Nutritional Assessment - Evidence Update
Welcome to the December Nutritional Assessment Evidence Update Bulletin being produced by the HEFT
Library Services. This bulletin is produced to support VITAL for Nurses core skills programme developed
in the Trust. This issue will highlight evidence published in the previous three months. Full text articles can
be accessed with your HEFT Athens ID.
Dignity and nutrition inspection programme
The Care Quality Commission has published a report 'Dignity and nutrition inspection programme'. The report looked into
the standards of care that older people receive in hospital, and calls for a system-wide response to combat the failings
identified. The report summarises the findings of 100 unannounced inspections of NHS acute hospitals which took place
between March and June, looking at whether the essential standards of dignity and nutrition were being met on wards
caring for older people. Around half of the hospitals needed to do more to ensure that they were meeting people's needs,
with twenty of the hospitals visited failing to meet essential standards required by law. Of the 100 hospitals inspected, 45
hospitals were fully compliant, meeting the essential standards relating to both dignity and nutrition, 35 met both standards
but still needed to make improvements in one or both and 20 hospitals did not meet one or both standards, with major
concerns identified in two cases.
If one hospital can give patients dignified care, all of them
Nursing Standard. August; 25(48) p.12-4
Examples of good and poor practice are discussed in this article, resulting from the Care Quality Commission's Dignity and
Nutrition Inspection Programme standards document. In particular, good practice at Aintree University Hospitals NHS
Foundation Trust in Merseyside is highlighted.
Available in fulltext at EBSCO Host and ProQuest (Legacy Platform)
NICE Bites: nutrition support in adults
The November NICE Bites bulletin from the North West Medicines Information Service covers nutrition support in adults.
The aim of this publication is to provide healthcare professionals with a clear and succinct summary of key prescribing
points taken from NICE guidance.
Nutritional COPD Guideline
NHS Improvement - Lung has published 'The Respiratory Healthcare Professional's Nutritional COPD Guideline' on its
website. The guideline has been designed to raise the awareness of nutrition with respiratory health professionals and their
COPD patients; to provide a simple tool to aid first line nutritional management of this patient group; and to improve the
nutritional status of COPD patients. The Respiratory Healthcare Professional's Nutritional COPD Guidelines were created
by a multidisciplinary working group of COPD and nutritional experts sponsored by an educational grant from Nutricia.
Patient Safety. A lot on your plate.
Health Service Journal. August; 121(6271) p.26-7
The need to maintain good standards of nutritional care for hospital patients is discussed. The dangers of malnutrition are
set out and the work of The British Association for Parenteral and Enteral Nutrition in developing a framework to enable
trusts to meet Care Quality Commission Standards are described.
Accuracy of Quick and Easy Undernutrition Screening Tools
in Patients Undergoing Cardiac Surgery.
Journal of the American Dietetic Association. December; 111(12) p.1924-30
The aim of this study was to compare the quick and easy undernutrition screening tools, such as the Short Nutritional
Assessment Questionnaire and Malnutrition Universal Screening Tool, in patients undergoing cardiac surgery. The study
compared their accuracy in detecting undernutrition measured by a low-fat free mass index and assessed their association
with postoperative adverse outcomes.
Available in fulltext at MD Consult
Long-form but not short-form Mini-Nutritional Assessment
is appropriate for grading nutritional risk - patients on
International Journal of Nursing Studies. Nov; 48(11) p.1429-35
This cross-sectional study aimed to evaluate the appropriateness of using the long-form (LF) and the short-form (SF) Mini
Nutritional Assessment (MNA) for grading the risk of protein-energy malnutrition in patients on haemodialysis.
Perceived health and risk of undernutrition: a comparison of
different nutritional screening results in older patients.
Journal of Clinical Nursing. August; 20(15-16) p.2162-71
This Norwegian cross-sectional study compared 3 nutrition screening tool results. I considered links between patients' own
perception of health, health-related issues and malnutrition risk in older hospital patients. Results of screening of patients
from 3 wards over a 6 month period were examined to ascertain the tools' accuracy in predicting malnutrition risk.
