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Often when we think of malnutrition, we think of extreme examples such as starving children in developing nations or emaciated individuals in war-torn areas and World War II concentration camps. However, these extreme images are relatively rare and malnutrition is not always visible to the naked eye of health care professionals and physicians who are not trained to identify this condition. In fact, in Canada, an estimated 45% of hospitalized medical and surgical patients are identified as malnourished.[1] Hospitalized patients can become malnourished very quickly. Patients admitted to hospital often miss multiple meals during their hospital admissions due to being kept NPO for medical tests and procedures and/or due to feeling unwell with concurrent anorexia. Combined with a lack of physical activity, hospitalized patients begin to lose muscle mass at a rate of 0.5% of total body muscle mass per day[2] which can lead to significant muscle losses during periods of immobility[3] as during hospitalization.
Early nutrition intervention is key to curtailing malnutrition. Dietitians are healthcare professionals who undergo specialized training in nutrition to focus on assessing and identifying patients at risk of malnutrition, preventing malnutrition and improving nutrition status. As mentioned by Eckert and Cahill (2018),[4] an effective strategy for preventing malnutrition is to involve the dietitian early, within 24 hours of hospital admission. For patients at risk of malnutrition, dietitian assessment and intervention is effective in improving dietary intake and quality.[4] When a dietitian is consulted, the dietitian will evaluate each patient and tailor the nutrition care plan to the individual’s needs.
Some of the dietitian-led initiatives undertaken in hospitals across Canada include Enhanced Recovery After Surgery (ERAS), Medpass, Canadian Nutrition Screening Tool (CNST) and protected meal times. ERAS is a program whose goals are to improve patient outcomes after surgery including shortening length of hospital stay and reducing surgical complications. A large component of ERAS focuses on maintaining patients’ nutrition status and decreasing risk of malnutrition by preventing pre-operative fasting and promoting early post-operative feeding through the administration of oral nutrition supplements. Medpass is another initiative that aims to decrease risk of malnutrition by having patients consume an oral nutrition supplement beverage with their medications in place of water in order to provide additional calories and protein. The CNST, a tool recommended by the Canadian Malnutrition Task force, is being implemented in many healthcare facilities as well. The purpose of the CNST is to identify patients who are at risk of malnutrition on admission to hospital (i.e. within the recommended 24 hours) and subsequently submit a referral to the dietitian for those patients. Protected meal times are also being implemented to ensure that patients have sufficient time to eat their meals and are not interrupted by health care professionals or medical tests and procedures.
In support of Eckert and Cahill,[4] physicians should feel comfortable referring their hospitalized patients to a dietitian for evaluation of malnutrition risk. Early intervention of malnutrition is important and a dietitian can utilize their professional expertise to attenuate this problem.
1. Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, Payette H, Bernier P, Vesnaver E, Davidson B, Teterina A, Lou W (2016) Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force. JPEN J Parenter Enteral Nutr 40 (4):487-497.
2. Wall BT, van Loon LJ (2013) Nutritional strategies to attenuate muscle disuse atrophy. Nutr Rev 71 (4):195-208.
3. Wall BT, Dirks ML, Snijders T, Senden JM, Dolmans J, van Loon LJ (2014) Substantial skeletal muscle loss occurs during only 5 days of disuse. Acta Physiol (Oxf) 210 (3):600-611.
4. Eckert KF, Cahill LE (2018) Malnutrition in Canadian hospitals. CMAJ 190 (40):E1207.