NutritionDay

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"nutritionDay worldwide" is a large scale, worldwide action project designed to reduce disease-related malnutrition among hospitalised patients and nursing home residents. The aim of this project is to increase awareness and knowledge regarding disease-related malnutrition in hospitalised patients and the elderly.

Contents

An initiative to raise awareness for disease-related malnutrition NutritionDay wordlwide Logo.png
An initiative to raise awareness for disease-related malnutrition

Background

In 1977 poor nutritional status and malnutrition was already detected in surgical patients. [1] Still, disease-related malnutrition is a much underrated public health issue and has also become an enormous economical concern. [2] It is estimated that over 50 million Europeans are at risk. A study performed in the UK in 2005 estimated the cost of malnutrition to the UK to be €10.6 b per year, double the projected €5.1 b cost of obesity. [3] Two population groups are at particularly high risk: hospitalized patients and residents of nursing homes.

Disease-related malnutrition can be responsible for a prolonged hospital stay, morbidity and premature mortality in hospitalized patients. Research has shown that approximately 31% of all hospitalized patients can be considered malnourished or at nutritional risk. [2]

Previous nutritionDay studies have shown that malnutrition is a major health concern that still gets too little attention in hospitals and nursing homes. Malnutrition, as it has been shown in many studies, increases infection rates, affects the patient's wound healing, leads to cardiac complications, and also prolongs hospital stay. [4] [5] [6]

Generally health care focuses mainly on the increasing incidence of obesity. Initially, health providers believed only patients with low body weight or low body mass index (BMI < 18.5 kg/m2) could be malnourished. However, studies show that BMI is not always a good parameter to detect malnutrition, and other screening tools should be used. Analysis shows that a high percentage of body fat reduces the sensitivity of BMI to detect nutritional depletion. [7]

Internationally, the issue of disease-related malnutrition was raised in various forums, most clearly in the adoption of a resolution by the Council of Europe. Resolution ResAP (2003)3 on Food and Nutritional Care in Hospitals of the Committee of Ministers of the Council of Europe emphasizes inter alia the unacceptable number of undernourished people in hospitals and the beneficial effects of adequate food service and nutritional care in hospitals on patients’ recovery and quality of life. The resolution identifies a long list of actions to be undertaken to remedy the situation. [8]

nutritionDay worldwide – The Project

The project “nutritionDay worldwide” addresses improved patient safety and quality of care by raising awareness and increasing knowledge about disease-related malnutrition. NutritionDay establishes a worldwide chart in which nutritional status and prevalence of malnutrition are portrayed. Further, it documents relevant nutritional infrastructures in hospitals and nursing homes. The aim of the project is to emphasize the importance of adequate clinical nutrition in both settings.

In January 2006 the project was conducted for the first time under the direction of Univ. Prof. Dr. Michael Hiesmayr (Medical University of Vienna) with support of the Austrian Society of Clinical Nutrition (AKE) and the European Society for Clinical Nutrition and Metabolism (ESPEN). A subsequent audit took place in January 2007 when the project was extended to intensive care units and nursing homes. Since then, nutritionDay is performed in all 3 settings. In 2012 “oncology nutritionDay” was performed as the first disease-specific nutritionDay.

The audit is unit and patient-centered. Information about the actual nutrition care and nutrition monitoring on participating wards is gathered using four questionnaires. This happens on one single day worldwide.

The hospital ward as an organisational unit is of particular interest. The ward, with all its specific characteristics and local culture, is the direct centre of care for a group of patients within the hospital.

The direct interview of patients is a characteristic specific to “nutritionDay project”. Patients are surveyed about their eating habits on the day (“how much of your meal did you eat?”) and about the reasons for not eating.

Transnational multilingual Approach

Hospitals and nursing homes of 51 countries worldwide participated in nutritionDay Nutritionday map europe 2007.jpg
Hospitals and nursing homes of 51 countries worldwide participated in nutritionDay

Hospital wards and nursing homes from 51 countries have already participated in nutritionDay. In January 2013, the nutritionDay database counts more than 132.000 datasets from patients and nursing home residents.

The questionnaires are available in over 30 languages. This enables the project to include minority groups of patients (e.g. immigrants, non-native speakers).

