Priority setting for adult malnutrition and nutritional screening in healthcare: a James Lind Alliance

Abstract

Background Malnutrition is one the greatest global health challenges of our generation, leading to the increased utilisation of healthcare resources, as well as morbidity and mortality. Research has primarily been driven by industry, academia and clinical working groups and has had little involvement from patients and carers. The project described in the present study aimed to establish a priority setting partnership allowing patients, carers and healthcare professionals an opportunity to influence the research agenda. Methods A national survey was conducted to gather malnutrition uncertainties and identify key issues (i.e. areas within scope where an evidence‐base is lacking) from those with experience of malnutrition. Uncertainties were analysed according to themes. Similar questions were grouped and summary questions were developed. A second survey was conducted and respondents were asked to choose their 10 most important summary questions. A workshop was conducted to finalise the top 10 research priorities from the most frequently indicated uncertainties on the interim survey. Results Overall, 1128 uncertainty questions were submitted from 268 people. The interim survey had 71 responses and a list of the top 26 questions was generated for the workshop. There were 26 questions discussed, ranked and agreed by healthcare professionals, carers and patients at the workshop. The top 10 research priorities were then chosen. These included questions on oral nutritional supplements, vulnerable groups, screening, community care, use of body mass index and technology. Conclusions The top 10 research priorities in malnutrition and nutritional screening have been identified from a robust process involving patients, carers and healthcare professionals.

Accuracy of three tools for malnutrition diagnosis in hospitalised patients: Comparison to subjective global assessment

“…45 Indeed, the James Lind Alliance Priority setting for adult malnutrition and nutritional screening in healthcare was highlighted as one of the 10 top research priorities with respect to investigating whether it is appropriate and accurate to use standard BMI ranges to diagnose malnutrition in elderly people, dementia patients, bed-bound patients and patients with fluid imbalances. 46 An important distinction should be made with regard to the different metrics of diagnostic performance and how they relate to the clinical implications of each method for nutritional assessment and identification of malnutrition. The AUROC curve is, by definition, a discriminative measure that may be interpreted as the overall test accuracy.…”

“…Indeed, BMI is not a sensible metric for accurately discriminating important aspects of body composition and therefore should not be used for nutrition‐related diagnosis or clinically important decision‐making at an individual patient‐level 45 . Indeed, the James Lind Alliance Priority setting for adult malnutrition and nutritional screening in healthcare was highlighted as one of the 10 top research priorities with respect to investigating whether it is appropriate and accurate to use standard BMI ranges to diagnose malnutrition in elderly people, dementia patients, bed‐bound patients and patients with fluid imbalances 46 …”

“…These aspects considered together will clarify whether, in clinical practice, AND‐ASPEN and GLIM are indeed interchangeable, as demonstrated in terms of concurrent validity in the present study, or whether there are aspects making one of them more favourable. Furthermore, the performance of both tools in community should be tested, considering that the best way to carry out screening in the community for effective identification of malnutrition is one of the ten priorities according to the James Lind Alliance Priority setting for adult malnutrition 46 . In addition, considering that misunderstanding, caused by a lack of knowledge regarding the causes and consequences of malnutrition, resulted in reduced risk perception and disbelief or the rejection of screening results in a recent systematic review, it is necessary to educate vulnerable groups regarding the role of nutritional screening, malnutrition, and its causes and consequences, combined with a tailored approach for providing nutritional advice 55 …”

An investigation of recommended serve food portions and attaining energy and protein requirements in older adults living in residential care

“…This research aligns with recent professional consensus documents that define future research priorities. Both in the UK (33) and in Australia (34) , research that extends the understanding of identification and management of malnutrition in older populations is a priority for dietetic research. Internationally, researchers have found similar problems with food guides underpinning RCH menus and reiterated the need for guidelines for menu development for the aged population rather than using a food guide aimed for a healthy older population (14,35) .…”

Nutrition screening tools: Still no consensus 40 years on

“…Nutrition screening tools are clearly a useful and important component of primary care and hospital treatment, although their utility does have limitations, not least the fact that there is still no consensus regarding which tools are the best for general use. As discussed by Jones et al, 15 these tools have, in most cases, been developed by academic researchers and manufacturers of oral nutrition supplements with little input from patients and the health professionals who use the tools. As discussed above, tools such as MUST and NRS2002, which depend on the determination of BMI, have little utility when assessing malnutrition risk in demented and bed‐bound people or in patients with fluid imbalances 13,15 .…”