Nutritional Screening

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Preoperative nutritional screening by the specialist instead of the nutritional risk score might prevent excess nutrition: a multivariate analysis of nutritional risk factors

Preoperative nutritional screening by the specialist instead of the nutritional risk score might prevent excess nutrition: a multivariate analysis of nutritional risk factors

The selection of surgical patients at nutritional risk is mandatory since early detection and treatment of malnutrition contribute to decrease postoperative mor- bidity after major gastrointestinal (GI) surgery [1,2]. Currently, a number of validated and easy to use screen- ing tools are available [2-5]. However, recently published surveys demonstrate that evidence-based guidelines for screening for malnutrition and for shaping nutritional interventions are rarely implemented outside centers with a special interest in clinical nutrition [6,7]. Instead, various clinical and laboratory parameters are preferred. A survey among Austrian and Swiss hospitals demon- strated that loss of weight, together with body mass index, were the clinical parameters most commonly used in this setting, whereas serum albumin and pre-albumin levels were the preferred laboratory parameters [6]. In that study, the screening tool currently recommended by the European Society for Parenteral and Enteral Nutri- tion, the Nutritional Risk Score (NRS-2002), was used by 14% of centers only [6].

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The Use of Biochemical Parameters as Nutritional  Screening Tools in Surgical Patients

The Use of Biochemical Parameters as Nutritional Screening Tools in Surgical Patients

Nutritional status influences surgical outcome and complication rates. The National Institute of Clinical Ex- cellence, (NICE) recommends screening patients on admission; yet traditional nutritional screening tools are underutilised. This retrospective case-control study investigates the association between biochemical factors and adverse outcomes in orthopaedic patients to ascertain whether they could provide more suitable alterna- tives to traditional screening tools. 66 patients with fractured neck of femur were investigated. Adverse out- comes including Length of Stay, (LOS), and deaths were recorded. Total Lymphocyte Counts, (TLC), Serum Albumin Levels and Haemoglobin levels, were recorded pre-operatively, (pre-op) and post-operatively, (post-op). Adverse outcomes in those with normal and abnormal biochemical values were compared using Chi Squared and T Testing. Linear associations were tested for using Pearson rank correlation. Automated Nutrition Scores Beta, (ANSB) were calculated and their relationship to adverse outcomes investigated. Pro- tein energy malnutrition was common on admission. However, only 2 patients were nutritionally screened during admission. Those patients with abnormal pre-op TLC had an increased LOS in hospital. Those with abnormal albumin and/or TLC had increased mortality rates. Abnormal albumin levels were associated with a significant 3 fold increase in mortality, (p = 0.009) and post-operative TLC were found to be negatively correlated with LOS, (r = –0.3, p = 0.038). ANSB were also found to correlate with increased adverse out- comes although this was not significant. This study demonstrates that nutritional status is poorly assessed on admission in orthopaedic patients and consequently that provision of nutritional supplements is suboptimal. This study also demonstrates a highly significant relationship between abnormal albumin and adverse out- comes and identifies a new correlation between post-operative TLC and LOS. This study confirms that indi- vidual biochemical parameters and biochemical scores can be used to identify orthopaedic patients at par- ticular risk of adverse post-op outcomes. These biochemical screening methods may be a more efficient and reliable way of stratifying malnutrition associated risk on admission.