Performance of the nutritionDay audit

On one specific day in November, the “nutritionDay” takes place every year. On this day, participating hospital wards and nursing homes collect data on the nutritional status of their patients and residents and record supply structures relevant for nutritional care. Thus, participants receive an actual snapshot of their hospital unit or nursing home. After a specified period of time, a follow-up evaluation is performed which gives information on the patients’ outcome.

After data collection, the hospital staff transfers the data into a database that is accessible over the website http://www.nutritionday.org. An individual code guarantees anonymity of participants.

Each unit receives feedback about its position compared to all other participating units of the same specialty type. Repeated participation in the audit allows benchmarking designed to enhance learning within units and to track changes in local practice and international trends.

nutritionDay questionnaires

Based on four to five questionnaires, information of the participating hospital units or nursing home and their patients and residents is collected. Of particular interest are the unit organisation and structure, health status and nutritional care of the patients, weight monitoring, and food intake. The unit acts as direct care unit of a group of patients with all its specific characteristics, its occupational group, its patient's population, and the local culture is from special interest. A characteristic of the project is the direct interrogation of the patient about their nutritional behaviour on nutritionDay and if there were reasons for not eating.

nutritionDay Oncology

Nutritional treatment plays an important role for patients who suffer from cancer. In studies it has been shown that weight stable cancer patients have a better prognosis than cancer patients with weight loss: in concrete, a lower number of treatment-related adverse reactions in weight stable patients is reported, the response to cancer treatment is increased, the patient reports a higher activity level and a better subjective quality of life. [9]

Moreover, the actual survival rate of weight stable patients is higher compared to patients with weight loss. [10]

The importance of nutritional treatment of cancer patients was reason to appoint „nutritionDay oncology“ the first disease-specific focus of the nutritionDay audit for the years 2012 and 2013. The project „nutritionDay oncology“, comprises three additional questionnaires which collect nutritional data of patients who suffer from cancer. Data obtained from „nutritionDay oncology“ will be incorporated into the new ESPEN (European Society for Clinical nutrition and Metabolism) guidelines and thus increase their practical worth.

nutritionDay Objectives

The overall objective of the nutritionDay project is to promote healthy nutrition practices worldwide by increasing knowledge, awareness, and nutrition monitoring and to bring attention to the importance of nutritional care for the patient's recovery. Further nutritionDay shall raise awareness of the interaction between food intake and recovery. Target groups are health care professionals as well as patients, their relatives and political and economical stakeholders.

Benefits for health facilities

nutritionDay findings

The nutritionDay study is conducted to determine the effects of nutritional factors on the outcomes of hospitalized patients and nursing homes. There were 3 papers publish from 2009 to 2010 on this topic.

An analysis of the data of the nutritionDay audit 2006 performed by Hiesmayr et al. (2009) revealed that less than half of all patients in European hospitals included in the audit eat less than provided as regular meal. Further, an association of reduced food intake with an increased risk of mortality in patients after 30 days was found. Reduced food intake can therefore be seen as a risk factor for hospital mortality. [11]

In 2009, Valentini et al. analyzed the data of the nutritionDay in nursing homes in 2007 and described the effects of 'nD' of first time participants. Therein outcome results indicated that nutritionDay participation induces behavioural changes such as awareness in malnutrition. [4]

Schindler et Al conducted a study based on the data of the nutritionDay audit of the years 2007 and 2008. Core findings of this study on “how nutritional risk is assessed and managed in European hospitals” indicate that still an inconsistent way of assessing nutritional risk in patients in different units and countries exists and that frequently energy goals of patients are not met. [6]

Related Research Articles

<span class="mw-page-title-main">Fat</span> Esters of fatty acid or triglycerides

In nutrition, biology, and chemistry, fat usually means any ester of fatty acids, or a mixture of such compounds, most commonly those that occur in living beings or in food.

<span class="mw-page-title-main">Malnutrition</span> Medical condition

Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues and form. Malnutrition is not receiving the correct amount of nutrition. Malnutrition is increasing in children under the age of five due to providers who cannot afford or do not have access to adequate nutrition.

