GP patient databases show that malnutrition is under-reported and under-treated in patients with chronic disease

Fry, Catherine Mary; Ramet, S.; Hubbard, G.P.; Stratton, R.J.

doi:10.1016/j.clnesp.2017.07.016

Cited by 4 publications

(3 citation statements)

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“…We already know that patients at risk of malnutrition have higher healthcare resource use, including hospitalisations, 37 and it has been shown that malnutrition is often undetected in general practice, results in higher healthcare resource use and, when managed appropriately, can potentially save money. 6,22,38 This project suggests that such savings are possible using this model of dietetic care. The dietitian not only potentially reduced costs in some areas, but also significantly influenced patient safety and quality of care.…”

Section: Discussionmentioning

confidence: 93%

“…This project focused on the management of frailty and malnutrition; an area that is often not given priority. 6 Frailty is associated with older age and chronic disease and increases the risk of falls, disability, hospitalisation and mortality. 7 Therefore, there is a need to ensure early identification and treatment to help minimise decline into frailty and reduce its impact.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a dietitian in general practice: Care of the frail and malnourished

Hickson

Child

Collinson

2021

J Human Nutrition Diet

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Background: There is an increased demand in primary healthcare but general practitioner (GP) numbers are declining, creating significant challenges. Dietitians are ideal professionals to lead the treatment of patients with conditions that are amenable to dietary manipulation, including the management of malnutrition and frailty. The present study evaluated the benefits of a model of care in which a dietitian, working as a first contact practitioner within a general practice, provided care to patients at risk of malnutrition and frailty, aiming to reduce GP workload, improve patient care and make cost savings. Methods: A service evaluation with a dietitian employed 6 h per week for 6 months. The practice database was screened for patients aged ≥65 years and electronic Frailty index 0.26-0.36 or body mass index <19 kg m -2 . These patients were triaged by the dietitian and those at risk of malnutrition offered consultations. Patients prescribed oral nutritional supplements (ONS) and not under dietetic management were also seen. Results: Approximately 1200 patients met the screening criteria; 189 (16%) patients were triaged by the dietitian. Most (75%) were at risk of malnutrition and 63 of these were seen. Improvements in strength, frailty and nutrition status were observed, and changes to ONS prescriptions in 27 patients equated to annual cost savings of £15,379. Patient satisfaction was high. Conclusions: Dietitians, acting as first contact practitioners, can deliver significant improvements in care for older people at risk of malnutrition and frailty as part of the practice multi-disciplinary team. Cost savings for ONS were made and other potential cost saving were evident.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Impact of a dietitian in general practice: Care of the frail and malnourished

Hickson

Child

Collinson

2021

J Human Nutrition Diet

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“…Malnutrition increases the risk of complications, mortality, and infections in hospitalized patients; is associated with poor quality of life (QoL); and leads to longer hospital stays [ 3 , 6 , 7 , 9 , 10 , 11 , 12 , 13 ]. Although certain guidelines recommend approaches to assess malnutrition [ 1 ] and diets and protocols according to hospitalized patients’ needs [ 14 ], malnutrition is often underdiagnosed and undertreated [ 15 , 16 ], posing a serious health risk to patients. However, malnutrition is mostly treatable and; thus, it is of utmost importance to identify patients who are malnourished or at risk of malnutrition to provide them with effective support.…”

Section: Introductionmentioning

confidence: 99%

Expert Consensus on Morphofunctional Assessment in Disease-Related Malnutrition. Grade Review and Delphi Study

et al. 2023

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Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions.

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Phase angle and rectus femoris cross-sectional area as predictors of severe malnutrition and their relationship with complications in outpatients with post-critical SARS-CoV2 disease

Simón-Frapolli,

Vegas-Aguilar,

Fernández-Jiménez

et al. 2023

Front. Nutr.