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A Dietician’s Bedside Supervision in a Geriatric Ward Is Effective

A Dietician’s Bedside Supervision in a Geriatric Ward Is Effective

Introduction: Health professionals have greater focus on nutrition issues when having access to a dietician. The aim of this study was to examine the effect of having bed-side access to a clinical dietician in a geriatric ward. Methods: A follow-up study included consecutively all patients admitted in two geriatric wards during three time periods of 2½ months each. The in- tervention was health professionals’ bed-side access to a clinical dietician. Patients hospitalized during the intervention period were compared to pa- tients hospitalized before and after. Patients hospitalized ≤2 days and not screened were excluded. Data on nutritional screening, patients’ daily energy and protein intake, change in body weight from admission to discharge, and a nutrition plan and prescribed oral nutritional supplement at discharge were analysed using ANOVA analysis of variance and Chi-squared test. Re- sults: A total of 554 patients (81%) were at nutritional risk. During the in- tervention period the compliance of diet registration was better. The pa- tients’ protein and energy intake was higher during the intervention com- pared with that before and after the intervention (p = 0.04/p = 0.005). Fewer patients lost weight during and after the intervention. Length of hospital stay (LOS) was 1 median day longer in the period before the intervention com- pared with that during and after the intervention (7 days). LOS was asso- ciated with weight change. Conclusions: Health professionals’ access to a bedside dietician in a geriatric ward seems to improve protein and energy intake and thereby the older patients’ body weight, but not sufficiently. The dietician also enhances the staffs’ awareness of nutrition improvements after discharge.

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CONUT: A Useful Alarm of Malnutrition in the Centralized Laboratory of a Spanish Hospital

CONUT: A Useful Alarm of Malnutrition in the Centralized Laboratory of a Spanish Hospital

The CONUT (COntrol NUTrition) program is an automatized method for the nutritional screening of patients at the University Hospital Ramón y Cajal. It provides information about patients for whom correcting their state of malnutrition should be emphasized in addition to information on the services that attend patients with greater risk. This tool uses 3 analytical parameters: serum albumin, total cholesterol, and total lymphocytes.

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Diagnostic performance of the Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients - a cross-sectional study

Diagnostic performance of the Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients - a cross-sectional study

The MEONF-II is an easy to use, relatively quick and sensitive screening tool to assess risk of undernutrition among hospital inpatients. High sensitivity is of primary concern in nutritional screening. With respect to user- friendliness and sensitivity, the MEONF-II appears to perform well compared to the NRS 2002, although lar- ger studies are needed for firm conclusions. The differ- ent scoring systems for undernutrition appear to identify overlapping but not identical patient groups. However, the appropriateness of using the MNA as gold standard among patients younger than 65 years can be questioned.

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Cancer, Malnutrition and Cachexia: We Must Break the Triad

Cancer, Malnutrition and Cachexia: We Must Break the Triad

Both parenteral and enteral nutrition are now increasingly integrated within the main oncologic strategy with the aim of making surgery, chemotherapy and radiation therapy more safe and effective. This requires a better awareness of the inherent risk of starvation and undernutrition by the surgeons, medical oncologists and radia- tion oncologists, the ability to implement a policy of nutritional screening of cancer patients and to propose them the nutritional support in a single bundle together with the oncologic drugs. Four different areas of nutritional intervention are now recognized which parallel the evolutionary trajectory of patients with tumour: the perioper- ative nutrition in surgical patients, the permissive nutrition in patients receiving chemotherapy and/or radiation therapy and the home parenteral nutrition which may be total (in aphagic-obstructed-incurable patients) or sup- plemental (in advanced weight-losing anorectic patients) [19]. The therapeutic goal for cancer patients is the improvement of function and outcome by 1) preventing and treating undernutrition; 2) enhancing antitumor treatment effects; 3) reducing adverse effects of antitumor therapies; and 4) improving QoL [15]. Nutritional therapy should be initiated when undernutrition already exists or when it is anticipated that the patient may be unable to eat for more than 7 days. Enteral nutrition should also be initiated when an inadequate food intake (<60% of estimated energy expenditure) is anticipated for more than 10 days. It should substitute the difference between actual intake and calculated requirements [15] [16]. Appropriate treatment of cancer cachexia should address the following conditions: inflammatory state, nutritional disorder, metabolic derangements, immuno- logical defects, poor quality of life, and, in particular, fatigue. Accordingly, treatment for cancer cachexia should include as primary endpoints the following variables: an increase in lean body mass and functional activity; a decrease in resting energy expenditure; and improvement of fatigue [20] [21].