<span class="mw-page-title-main">Parenteral nutrition</span> Intravenous feeding

Parenteral nutrition (PN) is the feeding of nutritional products to a person intravenously, bypassing the usual process of eating and digestion. The products are made by pharmaceutical compounding entities or standard pharmaceutical companies. The person receives a nutritional mix according to a formula including glucose, salts, amino acids, lipids and vitamins and dietary minerals. It is called total parenteral nutrition (TPN) or total nutrient admixture (TNA) when no significant nutrition is obtained by other routes, and partial parenteral nutrition (PPN) when nutrition is also partially enteric. It is called peripheral parenteral nutrition (PPN) when administered through vein access in a limb rather than through a central vein as central venous nutrition (CVN).

<span class="mw-page-title-main">Weight loss</span> Reduction of the total body mass

Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat, or lean mass. Weight loss can either occur unintentionally because of malnourishment or an underlying disease, or from a conscious effort to improve an actual or perceived overweight or obese state. "Unexplained" weight loss that is not caused by reduction in calorific intake or increase in exercise is called cachexia and may be a symptom of a serious medical condition.

<span class="mw-page-title-main">Marasmus</span> Medical condition

Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the age. Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus is inadequate energy intake in all forms, including protein. This clear-cut separation of marasmus and kwashiorkor is however not always clinically evident as kwashiorkor is often seen in a context of insufficient caloric intake, and mixed clinical pictures, called marasmic kwashiorkor, are possible. Protein wasting in kwashiorkor generally leads to edema and ascites, while muscular wasting and loss of subcutaneous fat are the main clinical signs of marasmus, which makes the ribs and joints protrude.

The glycemic load (GL) of food is a number that estimates how much the food will raise a person's blood glucose level after it is eaten. One unit of glycemic load approximates the effect of eating one gram of glucose. Glycemic load accounts for how much carbohydrate is in the food and how much each gram of carbohydrate in the food raises blood glucose levels. Glycemic load is based on the glycemic index (GI), and is calculated by multiplying the weight of available carbohydrate in the food (in grams) by the food's glycemic index, and then dividing by 100.

Calorie restriction is a dietary regimen that reduces the energy intake from foods and beverages without incurring malnutrition. The possible effect of calorie restriction on body weight management, longevity, and aging-associated diseases has been an active area of research.

<span class="mw-page-title-main">Healthy diet</span> Type of diet

A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.

<span class="mw-page-title-main">Failure to thrive</span> Condition of children whose current weight or rate of weight gain is much lower than expected

Failure to thrive (FTT), also known as weight faltering or faltering growth, indicates insufficient weight gain or absence of appropriate physical growth in children. FTT is usually defined in terms of weight, and can be evaluated either by a low weight for the child's age, or by a low rate of increase in the weight.

<span class="mw-page-title-main">Empty calories</span> Calories with no nutritional value

In human nutrition, empty calories are those calories found in beverages and foods composed primarily or solely of sugars and/or certain fats and oils such as cholesterol, saturated or trans fats, that provide little to no useful nutrients such as protein, fibre, vitamins, minerals, essential fatty acids, or antioxidants. Foods composed mostly of empty calories have low nutrient density, meaning few nutrients relative to their energy content. The consumption of large amounts of empty calories can have negative health consequences.

<span class="mw-page-title-main">Health in India</span> Overview of health in India

India's population in 2021 as per World Bank is 1.39 billion. Being the world's second-most-populous country and one of its fastest-growing economies, India experiences both challenges and opportunities in context of public health. India is a hub for pharmaceutical and biotechnology industries; world-class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, high rates of neonatal and maternal mortality, growth in noncommunicable diseases, high rates of road traffic accidents and other health related issues.

Megavitamin therapy is the use of large doses of vitamins, often many times greater than the recommended dietary allowance (RDA) in the attempt to prevent or treat diseases. Megavitamin therapy is typically used in alternative medicine by practitioners who call their approach orthomolecular medicine. Vitamins are useful in preventing and treating illnesses specifically associated with dietary vitamin shortfalls, but the conclusions of medical research are that the broad claims of disease treatment by advocates of megavitamin therapy are unsubstantiated by the available evidence. It is generally accepted that doses of any vitamin greatly in excess of nutritional requirements will result either in toxicity or in the excess simply being metabolised; thus evidence in favour of vitamin supplementation supports only doses in the normal range. Critics have described some aspects of orthomolecular medicine as food faddism or even quackery. Research on nutrient supplementation in general suggests that some nutritional supplements might be beneficial, and that others might be harmful; several specific nutritional therapies are associated with an increased likelihood of the condition they are meant to prevent.

