Treating Malnutrition Vital for Patient Health
It is estimated that at least one-third of patients in developed countries such as the United States are malnourished upon admission to the hospital. According to The Malnutrition Quality Collaborative’s National Blueprint: Achieving Quality Malnutrition Care for Older AdultsUp to 1 out of 2 older adults (>65 years old) are at risk for malnutrition.
If left untreated, two-thirds of those malnourished patients may experience adverse outcomes including suppression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay and increased mortality.
Nutrition is a team approach that includes all health care providers, patients and their families. In the hospital, patients are required to have a nutrition screening conducted within 24 hours of admission by nursing staff. A consult is sent to the dietitian if nutrition concerns are identified. The Registered Dietitian sees the patient and assesses their needs. Standard malnutrition characteristics are used as set forth by The Academy of Nutrition & Dietetics (AND) and A.S.P.E.N. guidelines to identify malnutrition.
“Nutrition concerns may include unplanned weight loss, decreased appetite or food intake, difficulty chewing or swallowing, chronic non-healing wounds, or need for tube feeding, IV nutrition or nutritional supplements in order to meet patient’s needs”, says Bethesda North Hospital Registered Dietitian Karolin Saweres, RDN, LD.
The Academy of Nutrition and Dietetics (AND) and the American Society for Enteral and Parenteral Nutrition (ASPEN) require two out of six criteria (decreased energy intake, weight loss, body fat loss, muscle mass wasting, fluid/edema, hand grip strength) to support a diagnosis of malnutrition.
Hepatic Protein (albumin, pre-albumin, and transferrin) labs are no longer supported to diagnose malnutrition as these are more indicative of inflammation.
If malnutrition is identified, Saweres works with them to develop an individualized nutrition care plan. She works on increasing actual food consumption. A nutritional supplement is often needed to accomplish this. The nutrition care plan is a continuous process. Positive or negative outcomes are monitored and revised as needed.
Steps to Treating Malnutrition
Saweres recommends the following:
- Calorie dense, high protein foods
- Small, frequent meals
- Oral nutritional supplements (including liquid nutritional supplements, protein bars or homemade shakes)
- Encouraging family to visit during meal times to help encourage or feed the patient
- Community nutrition programs such as home-delivered meals
- Following up with an outpatient dietitian to evaluate treatment plan
“Malnutrition can be prevented and is treatable. Malnutrition is 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 practices with TriHealth and sees inpatients at Bethesda North Hospital. She also sees patients at her private practice, My Nutrition & Me. She has 10+ years of experience.