. Well done George! I think more research should be conducted to identify the bio-markers of malnutrition.

Name
Asish

Name
Ruaa Al-Qazazi

Tue, 02/05/2019 - 11:30

Nicely written report George!
I agree with you Asish that more research need to be conducted in this field although Body mass index, hemoglobin , serum ferritin, and total cholesterol are useful biomarkers of malnutrition in patients with long term hospitalization chronic diseases and in elderly.

Name
Ruaa Al-Qazazi

Name
Kathleen Harrison

Wed, 02/06/2019 - 17:18

Thanks George! Great review, as this was a really interesting talk.

Relating to Asish and Ruaa's comments, there appears to be an issue of relatively little information regarding objective diagnosis of malnutrition, and thus difficulty in providing evidence-based dietary intervention. Empirical diagnosis of malnutrition is often confounded by disease co-morbidities; as how could physicians employ normative biomarkers (i.e. molecular serum albumin, or imaging calf muscle to adipose ratio) in the non-normative context of acute illness?

Second, I think it would be great to expand evidence-based education, and thus effective medical treatment, for malnutrition in various contexts. WHO definition of 'malnutrition' includes; Undernutrition (i.e. inadequacy of muscle mass and/or vitamins and mineral intake), Obesity (i.e. excess of mass, usually adipose), and Diet-related noncommunicable diseases (i.e. cardiovascular disease related to poor diet). This would include ICD-9/OHIP codes 263-278, and then some!
It would be great to have additional information regarding best-practice guidelines to assist physicians in treatment of the malnourished patient (i.e. In a septic patient, meeting full caloric requirements is not advised, as described in the "International Guidelines for Management of Severe Sepsis and Septic Shock".)

Name
Kathleen Harrison

Name
Paula James

Thu, 02/07/2019 - 12:52

I enjoyed reading this George - very interesting and well written!

Name
Paula James

Add new comment

Plain text

  • No HTML tags allowed.
  • Lines and paragraphs break automatically.
  • Web page addresses and email addresses turn into links automatically.