A protein supplement is a dietary supplement or a bodybuilding supplement, and usually comes in the form of a protein bar, protein powder, and even readily available as a protein shake. Usually made from whey, plant, and/or meat sources.

<span class="mw-page-title-main">Protein–energy malnutrition</span> Medical condition

Protein–energy malnutrition (PEM), sometimes called protein-energy undernutrition (PEU), is a form of malnutrition that is defined as a range of conditions arising from coincident lack of dietary protein and/or energy (calories) in varying proportions. The condition has mild, moderate, and severe degrees.

T. Alp Ikizler is a nephrologist, currently holding the Catherine McLaughlin Hakim chair in Medicine at Vanderbilt University School of Medicine, where he does clinical work and heads a research lab. Born in Istanbul, Turkey, he received his M.D. from the Istanbul University Faculty of Medicine.

Dietary Reference Values (DRV) is the name of the nutritional requirements systems used by the United Kingdom Department of Health and the European Union's European Food Safety Authority.

Nathan W. Levin is an American physician and founder of the Renal Research Institute, LLC., a research institute dedicated to improving the outcomes of patients with kidney disease, particularly those requiring dialysis. Levin is one of the most prominent and renowned figures in clinical nephrology as well as nephrology research. He has authored multiple book chapters and over 350 peer-reviewed publications, including articles in leading journals such as Nature, the New England Journal of Medicine, and The Lancet.

Clinical nutrition centers on the prevention, diagnosis, and management of nutritional changes in patients linked to chronic diseases and conditions primarily in health care. Clinical in this sense refers to the management of patients, including not only outpatients at clinics and in private practice, but also inpatients in hospitals. It incorporates primarily the scientific fields of nutrition and dietetics. Furthermore, clinical nutrition aims to maintain a healthy energy balance, while also providing sufficient amounts of nutrients such as protein, vitamins, and minerals to patients.

<span class="mw-page-title-main">Health in Mozambique</span>

Health in Mozambique has a complex history, influenced by the social, economic, and political changes that the country has experienced. Before the Mozambican Civil War, healthcare was heavily influenced by the Portuguese. After the civil war, the conflict affected the country's health status and ability to provide services to its people, breeding the host of health challenges the country faces in present day.

<span class="mw-page-title-main">Gianluca Tognon</span>

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References

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  2. 1 2 Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27:5-15.
  3. Stratton, IM, et al., The cost of disease-related malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults., de. M. Elia. BAPEN. 2005
  4. 1 2 Valentini L, Schindler K, Schlaffer R, et al., The first nutritionDay in nursing homes: Participation may improve malnutrition awareness. Clin. Nutr. 2009; 28(2):109-116.
  5. Hiesmayr M, Schindler K, Pernicka E, et al., Decreased food intake is a risk factor for mortality in hospitalised patients: The NutritionDay survey 2006. Clin Nutr. 2009; 28(5):484-491.
  6. 1 2 Schindler K, Pernicka E, Laviano A, et al., How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patients findings from the 2007-2008 cross-sectional nutritionDay survey. Clin. Nutr. 2010; 29(5):552-559.
  7. Kyle UG, Pirlich M, Lochs H, Schuetz T, Pichard C., Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study. Clin Nutr. 2005; 24(1):133-42.
  8. Council of Europe, Committee of Ministers Resolution Res AP(2003)3 on food and nutritional care in hospitals: https://wcd.coe.int/ViewDoc.jsp?id=85747
  9. Andreyev HJN, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 1998;34(4):503-9.
  10. Hiesmayr M, Schindler K, Pernicka E, et al., Decreased food intake is a risk factor for mortality in hospitalised patients: The NutritionDay survey 2006. Clin. Nutr. 2009; 28(5):484-491
  11. Hiesmayr M, Schindler K, Pernicka E, et al., Decreased food intake is a risk factor for mortality in hospitalised patients: The NutritionDay survey 2006. Clin. Nutr. 2009; 28(5):484-491.