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ObjectivesTo describe nutrition care documentation patterns and investigate predictors of nutrition diagnosis resolution.MethodsThis is a secondary data analysis of a 2-year pragmatic, quasi-experimental study conducted in outpatient clinics where nutrition care was provided to adults with diabetes Type 1 or 2 from May 2017 to June 2019 (n = 564 patients). The main outcome measures were frequency of standardized Nutrition Care Process (NCP) terms, NCP links, nutrition diagnosis resolution and predictors of nutrition diagnosis resolution. Predictors of diagnosis resolution were identified using a multivariable logistic regression model.ResultsThe most prevalent resolved diagnoses were excessive carbohydrate intake (32%), undesirable food choices (21%) and excessive energy intake (13%). The top etiology was food and nutrition related knowledge deficit (57%) and interventions were drawn mainly from the Nutrition Education domain (64%). One hundred forty-six patient cases (26%) had at least one follow-up visit and 26% of those with a follow-up (n = 38) had a resolved diagnosis. The presence of the evidence-diagnosis NCP link in documentation predicted diagnosis resolution (OR = 2.80, 95% CI 1.30–6.02; p = 0.008).ConclusionMost diagnoses were caused by patients' lack of knowledge and respective interventions focused on nutrition education. Odds of diagnosis resolution improved when the signs and symptoms of the diagnosis were documented during assessment (evidence-diagnosis NCP link). Training dietitians on NCP links may be important to resolve nutrition diagnoses. Presented findings are hypothesis generating.

Background & Aims COVID-19 is highly inflammatory and when it affects the elderly who have multiple comorbidities, the risk of malnutrition is high. The aim of this review is to highlight the evidence for COVID-19 and risk for malnutrition (macro- and micro-nutrient deficiency) sharing two case reports. Methods We report two cases of patients with COVID-19. The first case includes a 75-year-old male with increasing confusion, delirium and malnutrition once he had clinically resolved from his COVID-19 diagnosis. The patient had a number of comorbidities and was treated with diuretics before and after his hospital admission. He was treated with intravenous thiamine and enteral nutrition. The second case includes a 77-year-old male with diabetes who presented with suspected vitamin C deficiency likely due to chronic aspirin use nearly two weeks prior to being diagnosed with pneumonia and COVID-19. The patient recovered from his COVID-19 diagnosis but continued to decline nutritionally and was readmitted sixty days later with failure to thrive. Results The first case had significant improvements in his appetite and neurological conditions following thiamine infusion and enteral nutrition and was discharged to home after a 19-day hospital stay. The second case presented with a vitamin C deficiency before testing positive for COVID-19. Although he did recover from COVID-19 he struggled to meet nutritional needs post-COVID and passed away 60 days after his COVID-19 diagnosis with pneumonia and failure to thrive. Conclusion Elderly patients with chronic diseases who use nutrient depleting medications are particularly high risk for micronutrient deficiency when they also experience the inflammatory insult of COVID-19. Patients who continue to have poor nutrition intake even after they appear to be clinically resolved from the virus should be closely monitored.

Background: When nutrition assessments must be performed virtually, such as during the coronavirus pandemic, it is difficult to fully assess patients for malnutrition without the ability to perform a nutrition-focused physical exam.Practitioners may ask patients about their physical appearance, but there is currently no validated set of questions whose answers correlate with nutritionfocused physical findings for the diagnosis of malnutrition in such situations. The aim of this study was to evaluate correlations between patients' responses to verbalized questions and physical signs of malnutrition. Methods: Questions related to the physical findings of malnutrition were developed and evaluated for content validity. Thirty patients receiving nutrition assessments at an acute care veterans' hospital were asked the questions prior to a nutrition-focused physical exam. Patients' responses were compared with a diagnosis of malnutrition and physical findings of muscle, fat, fluid accumulation, and handgrip strength.Results: Four questions significantly correlated with malnutrition: "Does the area around your eyes appear sunken in?" (P = 0.03), "Are you able to see your ribs?" (P = 0.05), "Do you feel you are unusually skinny for you?" (P = 0.001), and "Do you find yourself eating less due to swelling in your belly?" (P = 0.008). Conclusion:There are relationships between patients' responses to certain verbalized questions and their physical status. Such questions can be used to identify physical signs of malnutrition when nutrition-focused physical exams cannot be performed. Further research is needed to validate these questions in other populations.