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Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition

Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition

The high prevalence of malnutrition, both as underweight and overweight, illustrated that the double burden of disease was also endemic in this study population. Patients falling in either of these categories were often unidentified and untreated for malnutrition, with only a fifth being referred to dietetic services. Further research is recommended to validate the proposed MUAC cut-offs in hospitalised patients, but also to extend it to other settings, e.g. community clinics and long-term care set- tings. As the selection of patients was not randomised, the results could not be generalised to all hospitalised patients. Research on larger samples of the white and Indian populations are needed, to develop MUAC cut-offs for these groups. The use of MUAC should be considered as a first step to manda- tory nutritional screening and a key nutritional status indicator in South African public hospitals and other settings.

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Comparison of two nutrition assessment tools in surgical elderly inpatients in Northern China

Comparison of two nutrition assessment tools in surgical elderly inpatients in Northern China

decreased treatment efficacy, and an increased hospital stay period [23, 24]. Worldwide studies have indicated that between 20 and 50 % of hospitalized patients have some degree of malnutrition. Despite the greater awareness of this condition by healthcare staff and improvements in the assessment of malnutrition, multiple reports have indicated that only a minority of malnourished patients actually receives appropriate nutrition support while hospitalized [25, 26]. Nutritional screening should be the first step to identify patients who are malnourished or are at risk of malnutrition, for early referral, further nutri- tional assessment and individualized intervention [27]. Several conventional approaches and criteria such as BMI, biochemical markers and anthropometric measure- ments could be used alone or in combination to diagnose malnutrition. In the clinical setting, most of the anthropo- metric measurements and laboratory assessments are not ideal because they are inaccurate, insensitive or unconve- nient to perform.

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Enhancing the quality of oral nutrition support for hospitalised patients: a mixed methods knowledge translation study  (The EQONS study)

Enhancing the quality of oral nutrition support for hospitalised patients: a mixed methods knowledge translation study (The EQONS study)

(organisation) and macro (healthcare system) level. At a micro level the benefits of supportive leadership, multi-disciplinary collaboration and shared ownership for nutritional innovation were important catalysts for change whereas staff turnover and a heavy clinical workload hindered progress. At the meso level, organisational turbulence caused by service reconfiguration had a detrimental effect on staff morale, which in turn impacted on progress made. At the macro level, external drivers from the commissioners and the Care Quality Commission (the independent regulator of healthcare services in England) to introduce MUST screening secured senior management

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Correlation between malnutrition, body mass index and complications in patients with urinary bladder cancer who underwent radical cystectomy

Correlation between malnutrition, body mass index and complications in patients with urinary bladder cancer who underwent radical cystectomy

Many reports show which vitamins and minerals are in deficiency in our population; it is also well known which microelements are necessary for wounds to heal properly. However, this knowledge is not utilized well enough be- fore important and cost-generating procedures like RC. The patients who undergo RC, besides cancer, suffer from a lot of other diseases; therefore, their condition should be optimized before the operation. Seriously ill patients should be provided with a nutritional, physical and mental health program as a standard procedure. An American survey conducted in 2014, entitled “Optimizing a frail elderly patient for radical cystectomy with a prehabilita- tion program”, proposes and shows a holistic preparation program, including nutritional counseling, protein supple- mentation, anxiety reduction, and a moderate exercise pro- gram. 15 This prehabilitation program was also checked

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PHYTOCHEMICAL AND ANTIMICROBIAL SCREENING AND NUTRITIONAL QUALITIES OF FICUS SUR (FORSSK)

PHYTOCHEMICAL AND ANTIMICROBIAL SCREENING AND NUTRITIONAL QUALITIES OF FICUS SUR (FORSSK)

The result obtained show that Ficus Sur (Forssk) has nutritional value and blood building ability. It is therefore recommended that this plant be included in the diet of people suffering from anaemia and also the dry leaves be taken as tea in food supplement. Apart from nutritional value, it has medicinal uses as shown by the antimicrobial screening. It is therefore advised that the plant be cultivated in our localities together with other vegetables.