Eating difficulties among stroke patients in the acute state: a
descriptive, cross-sectional, comparative study.
Journal of Clinical Nursing. September; 20(17-18) p.2563-72
This descriptive, cross-sectional, comparative study examines eating difficulties among male and female stroke patients. In
conclusion more women than men with stroke suffered from inadequate food consumption. The women had more severe
strokes, experienced poorer quality of life and showed lower functional status than the men.
Estimating energy needs in nutrition support patients.
Journal of Parenteral and Enteral Nutrition. September; 35(5) p.563-570
This paper looks at energy needs as a fundamental part of nutrition support. The amount of metabolically active tissue mass
is the major determinant of metabolic rate. In determining the energy prescription, all of the component parts must be
Improving the hydration of hospital patients.
Nursing Times. October; 107(39) p.21-3
The aim of this project was to identify patients at risk of dehydration in an acute hospital setting and improve procedures.
A fluid balance audit was carried out complimented by teaching sessions to raise awareness of dehydration, promote
monitoring of fluid charts and deliver hydration care.
Available in fulltext at ProQuest (Legacy Platform)
Prevalence of the notification of malnutrition in the
departments of internal medicine and its prognostic
Clinical Nutrition. August; 30(4) p.450-454
The aim of this paper was to describe how often discharge sheets from Internal Medicine units include malnutrition among
diagnoses. Factors associated with this diagnosis including dementia, cancer, HIV infection and chronic renal failure and its
prognostic implications are also assessed. The study concluded that notification of malnutrition in IM departments is low
and the diagnosis is associated with an increase in morbidity, mortality and costs.
Dietary advice with or without oral nutritional supplements
for disease-related malnutrition in adults.
Cochrane Database of Systematic Reviews 2011, Issue 9.
This review examines evidence that dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral
nutritional supplements in adults with disease-related malnutrition improves survival, weight and anthropometry. Disease-
related malnutrition has been reported in 10% to 55% of people in hospital and the community.
Dietary intake, nutritional status and rehabilitation outcomes
of stroke patients in hospital.
Journal of Human Nutrition and Dietetics. October; 24(5) p.460-9
This study describes nutritional status and food consumption in stroke patients within 2 weeks of hospital admission
and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes.
The authors suggest that there is scope for the multidisciplinary development of nutritional support for stroke patients to
improve these outcomes.
Different experiences and perspectives between head and
neck cancer patients - daily impact of a gastrostomy tube.
Journal of Human Nutrition and Dietetics. October; 24(5) p.449-459
This study aims to understand the daily impact of gastrostomy feeding on head and neck cancer patients and their care-
givers to identify improvements to services. Twenty-one adult patients were randomly selected from the Head and Neck
centre at University College London Hospital. Six head and neck cancer patients and three care-givers participated in focus
groups. The sessions were recorded, fully transcribed and qualitatively thematically analysed, and the resulting data were
tabulated. Different themes and experiences were explored.
Early versus late parenteral nutrition in critically ill adults.
New England Journal of Medicine. August; 365(6) p.506-517
In this randomized, multicenter trial, early initiation of parenteral nutrition is compared with late initiation in adults in the
intensive care unit (ICU) to supplement insufficient enteral nutrition. Late initiation of parenteral nutrition was associated
with faster recovery and fewer complications compared with early initiation.
Available in fulltext at EBSCO Host and ProQuest (Legacy Platform)
Jejunostomy after oesophagectomy: a review of evidence
and current practice.
