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Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition Methodology & Assessment".

Deadline for manuscript submissions: 5 May 2024 | Viewed by 8417

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Special Issue Editors

Prof. Dr. Maurizio Marra

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Guest Editor

Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini 5, 80138 Naples, Italy
Interests: body composition; malnutrition; nutritional status; clinical nutrition

Dr. Andrea P. Rossi

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Co-Guest Editor

Department of Medicine, Section of Geriatrics, Healthy Aging Center, University of Verona, Verona, Italy
Interests: nutritional sciences; sarcopenia; sarcopenic obesity; malnutrition; abdominal obesity; geriatrics and nutrition; ectopic adipose tissue
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Ming Yang

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Co-Guest Editor

National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
Interests: sarcopenia; frailty; geriatric syndromes; evidence-based medicine; bibliometrics

Special Issue Information

Dear Colleagues,

Malnutrition is defined as the development of undernutrition as a result of a disease process or a medical condition, and it may be present on admission or be acquired during hospitalization. Poor nutrition has been adversely associated with a wide range of adverse clinical, functional and economic outcomes.

A systematic approach to addressing malnutrition in hospitals should begin with a nutritional risk assessment of all patients at admission, followed by a detailed appraisal of the nutritional status of patients most at risk.

Although a wide range of tools, such as body composition, biological markers for malnutrition and nutritional risk detection tools are available to clinicians, the objective measurement of the malnutrition domains is hampered by limitations intrinsic to the screening and assessment tools. Examples of the issues with current technology and methods include interobserver variability, difficult reproducibility, technician experience, their long temporal duration time, the relative expense of techniques, lack of tools validation, etc. Furthermore, the heterogeneity of the populations being evaluated, as well as the setting in which malnutrition is being investigated, impacts the definition of “gold standard” screening and the assessment techniques being systematically adopted.

In summation, the aim of this Special Issue is to provide an overview of the most widely used methods for nutritional screening to identify individuals at risk of malnutrition with different chronic diseases.

Prof. Dr. Maurizio Marra
Dr. Andrea P. Rossi
Prof. Dr. Ming Yang
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

body composition
malnutrition
nutritional status
chronic disease
screening tools

Published Papers (7 papers)

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Editorial

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5 pages, 213 KiB

Open AccessEditorial

Nutritional Assessment in Patients with Chronic Diseases: Tools, Challenges, and Future Directions

by Huiyu Tang and Ming Yang

Nutrients 2023, 15(22), 4794; https://doi.org/10.3390/nu15224794 - 16 Nov 2023

Viewed by 1448

Abstract

Chronic diseases, such as cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, are leading causes of morbidity and mortality worldwide [...] Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

Research

Jump to: Editorial

11 pages, 400 KiB

Open AccessArticle

Hospital Malnutrition in the Medicine and Neurology Departments: A Complex Challenge

by Erica Starace, Giulia De Pasquale, Emanuela Morenghi, Camilla Crippa, Sofia Matteucci, Gabriella Pieri, Fanny Soekeland, Stefano Maria Gibbi, Giuliana Lo Cricchio, Francesco Reggiani, Marta Calatroni, Manuela Pastore, Beatrice Mazzoleni and Stefano Mancin

Nutrients 2023, 15(24), 5061; https://doi.org/10.3390/nu15245061 - 11 Dec 2023

Viewed by 1146

Abstract

Hospital malnutrition is especially common among elderly patients with neurological deficits or dementia. These conditions can be exacerbated by unpalatable diets and issues such as dysphagia and presbyphagia. Our study aimed to investigate the prevalence of malnutrition in patients on a homogenized diet and to identify potential correlations with specific clinical variables. We conducted a retrospective observational study in compliance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. The study encompassed 82 patients, mainly elderly and diagnosed with neurodegenerative diseases. Upon initial assessment, 46.34% of the sample displayed a risk of malnutrition based on the Malnutrition Universal Screening Tool (MUST), and 62.20% were classified as malnourished based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Only 45.12% retained autonomy in food intake. Weight loss identified prior to the study was closely tied to malnutrition and influenced BMI. Moreover, autonomy in food intake was strongly associated with a prolonged hospital stay (LOS), and a similar trend was observed for water intake. Our findings emphasize the importance of promptly recognizing patients at risk of malnutrition, especially within such a vulnerable population. Autonomy in food intake and hydration emerge as critical indicators in the clinical management of hospitalized patients. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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12 pages, 2784 KiB

Open AccessArticle

A Comparative Evaluation of the Caloric Intake and Economic Efficiency of Two Types of Homogenized Diets in a Hospital Setting

by Camilla Crippa, Sofia Matteucci, Manuela Pastore, Emanuela Morenghi, Erica Starace, Giulia De Pasquale, Gabriella Pieri, Fanny Soekeland, Stefano Maria Gibbi, Giuliana Lo Cricchio, Andrea Zorloni, Beatrice Mazzoleni and Stefano Mancin

