Treating Malnutrition Vital for Patient Health

It is estimated that at least one-third of patients indeveloped countries such as the United States are malnourished upon admissionto the hospital. According to The Malnutrition Quality Collaborative’s  National Blueprint: Achieving Quality MalnutritionCare for Older AdultsUp to 1 out of 2 older adults (>65years old) are at risk for malnutrition.

If left untreated, two-thirds of those malnourished patientsmay experience adverse outcomes including suppression of the immune system,impaired wound healing, muscle wasting, longer lengths of hospital stay andincreased mortality.

Nutrition isa team approach that includes all health care providers, patients and theirfamilies. In the hospital, patients are required to have a nutrition screeningconducted within 24 hours of admission by nursing staff. A consult is sent tothe dietitian if nutrition concerns are identified. The Registered Dietitiansees the patient and assesses their needs. Standard malnutrition characteristicsare used as set forth by The Academy of Nutrition & Dietetics (AND) andA.S.P.E.N. guidelines to identify malnutrition.

“Nutrition concerns may include unplanned weight loss, decreased appetite orfood intake, difficulty chewing or swallowing, chronic non-healing wounds, orneed for tube feeding,  IV nutrition ornutritional supplements in order to  meetpatient’s needs”, says Bethesda North Hospital Registered Dietitian KarolinSaweres, RDN, LD.

TheAcademy of Nutrition and Dietetics (AND) and the American Society for Enteraland Parenteral Nutrition (ASPEN) require two out of six criteria (decreasedenergy intake, weight loss, body fat loss, muscle mass wasting, fluid/edema,hand grip strength) to support a diagnosis of malnutrition. 

HepaticProtein (albumin, pre-albumin, and transferrin) labs are no longer supported todiagnose malnutrition as these are more indicative of inflammation.

If malnutrition is identified, Saweres works with them to developan individualized nutrition care plan. She works on increasing actual foodconsumption. A nutritional supplement is often needed to accomplish this. Thenutrition care plan is a continuous process. Positive or negative outcomes are monitoredand revised as needed.

Steps to TreatingMalnutrition 

 Saweres recommends the following:

• Caloriedense, high protein foods 
• Small,frequent meals 
• Oralnutritional supplements (including liquid nutritional supplements, protein barsor homemade shakes) 
• Encouragingfamily to visit during meal times to help encourage or feed the patient 
• Communitynutrition programs such as home-delivered meals 
• Followingup with an outpatient dietitian to evaluate treatment plan 

“Malnutrition can be prevented and is treatable. Malnutritionis common, especially in an acute care setting, but is frequently unrecognized.Early detection is key,” Saweres adds.

Karolin Saweres, RDN,LD is a Clinical Dietitian with special interest in malnutrition. She practiceswith TriHealth and sees inpatients at Bethesda North Hospital. She also seespatients at her private practice, My Nutrition & Me. She has 10+ years ofexperience.