NTR 330L Unit 1

malnutrition screening & diagnosis (1/2 done

what is nutrition screening, it’s purpose, and why it is done at the beginning of clinical care?

nutrition screening is identifying those who may have a nutrition diagnosis and benefit from assessment and intervention by an RD. The purpose is to identify those who are at nutritional risk so that MNT can be initiated. It is included in the initial clinical care process so the dietitian can prioritize conducting assessments on patients that are at higher risk for malnutrition and may need immediate intervention. This allows the more severe cases to be addressed sooner. The screening can be completed by the nurse or diet tech.

who can perform a nutrition screening?

A nurse or diet tech

18 self-reported questions asking about anthropometrics, general, diet and food history, and self-assessment. Also assess living arrangements, pressure injuries & # meals/day

reliable, inexpensive, and quick to perform - most widely used tool for nutritional screening/assmt in older adults but limited in it’s used for only older adults

MNA (mini nutritional assessment)

categories of MNA (older adults)

normal/well nourished, at risk, malnourished

the first 6 items of the MNA, takes about 5 minutes, is the first-step screening tool

MNA-SF

a 5-step tool that uses online calculators & apps, self-screening & categorizes into high, medium, or low risk

strenght

MUST

an acute, subacute, or chronic state of nutrition, in which a combination of varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function

malnutrition (any nutritional imbalance)

what differentiates the 3 types of malnutrition

if inflammation is present and to what severity

type of malnutrition involving chronic starvation without inflammation (give example)

starvation-related

type of malnutrition in which inflammation is chronic & of mild to moderate degree (give example)

chronic-disease related

type of malnutrition in which inflammation is acute & of severe degree (give example)

acute disease or injury related

someone with rheumatoid arthritis may have what type of malnutrition

chronic disease related

someone with a severe burn may have what type of malnutrition

acute disease or injury-related malnutrition

someone with anorexia nervosa may have what type of malnutrition

starvation related

what kind of information do screeners collect and assess?

weight loss (unintended, severe), food intake changes, anthropometrics, mobility, psychological factors, acute disease (with impact on metabolism), diet history

what does a nutrition assessment for malnutrition entail

body weight/composition changes (severity of loss - how much & how recent), physical examination (ascites, edema, muscle wasting, fat loss), diet history (EE intake & needs), functional assessment (grip strength), subjective (psychological state, financial factors, self-perception of fatigue), inflammation (CRP lab value, medical history)

characterized by increased levels of pro-inflammatory cytokines (can cause insulin resistance, reduced appetite, muscle loss, malabsorption, reduced IGF-1, metabolic demand increased)

inflammation (metabolic effects)

all are clinical effects of malnutrition except:

increased risks of falls, pressure injuries, or infections

delays in wound healing

poorer outcomes/survival in chronic illness

reduced visitors in hospital settings

increased length of stay & time spent in rehab

increased hospital readmission rate

reduced visitors in hospital settings

what possible characteristics may indicate a malnutrition diagnosis & how many must be present to give the diagnosis per the Academy & ASPEN

insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation that may mask weight loss, diminished functional status as measured by handgrip strength

how many of the following characteristics must be present for a malnutrition diagnosis as determined by Academy & ASPEN

insufficient energy intake

weight loss

loss of muscle mass

loss of subcutaneous fat

localized or generalized fluid accumulation that may sometimes mask weight loss

diminished functional status as measured by handgrip strength

2 or more

what is used to assess function in malnutrition assessment?

hand grip strength test

what lab value indicates inflammation

CRP (c-reactive protein as produced in liver) also proinflammatroy cytokines