| 1. |
- Kyle, Ursula G, et al.
(författare)
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Bioelectrical impedance analysis--part I: review of principles and methods.
- 2004
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Ingår i: Clinical nutrition (Edinburgh, Scotland). - : Elsevier BV. - 0261-5614. ; 23:5, s. 1226-43
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Forskningsöversikt (refereegranskat)abstract
- The use of bioelectrical impedance analysis (BIA) is widespread both in healthy subjects and patients, but suffers from a lack of standardized method and quality control procedures. BIA allows the determination of the fat-free mass (FFM) and total body water (TBW) in subjects without significant fluid and electrolyte abnormalities, when using appropriate population, age or pathology-specific BIA equations and established procedures. Published BIA equations validated against a reference method in a sufficiently large number of subjects are presented and ranked according to the standard error of the estimate. The determination of changes in body cell mass (BCM), extra cellular (ECW) and intra cellular water (ICW) requires further research using a valid model that guarantees that ECW changes do not corrupt the ICW. The use of segmental-BIA, multifrequency BIA, or bioelectrical spectroscopy in altered hydration states also requires further research. ESPEN guidelines for the clinical use of BIA measurements are described in a paper to appear soon in Clinical Nutrition.
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| 2. |
- Kyle, Ursula G, et al.
(författare)
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Bioelectrical impedance analysis-part II: utilization in clinical practice.
- 2004
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Ingår i: Clinical nutrition (Edinburgh, Scotland). - : Elsevier BV. - 0261-5614. ; 23:6, s. 1430-53
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Forskningsöversikt (refereegranskat)abstract
- BIA is easy, non-invasive, relatively inexpensive and can be performed in almost any subject because it is portable. Part II of these ESPEN guidelines reports results for fat-free mass (FFM), body fat (BF), body cell mass (BCM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) from various studies in healthy and ill subjects. The data suggests that BIA works well in healthy subjects and in patients with stable water and electrolytes balance with a validated BIA equation that is appropriate with regard to age, sex and race. Clinical use of BIA in subjects at extremes of BMI ranges or with abnormal hydration cannot be recommended for routine assessment of patients until further validation has proven for BIA algorithm to be accurate in such conditions. Multi-frequency- and segmental-BIA may have advantages over single-frequency BIA in these conditions, but further validation is necessary. Longitudinal follow-up of body composition by BIA is possible in subjects with BMI 16-34 kg/m(2) without abnormal hydration, but must be interpreted with caution. Further validation of BIA is necessary to understand the mechanisms for the changes observed in acute illness, altered fat/lean mass ratios, extreme heights and body shape abnormalities.
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| 3. |
- Bendavid, Itai, et al.
(författare)
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The centenary of the Harris-Benedict equations : How to assess energy requirements best? Recommendations from the ESPEN expert group
- 2021
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Ingår i: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 40:3, s. 690-701
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Forskningsöversikt (refereegranskat)abstract
- Background & aims: The year 2019 marked the centenary of the publication of the Harris and Benedict equations for estimation of energy expenditure. In October 2019 a Scientific Symposium was organized by the European Society for Clinical Nutrition and Metabolism (ESPEN) in Vienna, Austria, to celebrate this historical landmark, looking at what is currently known about the estimation and measurement of energy expenditure.Methods: Current evidence was discussed during the symposium, including the scientific basis and clinical knowledge, and is summarized here to assist with the estimation and measurement of energy requirements that later translate into energy prescription.Results: In most clinical settings, the majority of predictive equations have low to moderate performance, with the best generally reaching an accuracy of no more than 70%, and often lead to large errors in estimating the true needs of patients. Generally speaking, the addition of body composition measurements did not add to the accuracy of predictive equations. Indirect calorimetry is the most reliable method to measure energy expenditure and guide energy prescription, but carries inherent limitations, greatly restricting its use in real life clinical practice.Conclusions: While the limitations of predictive equations are clear, their use is still the mainstay in clinical practice. It is imperative to recognize specific patient populations for whom a specific equation should be preferred. When available, the use of indirect calorimetry is advised in a variety of clinical settings, aiming to avoid under-as well as overfeeding.
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| 4. |
- Guest, Julian F., et al.
