Guidelines & References
Handbook p176 |
2022. An evidence-based guide for the identification and nutritional management of malnutrition and frailty in Australian and New Zealand community |
GLIM criteria to diagnose malnutrition |
2009. DA best practice guidelines on management of malnutrition |
Screening
MST 3-5 = referral to APD. Acute and outpatient hospital settings |
MNA-SF. 0-11 points = at risk. Older adults (≥65 years), especially in hospitals, community and aged care |
MUST. All adults in hospital, community and residential care settings |
Low risk of malnutrition: MST 0-1, MUST 0 |
Moderate risk of malnutrition: MST 1, MUST 1. |
High risk of malnutrition: MST 3-5, MUST 2+. |
Usually by nurse/Nut assistant |
S/S
poor handgrip strength |
oedema |
thin calf |
bones prominent |
sunken eyes |
inability to sit up |
Complications
Muscle wasting & weakness (↑ falls risk) |
↓ immune function = more infections |
Delayed wound healing |
Cognitive impairment |
Gastrointestinal dysfunction |
↓ bone health |
Hormone imbalances |
Hair thinnning |
Cold intolerance |
Fatigue |
Intervention
HPHE |
ONS/EN |
Refer: OT - eating assistance tools. Speechie – signs of dysphagia |
|
|
Diagnosis
SGA (acute, aged care, post-op) |
PG-SGA (oncology) |
Diagnosis (GLIM Criteria)
Weight loss (%) |
>5% 6/12 OR >10% >6/12 |
BMI |
<20 (<70 years), <22 (>70 years). Asia <18.5 (<70 years), <20 (>70 years) |
Reduced muscle mass |
Physical findings SGA - signs of muscle wasting |
Reduced food intake |
<50% of ER >1/52 OR any reduction for >2/52, OR chronic GI condition impacting intake or absorbtion |
Inflammation |
Acute disease/injurt or chronic disease-related |
GLIM Grading
Moderate (stage 1) |
5-10% weight loss 6/12, OR 10-20% beyond 6/12. BMI <20 (<70 years), <22 (>70 years) |
Severe (stage 2) |
>10% within 6/12, OR 20% beyong 6/12. BMI <18.5 (<70 years), <20 if >70 years) |
Biochem
Refeeding risk |
GI profile: liver function tests |
Endocrine function: BGL, Fasted BG |
Inflammatory response: BGL, CRP |
Nutritional anaemia: Hb, Hct, s. Iron |
Stress: Alb, WC |
Strategies
Education |
eating order, |
Food |
food fortification (e.g. enriched milk), mid-meal snacks, smaller portions more frequently, finger foods, meal delivery services, encourage social eating, favourite foods, HE swaps |
HE additives |
cream, peanut butter, oil, mayo, cheese, honey, jam, sour cream |
Enriched milk = 1L full cream, 1 cup milk powder |
|
|
Nut Reqs
NEMO repletion |
Key Nuts: Vit D, total energy, total P, calcium |
ONS
ONS Type |
Uses |
Fruit based supplements |
good for patients tired of milky drinks |
Puddings |
Pts on thickened fluids or texture modified diets (different texture to milk) |
Powders |
fortifying meals, mid-meals and desserts without increasing volume of food |
Pressure injury specific |
contains nutrients reputed to aid wound healing |
1.0-1.5cal/mL |
Standard milk-based supplements |
2-2.5cal/ml |
patients on fluid restrictions or small appetites |
Example PESS
P |
Inadequate protein-energy intake (NI-5.2), Inadequate fluid (NI-3.2), Malnutrition (NC-4.1.2.1), Inadequate oral intake, chronic disease related malnutrition |
E |
Reduced appetite, inability to self-feed, chewing difficulty, cognitive impairment, nausea S/E of ___ medication, dislike of texture-modified diet, food refusal, low mood, poor eating environment |
SS |
Meeting __% of E/P requirements, SGA score of ___, recent ___% weight loss __1/12 |
Consider
Liaising with family/partners |
Medication S/E (eg. N/V/D) |
mobility/pain – tremors |
ability to self feed/open packets |
likes/dislikes – hospital menu |
texture-mod/fluid restrictions |
refeeding risk |
dysphagia/choking fear |
mood (e.g. grief) |
social network |
access to support |
financial situation |
changes to taste/smell/nausea in dementia |
Monitoring
Weight weekly |
BMI monthly |
Rescreen monthly |
Recheck likes/dislikes |
|