Nutrients 2023, 15(22), 4731; https://doi.org/10.3390/nu15224731 - 09 Nov 2023

Cited by 2 | Viewed by 910

Abstract

The prevalence of malnutrition is increasing globally due to factors such as age-related pathological conditions and diseases that impact food and beverage intake. In hospital settings, older adult patients often require homogenised diets, which can lead to malnutrition due to poor palatability and limited variety. This study compared the Standard Homogenised Diet (HSD) and a Modified Homogenized Diet (HMD) proposed in a tertiary hospital in Northern Italy. A retrospective and observational design was used to analyse data from 86 adult patients with various conditions requiring a homogenised diet. The primary goal was to compare food intake, rheological characteristics, and palatability of the two diets. The secondary objective was to evaluate the economic impact by comparing costs and quantifying food waste from unused meals. Patients on HMD had a median daily caloric intake of 852 kcal (IQR 787–926 kcal) compared to 631 kcal (IQR 506–797 kcal) in the HSD group. Taste, texture, palatability, and ease of intake for HMD outperformed HSD with scores such as 3.7 ± 0.6 vs. 2.5 ± 0.4 for taste. Economically, HMD was EUR 0.53 less expensive per day than HSD, and food wastage costs were significantly lower for HMD (EUR 2.66 ± 0.81) than HSD (EUR 4.66 ± 1.27). Overall, HMD presented substantial benefits in patient satisfaction and cost-efficiency. This insight may aid diverse care settings to enhance meal acceptance and nutritional intake for patients needing homogenised diets. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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13 pages, 610 KiB

Open AccessArticle

High Nutritional Risk Is Associated with Poor Functional Status and Prognostic Biomarkers in Stroke Patients at Admission to a Rehabilitation Unit

by Olivia Di Vincenzo, Ermenegilda Pagano, Mariarosaria Cervone, Raffaele Natale, Annadora Morena, Alessandra Esposito, Fabrizio Pasanisi and Luca Scalfi

Nutrients 2023, 15(19), 4144; https://doi.org/10.3390/nu15194144 - 25 Sep 2023

Cited by 3 | Viewed by 1065

Abstract

Considering that malnutrition (undernutrition) is common in stroke patients and may negatively impact body function, the aim of this study was to determine the relationship between nutritional risk and functional status in stroke patients at admission to a rehabilitation unit. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score. Functional status was assessed using the Barthel Index, the modified Rankin Scale, the Trunk Control Test and the Sitting Balance Scale, and cognitive function was assessed using the Short Portable Mental Status Questionnaire. C-reactive protein, fibrinogen and D-dimer were also evaluated as established prognostic biomarkers. Stroke patients (n = 245; age 69.7 ± 12.8 years; 47%, women; 82% ischemic stroke) at admission to a rehabilitation unit were included in this study. A high prevalence of nutritional risk was detected with each tool and was found to be greater using the GNRI and in patients aged ≥75 years. Multiple logistic regression analysis showed that age and dysphagia were independent predictors of high nutritional risk. High risk groups performed worse on all functional tests compared to the low-risk groups (p < 0.05). Nutritional risk with each tool was associated with functional and cognitive statuses (with the highest correlation being with the Trunk Control Test). Significant associations were also found with C-reactive protein, fibrinogen and D-dimer. In conclusion, a high nutritional risk, as evaluated with the GNRI, the PNI and the CONUT score, was detected in stroke patients at admission to a rehabilitation unit. High nutritional risk was associated with functional status and with predictors of clinical outcomes (and specifically in older patients). Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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11 pages, 289 KiB

Open AccessArticle

Validity and Applicability of the Global Leadership Initiative on Malnutrition (GLIM) Criteria in Patients Hospitalized for Acute Medical Conditions

by Laia Fontane, Maria Helena Reig, Sonika Garcia-Ribera, Miriam Herranz, Mar Miracle, Juan Jose Chillaron, Araceli Estepa, Silvia Toro, Silvia Ballesta, Humberto Navarro, Gemma Llaurado, Juan Pedro-Botet and David Benaiges

Nutrients 2023, 15(18), 4012; https://doi.org/10.3390/nu15184012 - 16 Sep 2023

Viewed by 897

Abstract

(1) Background: The objectives of this study were to evaluate the concurrent and predictive validity and the applicability of the global leadership initiative on malnutrition (GLIM) criteria in patients hospitalized for acute medical conditions. (2) Methods: prospective cohort study with patients hospitalized for acute medical conditions. For validation, the methodology proposed by the GLIM group of experts was used. Sensitivity and specificity values greater than 80% with respect to those for the subjective global assessment (SGA) were necessary for concurrent validation. The time necessary to complete each nutritional assessment test was determined. (3) Results: A total of 119 patients were evaluated. The SGA was applied to the entire cohort, but the GLIM criteria could not be applied to 3.4% of the patients. The sensitivity and specificity of the GLIM criteria with respect to those for the SGA to detect malnutrition were 78.0 and 86.2%, respectively. The GLIM predictive validity criterion was fulfilled because patients with malnutrition more frequently had a hospital stay >10 days (odds ratio of 2.98 (1.21–7.60)). The GLIM criteria required significantly more time for completion than did the SGA (p = 0.006). (4) Conclusion: The results of this study do not support the use of the GLIM criteria over the SGA for the diagnosis of malnutrition in patients hospitalized for acute medical conditions. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

