How dietitians can help identify the prevalence of low vitamin D levels in a hospital setting

Abstract

Malnutrition risk increases with age and is associated with adverse outcomes. This study assessed compliance with and tolerance of a low volume, energy and protein oral nutritional supplement (ONS) in older persons living in the community, in conjunction with increased dietetic input and its impact on nutritional outcomes, and malnutrition risk using the malnutrition universal screening tool (MUST). Elderly patients from community with a MUST score 1 or Body Mass Index (BMI) <24 kg/m 2 with a triceps skinfold or mid upper arm circumference <10th centile were eligible for inclusion. Patients were excluded if ONS were taken in the last 4 weeks or required thickened fluids. Patients were prescribed 120mls/day for 4 weeks (Pro-Cal shot®) providing 400 kcals (3.3 kcal/ml) and 8 g protein, in addition to increased dietetic contact (twice per week). Assessments completed at 3 time points include; anthropometry, nutritional intake (analysed by Nutritics®), tolerance and compliance (self-reported and measured). Statistical analysis was performed using SPSS®. Ethical approval was obtained from the local ethics committee. Fifteen completed the study (mean 81+8.4 years, BMI 20.5+4.2 kg/m 2 , 60% female, 40% cognitively impaired). Average 4 week compliance was 92% (57e100%). The ONS was well tolerated with no adverse gastrointestinal symptoms or appetite changes. A third changed flavour preference. Weight (p¼0.012), total reported energy (p<0.05) and fluid intake (p<0.05) significantly increased with supplementation, with no effect on other anthropometric measures. Reported dietary intake did not change (p¼0.122). After 4 weeks of supplementation, 67% reduced their malnutrition risk to MUST score 0 (low risk). The low volume, well tolerated ONS, combined with increased dietetic input and self-monitoring resulted in high compliance. This intervention for 'at risk' patients, resulted in small but significant weight-gain and reduction of malnutrition risk in older persons in the community.