BACKGROUND: Continuous effort has been made to identify patients at high risk of malnutrition, but monitoring and documentation of nutritional intake are relative less emphasized upon.
METHODS: A needs assessment through a cross-sectional study design was carried out at six hospitals in Yogyakarta, Indonesia. A self-administered semi-structured questionnaire was filled out by 111 respondents recruited from three different professions (nurses, dietitians and serving assistants) in the wards.
RESULTS: Seventy per cent of the respondents perceived that the current dietary assessment tool used to record patients' food intake was simple; however, the disadvantage of this tool was its tedious process of computing nutritional values of food consumed. Furthermore, more than half respondents encountered problems in conducting food intake record of patients, primarily due to limited number of human resources, followed by time constraints and perception that such dietary assessment as not part of their job scope.
DISCUSSION: This study has revealed important information in developing a simple, valid and reliable dietary assessment tool for monitoring food intake of hospitalized patients to be applied by interdisciplinary hospital professionals.
CONCLUSIONS: Awareness of the important on monitoring nutrient intake of patients should be emphasized among healthcare professionals. The current dietary assessment tool requires modification due to lengthy time taken to complete the task and poor accuracy in intake estimation.
IMPLICATION FOR NURSING AND HEALTH POLICY: Hospitals should provide protocols and guidelines of cooperation among interdisciplinary professionals, including nurses, which includes a simple dietary assessment tool to assist nutritional management of hospitalized patients.
METHODS: MICOS is a prospective cohort study conducted at selected government health clinics in two states, namely Selangor and Wilayah Persekutuan Kuala Lumpur, Malaysia. Women in their third trimester of pregnancy are recruited into the study and their infants will be followed-up at 3, 6, and 12 months of age. Information on prenatal factors including socio-demographic characteristics, obstetric history, pre-pregnancy body mass index, gestational weight gain, smoking, family history of allergic diseases, maternal dietary intake and sunlight exposure during pregnancy are obtained through face-to-face interviews. Postnatal factors including dietary intake, sun exposure, and anthropometric measurements of the mothers, as well as feeding practices, dietary intake, anthropometric measurements, and development of allergic diseases of the infants are assessed at each follow-up. Blood samples are collected from the mothers in the third trimester to determine 25-hydroxyvitamin D levels as well as from the infants at age 12 months to determine atopic sensitisation.
DISCUSSION: The concept of developmental origins of health and disease (DOHaD) which emphasises on the role of early life environments in shaping future health and disease susceptibility in adulthood has gained a huge interest in recent years. The DOHaD paradigm has influenced many fields of research including malnutrition and allergic diseases. While findings from the developed countries remain controversial, such studies are scarce in developing countries including Malaysia. The present study will determine the cause and effect relationship between early nutrition and the development of malnutrition and allergic diseases in infants' first year of life.
METHODS: A cross-sectional study was conducted among 134 geriatric patients with a mean age of 68.9 ± 8.4 who stayed at acute care wards in Hospital Tuanku Ampuan Rahimah, Klang from July 2017 to August 2017. The SGA, MNA, and GNRI were administered through face-to-face interviews with all the participants who gave their consent. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the GNRI and MNA were analyzed against the SGA. Receiver-operating characteristic (ROC) curve analysis was used to obtain the area under the curve (AUC) and suitable optimal cutoff values for both the GNRI and MNA.
RESULTS: According to the SGA, MNA, and GNRI, 26.9%, 42.5%, and 44.0% of the participants were malnourished, respectively. The sensitivity, specificity, PPV, and NPV for the GNRI were 0.622, 0.977, 0.982, and 0.558, respectively, while those for the MNA were 0.611, 0.909, 0.932, and 0.533, respectively. The AUC of the GNRI was comparable to that of the MNA (0.831 and 0.898, respectively). Moreover, the optimal malnutrition cutoff value for the GNRI was 94.95.
