BackgroundThere is a need for quick and easy methods to monitor nutritional intake in hospital and identify patients with poor intake. Food record charts are often used in clinical practice, with low levels of accuracy and completion. This study aims to describe the development and evaluate the performance of a new tool to estimate energy and protein intake and identify poor nutritional intake amongst adult hospital patients.MethodsNinety trays were sampled and assessed independently using the new tool ‘Meal Intake Points’ and a weighed (reference) method. The performance was tested by measuring association (Spearman's correlation), agreement (proportion of meals within specified limits of reference method), and sensitivity and specificity to identify poor energy and protein intake.ResultsThis new tool achieved very strong association for energy estimates (r = .91) and strong association for protein estimates (r = .86). Estimates for energy and protein were within 450 kJ and 4.5 g of the reference method in 77.8% and 62.2% of meals, respectively. It also displayed excellent performance as a screening tool (sensitivity 100%; specificity 76%‐80%). Minor revision of the original tool was needed to optimise performance.ConclusionsMeal Intake Points accurately estimates energy and protein intake and identifies patients with poor nutritional intake, providing a clinically relevant tool for use in hospitals to monitor intake and identify patients for proactive nutrition support. Further validation studies are needed to determine its performance in clinical practice and whether it is useful in predicting hospital‐acquired malnutrition.
Introduction: Bariatric surgery (BS) using restrictive and malabsorptive techniques remains the most effective treatment option for morbid obesity. Intestinal failure (IF) and decompensated chronic liver disease (CLD) are rare post-operative complications of BS. We reviewed a cluster of three post-bariatric surgery patients presenting to our center with IF and decompensated CLD to identify perioperative factors that may be associated with these life-threatening complications. Methods: A retrospective review of referrals to our IF unit in 2016 was performed to identify patients with a history of BS. Patient demographics, anthropometry, nutritional indices, liver function and investigations, nutritional management, and outcomes were reviewed. Results: Three of 10 patients who commenced home parenteral nutrition (HPN) at our institute in 2016 presented with IF and decompensated CLD following BS. All patients were female (aged 49-60 years) with co-existing liver failure (two non-alcoholic steatohepatitis [NASH] and one hepatitis C virus [HCV]). All operative procedures were malabsorptive: jejunoileal bypass (n = 2) and biliopancreatic diversion (n = 1). The mean body mass index at surgery was 44 kg/m 2 . Mean time between BS and liver disease diagnosis was 9.6 years; development of decompensated CLD occurred on average 2.3 years later, and referral to our service with rapid weight loss and IF arose on average 2.4 years thereafter. At presentation, patients exhibited severe malnutrition, sarcopenia, and micronutrient deficiencies. Parenteral nutrition and vitamin/mineral supplementation were implemented in each patient. All patients underwent diet modification and medical therapy to enhance enteral absorption, and two of three patients remain HPN-dependent. Postulated mechanisms for decompensated CLD and IF are the following: (i) malabsorption from BS resulted in rapid weight loss and progression to cirrhosis in patients already suffering NASH-or HCV-related liver fibrosis; (ii) the increased energy demands of liver disease precipitated liver decompensation due to malabsorption; and (iii) IF developed as patients were unable to meet their CLD-driven energy demands. Conclusion: IF and decompensated CLD are rare but life-threatening complications of malabsorptive BS. The risk of these complications likely relates to the degree of pre-operative fibrosis. Such patients should be monitored closely post-operatively, as CLD and IF can occur many years after surgery. Management options should be tailored to the severity of CLD and degree of malnutrition. Early diagnosis may avert liver disease progression via "prophylactic" reversal surgery alone in well patients. In malnourished patients with advanced liver disease, total parenteral nutrition followed by reversal surgery may be required. Liver transplant and reversal should only be reserved for those with irreversible liver disease. Background and Aim: The use of home parenteral nutrition (HPN) for patients with intestinal failure (IF) varies widely among countries. Robust...
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