Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-28T01:26:40.643Z Has data issue: false hasContentIssue false
  • English
  • Français

An algorithm for the clinical assessment of nutritional status in hospitalized patients

Published online by Cambridge University Press:  09 March 2007

J. Th. C. M. de Kruif  and
A. Vos
J. Th. C. M. de Kruif
Affiliation:
University Medical Centre Utrecht, Department of Surgery, P.O. Box 85500, 3505 GA Utrecht, The Netherlands
A. Vos*
Affiliation:
University Medical Centre Utrecht, Department of Surgery, P.O. Box 85500, 3505 GA Utrecht, The Netherlands
*
*Corresponding author: Dr A. Vos, fax +31 30 2505459, email a.vos@chir.azu.nl
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Upon admission to hospital, 30–50% of patients either are or become malnourished. There is no generally accepted definition of malnutrition or guidelines on the best way to establish nutritional status. We consider it self-evident that the nursing staff have an important role in screening patients at risk of malnutrition on admission and thereafter at regular times. This is why we developed the nursing nutritional screening form (NNSF). The NNSF was tested by nurses, dietitians and clinicians, in pairs, to establish the extent of agreement in two phases on sixty-nine and forty patients. Later, the form was used in practice by nursing staff on five wards (334 patients). Based on the results of the NNSF, patients were referred to a dietitian. The dietitian established whether the patient was indeed at risk, or was actually malnourished, using a complete nutritional history. The degree of concurrence within pairs was reasonable to good. The same applied to the concurrence between nursing staff and dietitians, but concurrence between clinicians and nursing staff was less. In total, 334 patients were screened and sixty-nine of them were referred to the dietitian. It was established that 86% of the referred patients were potentially at risk of malnutrition or were malnourished. Without the NNSF, 39% (n 27) of the patients referred to the dietitian would not have been referred, or would have been referred much later. The NNSF makes it possible for nurses to detect malnourished patients or patients at risk of malnutrition at an early stage of their hospitalization.

Keywords

MalnutritionScreeningNursingConsultation
Type
Research Article
Information
British Journal of Nutrition , Volume 90 , Issue 4 , October 2003 , pp. 829 - 836
Copyright
Copyright © The Nutrition Society 2003