(författare)
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Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK
- 2011
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Ingår i: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 30:4, s. 422-429
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: To examine the effect of malnutrition on clinical outcomes and healthcare resource use from initial diagnosis by a general practitioner (GP) in the UK. Methods: 1000 records of malnourished patients were randomly selected from The Health Improvement Network database and matched with a sample of 996 patients' records with no previous history of malnutrition. Patients' outcomes and resource use were quantified for six months following diagnosis. Results: Malnourished patients utilised significantly more healthcare resources (e.g. 18.90 versus 9.12 GP consultations; p < 0.001, and 13% versus 5% were hospitalised; p < 0.05). The six-monthly cost of managing the malnourished and non-malnourished group was 1753 pound and 750 pound per patient respectively, generating an incremental cost of care following a diagnosis of malnutrition of 1003 per patient. Thirteen percent and 2% of patients died in the malnourished and non-malnourished group respectively (p < 0.001). Independent predictors of mortality were: malnutrition (OR: 7.70); age (per 10 years) (OR: 10.46); and the Charlson Comorbidity Index Score (per unit score) (OR: 1.24). Conclusion: The healthcare cost of managing malnourished patients was more than twice that of managing non-malnourished patients, due to increased use of healthcare resources. After adjusting for age and comorbidity, malnutrition remained an independent predictor of mortality. (C) 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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| 5. |
- Hiesmayr, Michael, et al.
(författare)
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The Patient- And Nutrition-Derived Outcome Risk Assessment Score (PANDORA) : Development of a Simple Predictive Risk Score for 30-Day In-Hospital Mortality Based on Demographics, Clinical Observation, and Nutrition
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 10:5
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Tidskriftsartikel (refereegranskat)abstract
- Objective To develop a simple scoring system to predict 30 day in-hospital mortality of in-patients excluding those from intensive care units based on easily obtainable demographic, disease and nutrition related patient data. Methods Score development with general estimation equation methodology and model selection by P-value thresholding based on a cross-sectional sample of 52 risk indicators with 123 item classes collected with questionnaires and stored in an multilingual online database. Setting Worldwide prospective cross-sectional cohort with 30 day in-hospital mortality from the nutritionDay 2006-2009 and an external validation sample from 2012. Results We included 43894 patients from 2480 units in 32 countries. 1631(3.72%) patients died within 30 days in hospital. The Patient-And Nutrition-Derived Outcome Risk Assessment (PANDORA) score predicts 30-day hospital mortality based on 7 indicators with 31 item classes on a scale from 0 to 75 points. The indicators are age (0 to 17 points), nutrient intake on nutritionDay (0 to 12 points), mobility (0 to 11 points), fluid status (0 to 10 points), BMI (0 to 9 points), cancer (9 points) and main patient group (0 to 7 points). An appropriate model fit has been achieved. The area under the receiver operating characteristic curve for mortality prediction was 0.82 in the development sample and 0.79 in the external validation sample. Conclusions The PANDORA score is a simple, robust scoring system for a general population of hospitalised patients to be used for risk stratification and benchmarking.
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| 6. |
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| 7. |
- Schindler, Karin, et al.
(författare)
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How nutritional risk is assessed and managed in European hospitals : a survey of 21,007 patients findings from the 2007-2008 cross-sectional nutritionDay survey
- 2010
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Ingår i: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 29:5, s. 552-559
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Recognition and treatment of undernutrition in hospitalized patients are not often a priority in clinical practice.OBJECTIVES: We investigated how the nutritional risk of patients is determined and whether such assessment influences daily nutritional care across Europe and in Israeli hospitals.METHODS: 1217 units from 325 hospitals in 25 countries with 21,007 patients participated in a longitudinal survey "nutritionDay" 2007/2008 undertaken in Europe and Israel. Screening practice, the type of tools used and whether energy requirements and intake are assessed and monitored were surveyed using standardized questionnaires.RESULTS: Fifty-two percent (range 21-73%) of the units in the different regions reported a screening routine which was most often performed with locally developed methods and less often with national tools, the Nutrition Risk Screening-2002, or the Malnutrition Universal Screening Tool. Twenty-seven percent of the patients were subjectively classified as being "at nutritional risk", with substantial differences existing between regions. Independent factors influencing the classification of nutritional risk included age, BMI <18.5 kg/m(2), unintentional weight loss, reduced food intake in the previous week and on nutritionDay (for all parameters, p < 0.0001). The energy goal was defined as >=1500 kcal in 76% of the patients, but 43% of patients did not reach this goal.CONCLUSIONS: The process of nutrition risk assessment varied between units and countries. Additionally, energy goals were frequently not met. More effort is needed to implement current guidelines within daily clinical practice.