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Proximate Composition, Mineral Content, Phytochemical Screening and Anti-Nutritional Constituents of Walnut ( Tetracarpidium conophorum(OR Plukenetia conophora) Seeds.

Proximate Composition, Mineral Content, Phytochemical Screening and Anti-Nutritional Constituents of Walnut ( Tetracarpidium conophorum(OR Plukenetia conophora) Seeds.

Abstract: This study was designed to evaluate the phytochemical screening, proximate composition, mineral content and anti nutritional constituents of cooked and raw African walnut (Tetracarpidium conophorum or Plukenetia conophora) seeds. The phytochemical screening of the seed reveals the presence of alkaloids, glycosides, steroids and polyphenols. The result of the proximate analysis was shown to be moisture (17.5±0.03%), crude protein (4.506±0.01%), lipid (20.0±0.05%), crude fibre (20.0±0.02%), ash (15.5±0.05%), carbohydrate (22.49±0.01%), vitamin C (11.15±0.1mg/kg) for cooked seeds and moisture (18.0±0.02%), crude protein (13.13±0.01%), lipid (22.50±0.025%), crude fibre(18.0±0.01%), ash (14.25±0.08%), carbohydrate (14.12±0.01%) and vitamin C (11.0±0.1mg/kg) for the raw seeds. The result of the mineral content of the seed was shown to be Cu (0.079±0.003PPM), Zn (0.1507±0.01PPM), Mn (0.124±0.01PPM), and Fe (0.124±0.01PPM) for the cooked seeds and Cu (1.08±0.1PPM), Zn (2.26±0.1PPM), Mn (0.064±0.001PPM) and Fe (0.079±0.002PPM) for the raw seeds. The anti nutrients content of the cooked sample was shown to be oxalate (0.0207± 0.01mg/100ml), phytate (0.114±0.01mg/100ml), hydocyanide (0.011±0.10mg/100ml) and that of the raw seeds was shown tobe oxalate (0.204±0.10mg/100ml), phytate (0.123±0.02mg/100ml) and hydrocyanide (0.112±0.10mg/100ml). This analysisshowed that African walnut seedsare a rich source of lipid, fibre, carbohydrate, vitamin C, alkaloids, Polyphenols, glycosides, Cu, Zn, Mn and Fe. The concentration of some of the analytes were lower in the cooked sample especially the anti-nutritional constituent, while carbohydrate, fibre and ash were higher in the cooked sample; this implies that processing of food results in the reduction of anti-nutritional factors. This seed could be eaten frequently by diabetic and hypertensive patients because of its constituents.

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PHYTOCHEMICAL SCREENING AND ESTIMATION OF NUTRITIONAL CONTENT OF WHEATGRASS POWDER AND WHEATGRASS JUICE

PHYTOCHEMICAL SCREENING AND ESTIMATION OF NUTRITIONAL CONTENT OF WHEATGRASS POWDER AND WHEATGRASS JUICE

Wheatgrass is rich in many minerals, vitamins, amino acids, proteins, carbohydrates, chlorophyll, enzymes that are useful for our body. Now-a-days, many formulations of wheatgrass are available in market, but no proper study is available to compare the effectiveness between wheatgrass powder and wheatgrass juice. Present work of estimate the phytochemical screening and nutritional content present in both wheatgrass powder and fresh wheatgrass juice, based on chemical investigation and spectroscopy which is simple, inexpensive and less time-consuming method. This method is properly validated using standard chemicals. In our project, the contents of Chlorophyll and Vitamin C in wheatgrass powder and fresh wheatgrass juice, were determined. Along with estimation of phytochemical screening of active constituents which are extracted in aqueous, chloroform and n-hexane solvents.