CONCLUSIONS: The prevalence of malnutrition remains high among hospitalized elderly patients. Validity of the GNRI is comparable to that of the MNA, and use of the GNRI to assess the nutritional status of this group is proposed with the new suggested cutoff value (GNRI ≤ 94.95), as it is simpler and more efficient. Underdiagnosis of malnutrition can be prevented, possibly reducing the prevalence of malnourished hospitalized elderly patients and improving the quality of the nutritional care process practiced in Malaysia.
METHODS: This cross-sectional study recruited children below 18 years old admitting into general paediatric ward in a public hospital. The PNST and Subjective Global Nutritional Assessment (SGNA) were performed on 100 children (64 boys and 36 girls). The objective measurements include anthropometry (z-scores for weight, height and body mass index), dietary history and biochemical markers were measured. These were used to classify malnutrition as per Academy of Nutrition and Dietetics/American Society of Parental and Enteral Nutrition (AND/ASPEN) Consensus Statement for identification of paediatric malnutrition and WHO growth standards for children. Cohen's kappa was computed to report the level of agreement.
RESULTS: The PNST identified 57% of hospitalized children as being at risk of malnutrition. In this study, there was a stronger agreement between PNST with AND/ASPEN malnutrition classification (k = 0.602) as when PNST was compared with WHO (k = 0.225) and SGNA (k = 0.431). The PNST shows higher specificity (85.29%) and sensitivity (78.79%) when compared with AND/ASPEN than with WHO malnutrition criteria (55.81% specificity and 66.67% sensitivity).
CONCLUSION: This study showed the usefulness of routine use of PNST for screening the malnutrition risk of hospitalized children in Malaysian tertiary hospital settings.
DESIGN: The 2011 Bangladesh Demographic and Health Survey, conducted from 8 July to 27 December 2011.
SETTING: Selected urban and rural areas of Bangladesh.
SUBJECTS: A total of 2197 ever-married women living with at least one child younger than 5 years. Exposure was determined from maternal reports of high-risk fertility behaviours. We considered three parameters, maternal age at the time of delivery, birth order and birth interval, to define the high-risk fertility behaviours. Chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women were the outcome variables.
RESULTS: A substantial percentage of women were exposed to have a high-risk fertility pattern (41·8 %); 33·0 % were at single high-risk and 8·8 % were at multiple high-risk. After adjusting for relevant covariates, high-risk fertility behaviours were associated with increased likelihood of chronic undernutrition (adjusted relative risk; 95 % CI: 1·22; 1·03, 1·44), anaemia (1·12; 1·00, 1·25) and the coexistence of anaemia and undernutrition (1·52; 1·17, 1·98). Furthermore, multiple high-risk fertility behaviours appeared to have more profound consequences on the outcome measured.
CONCLUSIONS: Maternal high-risk fertility behaviours are shockingly frequent practices among women in Bangladesh. High-risk fertility behaviours are important predictors of the increased likelihood of women's chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition.
METHODS: A cross-sectional study was conducted between January and December 2012. A total of 350 adult patients in a teaching hospital were screened for risk of malnutrition using 3-MinNS and Subjective Global Assessment (SGA). To assess interrater reliability, each patient was screened for risk of malnutrition using 3-MinNS by 2 different nurses on 2 different occasions within 24 hours after admission. To assess the validity of 3-MinNS, the level of risk of malnutrition identified by the nurses using 3-MinNS was compared with the risk of malnutrition as assessed by a dietitian using SGA within 48 hours after the patients' enrolment into the study. The sensitivity, specificity, and predictive values were calculated in detecting patients at risk of malnutrition. Interrater reliability was determined using κ statistics.
RESULTS: Using SGA, the estimated prevalence of moderate to severe malnutrition was 36.3% (127/350). There was 94% proportional agreement between 2 nurses using 3-MinNS, and interrater reliability was substantial (κ = 0.79, P < .001). The analysis showed that 3-MinNS had moderate sensitivity (61.4%-68.5%) but high specificity (95.1%).
CONCLUSIONS: The 3-MinNS is a reliable and valid screening tool for use by healthcare professionals for identifying newly admitted medical and surgical patients who are at risk of malnutrition.