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| 8. |
- Schindler, Karin, et al.
(författare)
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nutritionDay : 10 years of growth
- 2017
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Ingår i: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 36:5, s. 1207-1214
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND & AIMS: Despite high prevalence at hospital admission, disease related malnutrition (DRM) remains under recognized and undertreated. DRM is associated with increased morbidity, hospital readmission rate, and burden for the healthcare system. The compelling need to increase awareness and knowledge through an international survey has triggered the launch of the nutritionDay (ND) concept.METHODS: ND is a worldwide annual systematic collection and analysis of data in hospital wards, intensive care units and nursing homes. ND is based on questionnaires to systematically collect and analyze the patient's characteristics, food intake and nutrition support, as well as the determinants of their environment (facility, health care personal, etc …). Questionnaires, outcome documentation sheets and step-by-step guidance are available as download in 30 languages.RESULTS: ND has described the nutritional status and behavior of over 150,000 hospitalized patients and nursing home's patients in over 56 participating countries. These data allowed a local, regional, national and international benchmarking at different levels (i.e. type of medical pathologies, care facilities, etc.) and over time. Sixteen peer-reviewed publications have already been released and picture the international scene of DRM.CONCLUSION: This review presents the 10-year of the ND project development and shows how ND serves all health care professionals to optimize nutrition care and nutrition related structures. ND keeps progressing and is likely to become a standard tool for determining the nutritional status and behavior of hospitalized patients and nursing home's population.
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| 9. |
- Schindler, Karin, et al.
(författare)
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To eat or not to eat? Indicators for reduced food intake in 91,245 patients hospitalized on nutritionDays 2006-2014 in 56 countries worldwide : a descriptive analysis
- 2016
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Ingår i: American Journal of Clinical Nutrition. - Bethesda, USA : American Society for Nutrition. - 0002-9165 .- 1938-3207. ; 104:5, s. 1393-1402
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Tidskriftsartikel (refereegranskat)abstract
- Background: Inadequate nutrition during hospitalization is strongly associated with poor patient outcome, but ensuring adequate food intake is not a priority in clinical routine worldwide. This lack of priority results in inadequate and unbalanced food intake in patients and huge amounts of wasted food.Objectives: We evaluate the main factors that are associated with reduced meal intake in hospitalized patients and the differences between geographical regions.Design: We conducted a descriptive analysis of data from 9 consecutive, annual, and cross-sectional nutritionDay samples (2006-2014) in a total of 91,245 adult patients in 6668 wards in 2584 hospitals in 56 countries. A general estimation equation methodology was used to develop a model for meal intake, and P-value thresholding was used for model selection.Results: The proportion of patients who ate a full meal varied widely (24.7-61.5%) across world regions. The factors that were most strongly associated with reduced food intake on nutritionDay were reduced intake during the previous week (OR: 0.20; 95% CI: 0.17, 0.22), confinement to bed (OR: 0.49; 95% CI: 0.44, 0.55), female sex (OR: 0.53; 95% CI: 0.5, 0.56), younger age (OR: 0.74; 95% CI: 0.64, 0.85) and older age (OR: 0.80; 95% CI: 0.74; 0.88), and low body mass index (OR: 0.84; 95% CI: 0.79, 0.90). The pattern of associated factors was homogenous across world regions.Conclusions: A set of factors that are associated with full meal intake was identified and is applicable to patients hospitalized in any region of the world. Thus, the likelihood for reduced food intake is easily estimated through access to patient characteristics, independent of world regions, and enables the easy personalization of food provision. This trial was registered at clinicaltrials.gov as NCT02820246.
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| 10. |
- Thibault, Ronan, et al.
(författare)
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ESPEN guideline on hospital nutrition
- 2021
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Ingår i: Clinical Nutrition. - 0261-5614 .- 1532-1983. ; 40:12, s. 5684-5709
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Tidskriftsartikel (refereegranskat)abstract
- In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.
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