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Background and aimsThe diagnosis of malnutrition in post-critical COVID-19 patients is challenging as a result of the high prevalence of obesity, as well as the variability and previously reported inconsistencies across currently available assessment methods. Bioelectrical impedance vector analysis (BIVA) with phase angle (PhA) and nutritional ultrasound (NU®) are emerging techniques that have been proven successful in assessing body composition with high precision in previous studies. Our study aims to determine the performance and usefulness of PhA and rectus femoris cross-sectional area (RF-CSA) measurements in assessing body composition as part of the full routine morphofunctional assessment used in the clinical setting, as well as their capacity to predict severe malnutrition and to assess complications and aggressive therapy requirements during recent intensive care unit (ICU) admission, in a cohort of post-critically ill COVID-19 outpatients.MethodsThis prospective observational study included 75 post-critical outpatients who recovered from severe COVID-19 pneumonia after requiring ICU admission. Correlations between all the morphofunctional parameters, complications, and aggressive therapy requirements during admission were analyzed. Multivariate logistic regression analysis and ROC curves were provided to determine the performance of NU® and PhA to predict severe malnutrition. Differences in complications and aggressive therapy requirements using the cutoff points obtained were analyzed.ResultsIn total, 54.7% of patients were classified by Subjective Global Assessment (SGA) as SGA-B and 45.3% as SGA-C, while 78.7% met the Global Leadership Initiative of Malnutrition (GLIM) criteria. PhA correlates positively with body cell mass/height (BCM/h) (r = 0.74), skeletal muscle index (SMI) (r = 0.29), RF-CSA (r = 0.22), RF-Y axis (r = 0.42), and handgrip strength (HGS) assessed using dynamometry (r = 0.42) and the Barthel scale (r = 0.29) and negatively with ICU stay (r = −0.48), total hospital stay (r = −0.57), need for invasive mechanical ventilation (IMV) (r = −0.39), days of IMV (r = −0.41), need for tracheostomy (r = −0.51), and number of prone maneuvers (r = −0.20). RF-CSA correlates positively with BCM/h (r = 0.41), SMI (r = 0.58), RF-Y axis (r = 0.69), and HGS assessed using dynamometry (r = 0.50) and the Barthel scale (r = 0.15) and negatively with total hospital stay (r = −0.22) and need for IMV (r = −0.28). Cutoff points of PhA < 5.4° and standardized phase angle (SPhA) < −0.79 showed good capacity to predict severe malnutrition according to SGA and revealed differences in ICU stay, total hospital stay, number of prone maneuvers, need for IMV, and need for rehabilitation, with statistical significance (p < 0.05). An RF-CSA/h < 2.52 cm2/m (for men) and <2.21 cm2/m (for women) also showed good performance in predicting severe malnutrition and revealed differences with statistical significance (p < 0.05) in ICU stay and total hospital stay.ConclusionMore than 75% of the post-critical COVID-19 survivors had malnutrition, and approximately half were obese. PhA, SPhA, RF-CSA, and RF-CSA/h, when applied to the assessment of body composition in post-critical COVID-19 patients, showed moderate-to-high correlation with other morphofunctional parameters and good performance to predict severe malnutrition and to assess complications and aggressive therapy requirements during ICU admission. Besides being readily available methods, BIVA and NU® can help improve the morphofunctional assessment of malnutrition in post-critical COVID-19 survivors; however, more studies are needed to assess the performance of these methods in other populations.

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GP patient databases show that malnutrition is under-reported and under-treated in patients with chronic disease

Cited by 4 publications

References 0 publications

Impact of a dietitian in general practice: Care of the frail and malnourished

Impact of a dietitian in general practice: Care of the frail and malnourished

Expert Consensus on Morphofunctional Assessment in Disease-Related Malnutrition. Grade Review and Delphi Study

Phase angle and rectus femoris cross-sectional area as predictors of severe malnutrition and their relationship with complications in outpatients with post-critical SARS-CoV2 disease

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