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Phytochemical Screening, Nutritional and Toxicological Analyses of Leaves and Fruits of Solanum macrocarpon Linn (Solanaceae) in Cotonou (Benin)

Phytochemical Screening, Nutritional and Toxicological Analyses of Leaves and Fruits of Solanum macrocarpon Linn (Solanaceae) in Cotonou (Benin)

Vegetables are very important sources of protein and minerals. Some of them even have medicinal properties recog- nized traditionally. Despite the large number of studies carried out on various vegetables and vegetable crops, very few have scientifically explored the usefulness of S. macrocarpon. This study identified the main groups of chemicals and mineral elements to explain any medicinal or nutritional value. It has also identified some toxic elements contained in this vegetable. Phytochemical screening was carried out on the leaves and fruits of S. macrocarpon. Some mineral ele- ments were determined by Atomic Absorption Spectrophotometry (sodium, potassium, calcium, magnesium) while protein, phosphorous, iron, copper, zinc and toxic metals (lead, cadmium) were determined by Molecular Absorption Spectrophotometry. Fat, ash, moisture and vitamins were sought. The study showed that the leaves of S. macrocarpon were more nutritious than fruits (P < 0.05). The high protein content of the leaves and fruit suggests an interesting nutri- tive property. The presence of chemical groups and toxic elements (lead, cadmium) in S. macrocarpon require that the consumption of vegetables should be as varied as possible and that the fruit may be consumed with caution. In addition, constraints about vegetable cultivation in Cotonou could lead to research findings that could help provide techniques for producing healthy vegetables.Vitamins A and K1 were found in both parts of this vegetable very rich in water while vitamin E has not been detected. S. macrocarpon also contains lipids at various levels.

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Clinical and nutritional correlations in Parkinson’s disease: Preliminary report

Clinical and nutritional correlations in Parkinson’s disease: Preliminary report

2002, results ≥3 indicate the threat of malnutrition and the necessity for nutritional intervention. The thickness of 3 skin folds was measured: deltoid, abdominal, and sub- scapular. The neurological status was based on the Unified Parkinson’s Disease Rating Scale (UPDRS, v. 1987; at the time of the study the new version, MDS-UPDRS, had not yet received official approval in Poland), 8 Schwab and England

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The prognostic significance of nutritional status using malnutrition universal screening tool in patients with pulmonary tuberculosis

The prognostic significance of nutritional status using malnutrition universal screening tool in patients with pulmonary tuberculosis

A number of nutrition screening tools have therefore been developed. MUST is a well-validated and reliable screening tool. Stratton et al. showed that MUST has predictive validity in an elderly hospitalized population, with regard to mortality, both in hospital and after discharge, and length of hospital stay [20]. Harris et al. reported that MUST was a sensitive and specific method of identifying those requiring further nutritional assessment in elderly people living in sheltered accom- modation [21]. Recently, a cross-sectional study of the nutritional status of community-dwelling people with idiopathic Parkinson’s disease revealed the usefulness of MUST as an early screening tool [22].

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“Nutritional Profile, Antinutritional Profile and Phytochemical Screening of Garhwal Himalaya Medicinal Plant Dioscorea alata Tuber” by Sarla Saklani,Subhash Chandra, Abhay P. Mishra, Pankaj Bisht, India.

“Nutritional Profile, Antinutritional Profile and Phytochemical Screening of Garhwal Himalaya Medicinal Plant Dioscorea alata Tuber” by Sarla Saklani,Subhash Chandra, Abhay P. Mishra, Pankaj Bisht, India.

