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Malnutrition

Malnutrition. Dr. Irit Chermesh Clinical director of clinical nutrition Gastroenterology Department Rambam health care campus President of the Israeli Society for Clinical Nutrition. Why am I here?. Importance Need for cooperation My best friend My mother. Malnutrition? Here?!!!.

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Malnutrition

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  1. Malnutrition Dr. Irit Chermesh Clinical director of clinical nutrition Gastroenterology Department Rambam health care campus President of the Israeli Society for Clinical Nutrition

  2. Why am I here? • Importance • Need for cooperation • My best friend • My mother

  3. Malnutrition? Here?!!!

  4. Malnutrition -the silent killer

  5. Malnutrition • Deficiency of one or more food components • May cause multi-system malfunction- neurologic, musculosceletal • Common in patients with cognitive impairment

  6. Consequences of malnutrition

  7. Hospitalized malnourished patients • Hospitalizations • Complications • Infectious • Non Infectious • Increased length of stay (LOS) • Dependency • Death • Increased costs ClinNutr. 2007

  8. Malnutrition in hospitalized patients in England Stratton Clin Nut. 2007

  9. Nutrition Day 2008 in Israel NATIONAL REPORT A snapshot on nutrition care An initiative to improve healthcare No fiananecial disclosuresupported by

  10. Results >40% patients at risk for malnutrition

  11. One study day ~80% of patients ate<50%

  12. Who eats less- dies more3200 patients age 78 - 103 nutritionDay 2006

  13. MUST 1.2008-5.2009 • 2 general surgery • 1 internal medicine • 1 cardiac surgery • ~60% (4731/7973) patients screened • 40% high risk for malnutrition

  14. Malnutrition and LOS * * P<0.01

  15. Malnutrition and mortality * * P<0.01

  16. Nutrition status and mortality

  17. Malnutrition, severity-of-illness and mortality * * * * Pneumonia Patient Outcomes Research Team (PORT) P<0.05

  18. At risk in the community • Chronic disease • COPD • Cardiac failure • Cirrhosis • Cancer • Post hospitalization • Elderly • Cognitive impairments • Low socioeconomic group

  19. Intervention • Enteral- P.O • Tube feeding: • nasogastric • enteral • Parenteral

  20. Enteral/PO • ONS- Oral Nutrition Support

  21. Mortality and ONS Stratton Clin Nut. 2007

  22. ONS and prevention of pressure sores ~25% reduction Stratton Clin Nut. 2007

  23. Practical and efficient? • Older adults and patients in need of nutritional support: Review of current treatment options and factors influencing nutritional intake Nieuwenhuizen clinical nutrition 2009

  24. Meta analysis- 24 trials 2387 patients • ONS in older adults • reduced mortality overall and consistently significant in undernourished older adults (>75 years) who were offered ≥400 kCal/day in the supplement for ≥35 days • Body weight increased significantly • Milne Nestle Nutr Workshop Ser Clin Perform Programme 2005

  25. And more- • ONS have been shown to be consistently beneficial and to be superior to dietary counseling • ONS were found to provide significantly greater energy and protein than isocaloric food snacks • Clin Nutr 2008; Stratton Proc Nutr Soc 2006

  26. Further optimization • Increased compliance with small volumes 4X60 ml of ONS between meals Jukkola Aust J Ageing 2005

  27. ONS easy to use • Usually 1 kcal/ml if not- name self explanatory • Constant protein/energy ratio • All micro-elements being taken care of

  28. Formulas • Whole • Semi-elemental/elemental • Caloric concentration 1-2 kcal/cc • Additives • Fibers • Immunonutrition • Disease specific • ARDS • Renal • Stress Price

  29. So- The Wh questions • Who • Post prolonged hospitalization • Dependent • Elderly • Chronic diseases • Underprivileged • When- ASAP =as suspicion of malnutrition arises • Where- anywhere • How- easy • Why- hope I convinced you

  30. Take home messages • Malnutrition is common • Identifying patients at risk is easy • Treatment is: • effective • feasible • cost effective

  31. Team work

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