Clinical Nutrition 2 Lecture Notes PDF

Clinical Nutrition 2 Lecture 1 Dietetics program Fourth level dr. Alzahraa Motawei 1  Clinical Nutrition Screening, Subjective Global Assessment, and Intake assessment Dr. Alzahraa Motawei, PhD Lecturer Of Food Sciences And Nutrition...

Clinical Nutrition 2 Lecture 1 Dietetics program Fourth level dr. Alzahraa Motawei 1  Clinical Nutrition Screening, Subjective Global Assessment, and Intake assessment Dr. Alzahraa Motawei, PhD Lecturer Of Food Sciences And Nutrition Faculty Of Agriculture Mansoura University dr. Alzahraa Motawei 2 Objectives Define and discuss the nutrition screening process for hospitalized patients Describe the steps and goals of a comprehensive nutrition assessment – Subjective global assessment Review methods to assess dietary intake dr. Alzahraa Motawei 3 Nutrition Screening ≠ Nutrition Assessment dr. Alzahraa Motawei 4 Nutrition Screening: definition “The process of identifying patients, clients, or groups who may have a nutrition diagnosis and benefit from nutrition assessment and intervention by a registered dietitian (RD).” -Academy of Nutrition and Dietetics (The Academy) Quality Management Committee dr. Alzahraa Motawei 5 Better Practice… Screening At risk Assessment dr. Alzahraa Motawei 6  Nutrition screening can help make sure dietitians are seeing the RIGHT patients dr. Alzahraa Motawei 7 Main considerations in selecting a screening tool Easy Implemented as part of a Front-line personnel can use general work-up Uses existing personnel, Data readily available processes Appropriate for the setting Inexpensive to collect on all in which it is to be used clients Specific to the population On electronic medical chart dr. Alzahraa Motawei 8 Nutrition Screening Tool dr. Alzahraa Motawei 9 Other Validated Nutrition Screening Tools (for hospital use) Malnutrition Screening Tool (MST) Some Challenges Simple Screening Tools (#1 & #2) Require detailed Mini Nutritional Assessment – information Short Form (MNA-SF) Nutritional Risk Screening 2002 Time to (NRS 2002) complete Malnutrition Universal Screening May be difficult Tool (MUST) to complete at Short Nutritional Assessment first contact Questionnaire (SNAQ) dr. Alzahraa Motawei 10 dr. Alzahraa Motawei 11 Nutrition Assessment Nutrition assessment data are obtained from a variety of sources, including: – Screening or referral form – Patient/client interview – Medical or health records – Consultation with other caregivers, including family members – Community-based surveys and focus groups – Statistical reports, administrative data, and epidemiological studies dr. Alzahraa Motawei 12 Nutrition Assessment Goal: Identify any specific nutrition risk(s) or clear existence of malnutrition – 1. Identify individuals who require aggressive nutrition support – 2. Restore or maintain an individual’s nutrition wellness – 3. Identify appropriate medical nutrition therapy dr. Alzahraa Motawei 13 Tools for Assessment of Nutritional Status Subjective Global Assessment (SGA) validated nutrition assessment tool that correlates well with nutrition risk indices and other assessment data in hospitalized patients Mini Nutritional Assessment (MNA) reliable and quick method for evaluating nutritional status in older adults, >65 years old – Evaluates independence, medication therapy, pressure ulcers, number of full meals consumed per day, protein intake, fruit and vegetable intake, fluid intake, mode of feeding, self- view of nutritional status, comparison with peers, mid-arm and calf circumferences dr. Alzahraa Motawei 14 Nutrition Assessment Components Evaluate patient’s knowledge, readiness to learn, and potential for changing behaviors Identify the standards by which data will be compared Identify possible problem areas for making nutrition diagnoses dr. Alzahraa Motawei 15 Subjective Global Assessment (SGA) SGA is the gold standard for diagnosing malnutrition in hospital. SGA predicts a variety of nutrition related outcomes and this has been demonstrated in several studies worldwide Trained professionals assess food intake, functional status, and body composition. dr. Alzahraa Motawei 16  Subjective Global Assessment: Components History: Changes in dietary intake Gastrointestinal and other symptoms that impair food intake/absorption Functional capacity Potential stress of disease and/or cachexia Changes in weight over past 6 months Trajectory of recent changes Physical: Loss of subcutaneous fat: triceps, chest, trunk Muscle wasting: deltoids, quadriceps, biceps, … Edema: ankle, sacral, ascites; clarifies potential cause of weight changes dr. Alzahraa Motawei Detsky et al.1987 JPEN 17  SGA A (Well Nourished) no decrease in food intake < 5% weight loss no/minimal symptoms affecting food intake no deficit in function no deficit in fat or muscle mass OR An individual with some criteria for SGA B or C but with recent adequate food intake; non-fluid weight gain; significant recent improvement in symptoms allowing adequate oral intake; significant recent improvement in function; and chronic deficit in fat and muscle mass, but with recent clinical improvement in function. dr. Alzahraa Motawei 18 SGA B (Moderately Malnourished) definite decrease in food intake 5% - 10% weight loss without stabilization or gain mild/some symptoms affecting food intake moderate functional deficit or recent deterioration mild/moderate loss of fat and/or muscle mass OR An individual meeting criteria for SGA C but with improvement (but not adequate) of oral intake, recent stabilization of weight, decrease in symptoms affecting oral intake, and stabilization of functional status. dr. Alzahraa Motawei 19  SGA C (Severely Malnourished) severe deficit in food/nutrient intake > 10% weight loss which is ongoing significant symptoms affecting food/nutrient intake severe functional deficits OR Recent significant deterioration obvious signs of fat and/or muscle loss. dr. Alzahraa Motawei 20 Why should we use SGA? An example from the Nutrition Care in Canadian Hospitals study SGA when adjusted for other covariates predicts Length of stay As relevant as key predictors such as age, disease state for key health outcomes Only food intake and handgrip add to the predictive ability of SGA for the outcomes of length of stay and readmission (Jeejeebhoy et al., AJCN 2015) Other objective indicators do not add to the predictive value of SGA SGA is the start of a comprehensive assessment, which will include other indicators and investigations to determine micronutrient malnutrition, cause of malnutrition etc. dr. Alzahraa Motawei 21