References

Arrowsmith, H (1999) A critical evaluation of the use of nutrition screening tools by nurses. Br J Nurs 22, 1483–1490.CrossRefGoogle Scholar
Baker, JP, Detsky, AS, Wesson, DE, et al. (1982) Nutritional assessment – A comparison of clinical judgment and objective measurements. N Engl J Med 306, 969–972.CrossRefGoogle Scholar
Bistrian, BR, Blackburn, GL, Hallowell, E & Heddle, R (1974) Protein status of general surgical patients. JAMA 239, 858–860.CrossRefGoogle Scholar
Blackburn, G & Thornton, P (1979) Nutritional assessment of the hospitalised patient. Med Clin North Am 63, 1103–1115.CrossRefGoogle Scholar
Buzby, GP, Mullen, JL, Matthews, DC, Hobbs, CL & Rosato, EF (1980) Prognostic Nutritional Index in gastrointestinal surgery. Am J Surg 139, 160–167.CrossRefGoogle ScholarPubMed
Coats, KG, Morgan, SL, Bartolucci, AS & Weinsier, RL (1993) Hospital associated malnutrition: a reevaluation 12 years later. J Am Diet Assoc 93, 27–33.CrossRefGoogle ScholarPubMed
Collins, JP, McCarthy, ID & Hill, GL (1979) Assessment of protein nutrition in surgical patients – the value of anthropometrics. Am J Clin Nutr 32, 1527–1530.CrossRefGoogle Scholar
Detsky, AS, McLaughlin, JR, Baker, JP, et al. (1987) What is subjective global assessment of nutritional status? J Parenter Enteral Nutr 11, 8–13.CrossRefGoogle ScholarPubMed
Edes, TE (1991) Nutrition support of critically ill patients. Post-grad Med 5, 193–200.CrossRefGoogle Scholar
Edington, J, Boorman, J, Durrant, ER, et al. (2000) Prevalence of malnutrition on admission to four hospitals in England. Clin Nutr 19, 191–195.CrossRefGoogle ScholarPubMed
Evans-Stoner, N (1997) Nutrition assessment. A practical approach. Nurs Clin North Am 4, 637–650.CrossRefGoogle Scholar
Forse, RA & Shizgal, HM (1980) The assessment of malnutrition. Surgery 88, 17–24.Google ScholarPubMed
French Speaking, Society for, Parenteral and Enteral Nutrition (1996) Perioperative artificial nutrition in elective adult surgery. Clin Nutr 15, 223–229.CrossRefGoogle Scholar
Green, CJ (1999) Existence, causes and consequences of disease-related malnutrition in the hospital and the community, and clinical and financial benefits of nutritional intervention. Clin Nutr 18, Suppl. 2, 3–28.CrossRefGoogle Scholar
Grindel, GC & Costello, MC (1996) Nutrition screening: an essential assessment parameter. J Acad Med-Surg Nurs 3, 145–156.Google Scholar
Halsted, ChH (2001) Malnutrition and nutritional assessment. In Harrison's Principles of Internal Medicine, pp. 455–461 [Braunwald,, E, Fauci,, AS, Kasper,, DL, Hauser,, SL, Longo, DLJameson, JL, editors]. New York, NY: McGraw-Hill Inc.Google Scholar
Ham, RJ (1994) The signs and symptoms of poor nutritional status. Prim Care 1, 33–54.CrossRefGoogle Scholar
Henry, CJK (1990) Body mass index and the limits of human survival. Eur J Clin Nutr 44, 329–335.Google ScholarPubMed
Jeejeebhoy, KN, Detsky, AS & Baker, JP (1990) Assessment of nutritional status. J Parenter Enteral Nutr 14, 193–196.CrossRefGoogle ScholarPubMed
Jones, JM (2002) The methodology of nutritional screening and assessment tools. J Hum Nutr Diet 15, 59–71.CrossRefGoogle ScholarPubMed
Jong, PCM de, Wesdorp, RIC, Volovics, A, Rouffart, M, Greep, JM & Soeters, PB (1985) The value of objective measurements to select patients who are malnourished. Clin Nutr 4, 61–66.CrossRefGoogle ScholarPubMed
Kern, K & Norton, J (1988) Cancer cachexia. J Parenter Enteral Nutr 12, 286–295.CrossRefGoogle ScholarPubMed
Klein, S, Kinney, J, Jeejeebhoy, KN, et al. (1997) Nutrition support in clinical practice: review of published data and recommendations for future research directions. Am J Clin Nutr 66, 683–706.CrossRefGoogle ScholarPubMed
Kovacevich, DS, Boney, AR, Braunschweig, CL, Perez, A & Stevens, M (1997) Nutrition Risk Classification: A reproducible and valid tool for nurses. Nutr Clin Pract 12, 20–25.CrossRefGoogle ScholarPubMed
Landis, RJ & Koch, GG (1977) The measurement of observer agreement for categorical data. Biometrics 33, 159–174.CrossRefGoogle ScholarPubMed
Leistra, E, Liefhebber, S, Geomini, M & Hens, H (1999) Job Description for Nurses. Maarssen, The Netherlands: Elsevier/De Tijdstroom; Netherlands Centre for Excellence in Nursing.Google Scholar
Livingstone, MBE (1995) Assessment of food intakes: are we measuring what people eat? Br J Biomed Sci 52, 58–67.Google Scholar
Lyne, PA & Prowse, MA (1999) Methodological issues in the development and use of instruments to assess patient nutritional status or the level of risk of nutritional compromise. J Adv Nurs 4, 835–842.CrossRefGoogle Scholar
Markou, SA, Kalfarentzos, F & Androulakis, J (1993) Prediction of nutrition-associated complications using clinical nutritional assessment: an objective medical decision making approach. Theor Surg 8, 84–89.Google Scholar
McWhirter, JP & Pennington, CR (1994) Incidence and recognition of malnutrition in hospital. Br Med J 308, 945–948.CrossRefGoogle ScholarPubMed
von Meyenfeldt, MF, Meijerink, WJHJ, Rouflart, MMJ, Builmaassen, MTHJ & Soeters, PB (1992) Perioperative nutritional support: a randomised clinical trial. Clin Nutr 11, 180–186.CrossRefGoogle ScholarPubMed
Naber, THJ, Schermer, T, de Bree, A, et al. (1997) Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr 66, 1232–1239.CrossRefGoogle ScholarPubMed
Pettigrew, RA, Charlesworth, PM, Farmilo, RW & Hill, GL (1983) Assessment of nutritional depletion and immune competence: A comparison of clinical examination and objective measurements. J Parenter Enteral Nutr 8, 21–24.Google Scholar
Reilly, HM, Martineau, JK, Moran, A & Kennedy, H (1995) Nutritional screening. Evaluation and implementation of a simple Nutrition Risk Score. Clin Nutr 14, 269–273.CrossRefGoogle ScholarPubMed
Schneider, SM & Hebutherne, X (2000) Use of nutritional scores to predict clinical outcomes in chronic diseases. Nutr Rev 2, 31–38.Google Scholar
Symreng, T, Anderberg, B, Kågedal, B, Schildt, AB & Sjödahl, R (1983) Nutritional assessment and clinical course in 112 elective surgical patients. Acta Chir Scand 149, 657–662.Google ScholarPubMed
Van Bokhorst-de, van der, Schueren, MAE, van Leeuwen, PM, Sauerwein, HP, Kuik, DJ, Snow, GB & Quak, JJ (1997) Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications. Head Neck 19, 419–425.3.0.CO;2-2>CrossRefGoogle Scholar
Weinsier, RL, Edie, PH, Hunker, RN, Krumdieck, CL & Butterworth, CE (1979) Hospital nutrition: a prospective evaluation of general medical patients during the course of hospital-isation. Am J Clin Nutr 32, 418–426.CrossRefGoogle Scholar
White, JV (1994) Risk factors for poor nutritional status. Prim Care 1, 19–32.CrossRefGoogle Scholar