The present study aimed at evaluating nutritional Profile, antinutritional profile and phytochemical screening of Garhwal Himalaya medicinal plant Dioscorea alata tuber. The plant has been found to rich in medicinal properties such as anticancer, antidibetic, antimicrobial activity. The plant tuber have been found to rich in nutrients and antinutrients such as crude protein 2.81(%), carbohydrates 6.80(%), crude fibre 4.01(%), crude fat 0.81(%) and antinutrients alkaloids 0.51(%), flavonoids 1.32(%), saponins 2.56(%) and tannins 0.66(%) respectively. This analysis revealed that the plants contained potent medicinal properties as compared to another medicinal plant.

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Frailty and nutritional status in older people: the Mini Nutritional Assessment as a screening tool for the identification of frail subjects

Frailty and nutritional status in older people: the Mini Nutritional Assessment as a screening tool for the identification of frail subjects

deployed to compare proportions. Pearson’s linear regression was used to correlate continuous variables. Nonparametric correlations were evaluated using Spearman’s rank cor- relation, as indicated. One-way ANOVA and simple linear correlation assessed the relationship between continuous variables. The analysis of covariance (ANCOVA) was used to evaluate the influence of fracture on the relationship between nutritional status (through the MNA) and frailty

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Predicting clinical outcome of cardiac patients by six malnutrition screening tools

Predicting clinical outcome of cardiac patients by six malnutrition screening tools

In a study done on acute stroke patients to determine the nutritional status and the association between nutri- tional status and health outcomes, 19.2 % of patients were malnourished on admission according to Subjective Global Assessment (SGA) [12]. Moreover malnutrition was found to be associated with increased length of stay and increased prevalence of dysphagia, enteral feeding and other complications. The ability of Mini Nutritional Assessment (MNA-SF) to predict increased risk of mor- tality and transfers is shown in a study done in a tertiary-care geriatric hospital in Switzerland [13] as well as in a study done in a sub acute care facility in Australia [14]. Cardiac patients are specially considered as at risk of malnutrition due to apparent factors includ- ing heart failure, anorexia, pre-investigate ‘nil by mouth’ and due to cardiac cachexia [15]. Mortality risk is two times more in cardiac patients with moderate or severe protein energy malnutrition [16]. The research evidence on predicting the clinical outcome according to nutri- tional status of the cardiac patients is limited. More than half of the cardiac patients and sixty percent of the pa- tients with congestive cardiac failure were identified as malnourished according to SGA in study done in Brazil [16]. Though malnutrition is rarely the primary cause of death, it contributes to poor patient prognosis by aggra- vating pre-existing heart failure and increasing the sus- ceptibility to infections [17].

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 NUTRITIONAL EVALUATION, ANTIMICROBIAL ACTIVITY AND PHYTOCHEMICAL SCREENING OF WILD EDIBLE FRUIT (CARISSA OPACA)

 NUTRITIONAL EVALUATION, ANTIMICROBIAL ACTIVITY AND PHYTOCHEMICAL SCREENING OF WILD EDIBLE FRUIT (CARISSA OPACA)

The aim of the present study was to investigate Nutritional profile, Antimicrobial activity and Phytochemical Screening of Wild edible fruit of Garhwal Himalaya, Carissa opaca. The fruits have been found to rich in nutrients such as crude protein1.3%, carbohydrates17.39%, crude fiber3.4%, ash content1.25% and minerals as calcium, magnesium, potassium and phosphorus (1.0, 8.4, 1.98 and 0.24 mg/100g) respectively. The ethanolic fruit extracts of Carissa opaca showed significant activity 15±1mm, 14±1mm and 13±1mm against Streptococcus pyogenes, Streptococcus aureus and Bacillus cereus against food poisoning bacteria, and phytochemical screening for the presence of glycosides, flavonoids, phenols, resin and tannins. However, alkaloids were present in leaf. This analysis revealed that, the fruits contained higher value of fat, protein, fiber and minerals as compared to the cultivated fruits with apple and 200 gm fruits contain sufficient amount of nutrients, required per day by a person. Consumption of fruits may promote general health and well-being as well as reduce the risk of chronic diseases.

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