15 pages, 3298 KiB

Open AccessArticle

Detection of Sarcopenia in Patients with Liver Cirrhosis Using the Bioelectrical Impedance Analysis

by Dorotea Bozic, Ivica Grgurevic, Bisera Mamic, Vesna Capkun, Josipa Bilandzic-Ivisic, Tomislav Ivanovic, Ivona Bozic, Ivan Zaja, Kristian Podrug, Zeljko Puljiz, Zdravko Perko and Ivana Mikolasevic

Nutrients 2023, 15(15), 3335; https://doi.org/10.3390/nu15153335 - 27 Jul 2023

Cited by 1 | Viewed by 1062

Abstract

Bioelectrical impedance analysis (BIA) is a body composition assessment method. We aimed to determine its accuracy in the detection of sarcopenia in patients with liver cirrhosis (LC), using skeletal muscle index (SMI) at the level of third lumbar vertebra (L3-SMI) obtained using multislice computed tomography as the reference method. Patients with LC were enrolled in the period October 2019–March 2022 and follow-ups were conducted until January 2023. Their BIA parameters were compared against L3-SMI, and BIA cut-off values were proposed using AUROC analysis. Patients underwent outcome analysis based on obtained clinical characteristics. A total of 106 patients were included. We found a fair correlation between BIA parameters with the L3-SMI. We determined cut-off values of ≤11.1 kg/m² for BIA-SMI (Se 73%, Sp 66%, AUROC 0.737, p < 0.001) and ≤5.05° for phase angle (PA) (Se 79%, Sp 60%, AUROC 0.762, p < 0.001) in the detection of sarcopenia. The relative risk of death was 2.2 times higher in patients with skeletal muscle mass (SMM) ≤ 36.5 kg. SMM was significantly associated with outcome in Kaplan–Meier analysis. This non-invasive and simple method that showed fair performances and a very good outcome prediction could provide for the unmet need for fast and affordable detection of sarcopenia in patients with LC and should be further evaluated. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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18 pages, 659 KiB

Open AccessArticle

Nutritional Status of People with a Coexisting Chronic Wound and Extended Assessment Using Bioelectrical Impedance

by Mateusz Skórka, Paweł Więch, Joanna Przybek-Mita, Anna Malisiewicz, Kamila Pytlak and Dariusz Bazaliński

Nutrients 2023, 15(13), 2869; https://doi.org/10.3390/nu15132869 - 25 Jun 2023

Cited by 2 | Viewed by 1274

Abstract

The diagnosis of malnutrition should be one of the pillars of comprehensive patient care, especially in the case of patients with large wounds, prolonged healing, or comorbidities. The condition for a reliable and accurate nutritional diagnosis is to link it with the parameters of nutritional status assessment at the basic level (anthropometric measurements and clinical assessment) and in depth (biochemical tests and bioelectrical impedance). A prospective study included a sample of 60 patients with coexisting chronic wounds (venous ulcers, diabetic foot syndrome, pressure injury) treated at the Wound Treatment Clinic of Fr. B. Markiewicz Podkarpackie Oncology Center (Poland). The method of estimation and diagnostic survey was used; the research tool was a scientific research protocol consisting of four parts. Self-care capacity was assessed based on the Barthel scale, nutritional status using blood biochemical parameters, and electrical bioimpedance. Wounds were classified according to the extent, depth of tissue structures, and potential infection. Subjects with pressure ulcers had statistically significantly lower fat-free mass component indices compared to those with diabetic foot syndrome and venous ulceration. The subjects with pressure ulcers had significantly lower values of body composition components compared to those with diabetic foot syndrome and venous ulcers. In the group of patients with pressure ulcers, the lowest values of albumin (3.20 g/dL), hemoglobin (10.81 g/dL), and nutritional risk index (NRI) (88.13 pts.) scores were confirmed. Subjects with pressure ulcers with limited self-care presented a non-physiological nutritional status, indicating a risk of malnutrition. Local actions related to wound treatment should be preceded by a general examination, considering the state of augmented nutrition with the use of electrical bioimpedance. Full article

(This article belongs to the Special Issue Nutritional Assessment for the Identification and Monitoring of Malnutrition in Patients with Chronic Diseases)

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