Proceedings of the Nutrition Society. August; 70(3) p.316-20
The aim of this article is to review the current literature and report on the author's experience of routine feeding jejunostomy
insertion following oesophagectomy Patients undergoing oesophagectomy often have nutritional needs at the time of
diagnosis and in the post-operative period. Routine jejunostomy insertion is recommended to ensure adequate nutrition in
patients who develop post-operative complications and for those patients with long-term reduced appetite and poor oral
Nutrition in Inflammatory Bowel Disease
Journal of Parenteral and Enteral Nutrition. September; 35(5) p.571-580
Malnutrition is relatively unusual in Ulcerative Colitis, but in Crohn Disease, which often affects the small intestine, it is
frequent and may be severe. Nutrition support is therefore often indicated. This paper looks at the current evidence.
Nutrition therapy of the severely obese, critically ill patient:
summation of conclusions and recommendations.
Journal of Parenteral and Enteral Nutrition. September; 35(5 Suppl) p88s 96s
Obesity adds to the complexity of nutrition therapy in the intensive care unit. This report includes recommendations for
nutrition therapy for obese, critically ill patients. Although the basic principles of critical care nutrition apply, a high-protein,
hypocaloric regimen is recommended to reduce the fat mass, improve insulin sensitivity, and preserve lean body mass. The
ideal enteral formula should have a low nonprotein calorie to nitrogen ratio and a range of pharmaconutrient agents to
modulate immune responses and reduce inflammation.
Nutritional intervention and quality of life in palliative care
British Journal of Nursing, November; 20(20) p.1320 - 1324
This article considers quality of life measures that can be used by health professionals to assess effectiveness of nutritional
interventions administered to palliative care patients. Stabilizing, maintaining and attempting to increase weight through
the support of oral feeding, and provision of artificial feeding, has been shown to mediate the metabolic and physical wasting
effects of the disease process and improve general comfort. Use of quality of life scales provides health professionals and
organizations with an ideal measure for planning, targeting and evaluating nutritional interventions.
Symptoms associated with dietary fiber supplementation
over time in individuals with fecal incontinence.
Nursing Research. June; 60(3 Suppl) p.S58-67
There isn't much knowledge about adverse symptoms from fiber supplementation available. Patients with fecal incontinence
experience a variety of GI symptoms over a period of time. The symptom severity and emotional upset appear to influence
fiber tolerance. Supplements seem overall to be well tolerated.
Nutrition: safe practice in adult enteral tube feeding.
British Journal of Nursing. October; 20 (19) p.1234-239
Recent alerts and recommendations from the National Patient Safety Agency (NPSA) regarding enteral feeding have led
health professionals to review their practice and guidelines. This article explores safe practice, promoting safer measurement
and administration of liquid medicines via oral and other enteral routes.
Reducing variable consistency in thickened drinks.
Nursing & Residential Care. October; 13(10) p.469-473)
This article discusses the results of a hospital research study investigating the consistency of the thickness of drinks for
patients with dysphagia. Recommendations for practice are made including the need for staff training on drink preparation.
Available in fulltext at EBSCOhost
Using mealtime volunteers to support patients.
Nursing Times. October; 107(41) p.21-3
The Royal Hampshire County Hospital has introduced a scheme of a mealtime volunteers, aiming to decrease the incidence
of malnutrition among hospital patients. Ideas for reducing malnutrition, the roles the volunteers take on as well as the
development and implementation of the scheme are described. Feedback from nursing staff, volunteers and patients is
Available in fulltext at ProQuest (Legacy Platform)
Multiple sources – websites, journals and healthcare databases – have been searched for evidence published in
the last three months. For further information please contact [email protected] or ext 45195
Please login with your Athens ID on www.evidence.nhs.uk ‘before’ clicking on any of the journal full text links
in this bulletin for seamless access.
To request articles where there is no full text link, please complete an online article request form available on
HEFT Library website www.heftlibrary.nhs.uk under ‘Electronic Forms’ menu. Please note that there is now a
charge of £1 for such requests.
For more information on how to register for Athens, access the Athens Registration leaflet via HEFT Library
website www.heftlibrary.nhs.uk under the ‘Publications’ menu.