DIAGNOSIS OF ADULT MALNUTRITION

Transcription

1 CPTA 2018 Student Conclave DIAGNOSIS OF ADULT MALNUTRITION CALIFORNIA STATE UNIVERSITY, LONG BEACH LONG WANG, PHD, MD, RDN, FAND

2 2 Define of malnutrition Understand why serum markers such as albumin are not good tools for diagnosing malnutrition Describe the three general etiologies of malnutrition List the diagnostic criteria for adult malnutrition Apply the current diagnostic criteria for adult malnutrition

3 3 MALNUTRITION Simple definition: any nutritional imbalance Synonym: Undernutrition Overarching definition: decline in LBM with the potential for functional impairment at multiple levels Molecular, Physiological, and/or Gross motor

4 Long Wang, PhD, MD, RDN 4 IMPACTS OF MALNUTRITION

5 5 MALNUTRITION Typically occurs along a continuum of Inadequate intake and/or Increased requirements Impaired absorption Altered transports Altered nutrient utilization Conditions that may also be present Inflammatory (no marker proposed for diagnosis!) Hypermetabolic, and /or Hypercatabolic

6 6 DIAGNOSIS Need to standardize Evidence: Changes in acute-phase proteins such as albumin and pre-albumin Do NOT consistently and predictably change with wt loss, calorie restriction, or N balance Better indicators of severity of inflammation rather than nutrition status ASPEN and AND collaborated to develop an Etiology-Based Malnutrition Definitions

7 7 ETIOLOGY-BASED DIAGNOSIS

8 8 DIAGNOSIS (MEMORIZE!) No definitive, single parameter Have to meet 2 or more of the 6 characteristics: 1. Insufficient energy intake 2. Weight loss 3. Loss of muscle mass 4. Loss of subcutaneous fat 5. Localized or generalized fluid accumulation that may sometimes mask wt loss 6. Diminished functional status as measured by hand grip strength

9 9 DIAGNOSIS The 6 characteristics Continuous rather than discrete Distinguish between severe and non-severe malnutrition Do not allow for further distinction between mild and moderate malnutrition Should be routinely assessed Upon admission and At frequent intervals During pt s stay in all settings, acute, long-term, or transitional

10 10 DIAGNOSIS Data obtained by clinicians should be shared with all members of the health care team Should be considered in doctor s formulation and documentation of a diagnosis Need to be monitored during stay and after discharge Part of the nutrition care/intervention plan If malnutrition is suspected in patients in ambulatory care settings, doctors and a qualified nutritional professional should assess the characteristics

11 11 APPLICATION IN CLINICAL SETTINGS Malnutrition may not be the appropriate diagnosis even when the characteristics are present See examples in the statement May be difficult to document with acute onset How accurate is the information provided by The patients? The care givers?

12 12 APPLICATION IN CLINICAL SETTINGS Need to consider the progression of the disease states On admission may be okay Massive inflammatory responses can Limit effectiveness of nutrition care Contribute to development of malnutrition Medical care/procedures may contribute to malnutrition as well Malnutrition blunts the results of medical treatment

13 13 APPLICATION IN CLINICAL SETTINGS Critically ill patients, especially the elderly are at high risk for developing malnutrition on admission Pay attention to Inability to eat (compromised intake) immediately prior to admission Repeated/extended cessation of feeding regimens Frequent interruptions in oral/enteral nutrition Unintended wt changes Therefore, need frequent and intensive monitoring of the critically ill

14 FROM THE ACADEMY Consensus Statement Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition) Jane V. White, PhD, RD, FADA; Peggi Guenter, PhD, RN; Gordon Jensen, MD, PhD, FASPEN; Ainsley Malone, MS, RD, CNSC; Marsha Schofield, MS, RD; the Academy Malnutrition Work Group; the A.S.P.E.N. Malnutrition Task Force; and the A.S.P.E.N. Board of Directors American Society for Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics (2012) Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition. J Acad Nutr Diet 2012; 112:

15 15 RESOURCES FOR NFPE NFPE Hands-on Training Workshops