Adult Malnutrition: Diagnosis and Treatment

Cover
Half Title
Title Page
Copyright Page
Table of Contents
Contributors
1 History and Consequences
I Introduction
II History
A Early Identification, Significance, and Prevalence
B Diagnosis
III Consequences
IV Conclusion
References
2 Diagnosis
I Introduction
A World Health Organization (WHO)
1 Severe Protein-Energy Malnutrition
2 Body Mass Index (BMI)
B Subjective Global Assessment (SGA)
C International Consensus Guideline Committee
D Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition Consensus Statement
E European Society for Clinical Nutrition and Metabolism (ESPEN) Consensus Statement
F Global Leadership Initiative On Malnutrition (GLIM)
II Overlapping Conditions
III Conclusion
References
3 Prevalence and Risk Factors
I Introduction
II Geography
III Healthcare Setting
IV Acute and Chronic Disease
A Reduced Intake
B Increased Nutrient Needs
C Impaired Nutrient Absorption and Utilization
V Functional Status
VI Demographics
A Age
B Gender
C Race/Ethnicity
D Socioeconomic Factors
1 Marital Status
2 Residence
3 Income
4 Education Level
VII Conclusion
References
4 Screening
I Introduction
II Screening Tool Characteristics
III Acute Care
A Malnutrition Screening Tool (MST)
B Malnutrition Universal Screening Tool (MUST)
C Nutritional Risk Screening – 2002 (NRS-2002)
D Nutrition Risk in the Critically Ill (NUTRIC Score)
IV Long-Term Care (LTC)
A Mini Nutritional Assessment (MNA)
B Short Nutritional Assessment Questionnaire (SNAQ)
V Community
A Determine Checklist
B Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)
VI Conclusion
References
5 Assessment – Anthropometrics and Functional Status
I Introduction
II Patient Interaction and Exam Considerations
A Presentation and Interview
B Safety
C Privacy
D Cultural Considerations
E Consent
F Other Considerations
III Exam Methodology
IV Anthropometric Measurements
A Height
1 Knee Height
2 Forearm Length
3 Arm Span
4 Recumbent Length
B Weight
1 Weight History
2 Weight Change
3 Ideal Body Weight
C Body Mass Index
D Other Measures
1 Calf Circumference
2 Mid-Upper Arm Circumference
V Functional Examination
A Hand Grip Strength
B Other Functional Measures
VI Data Interpretation
VII Technological Tools
VIII Conclusion
References
6 Assessment – Nutrition-Focused Physical Exam to Detect Macronutrient Deficiencies
I Introduction
II Basic Exam Techniques
III Preparing for NFPE
IV Etiquette
V Interview Techniques
VI Head-To-Toe Approach
VII Examination for Muscle Atrophy
A Temporalis Muscle Exam
B Upper Body Muscle Exam
C Back Muscle Exam
D Hand Muscle Exam
E Lower Body Muscle Exam
VIII Examination for Subcutaneous Fat Loss
A Orbital Fat Pad Exam
B Buccal Fat Pad Exam
C Biceps and Triceps Skinfold Exam
D Iliac Crest Skinfold Exam
IX Examination for Fluid Accumulation
X Hand Grip Strength
XI Challenges – Obesity
XII Challenges – Age-Related Sarcopenia
XIII NFPE Competence
XIV Conclusion
References
7 Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
I Introduction
II Hair
III Eyes
IV Oral Cavity
A Lips
B Gums
C Tongue
V Skin
VI Nails
VII Conclusion
References
8 Assessment – Macronutrient Needs and Oral Intake
I Background
II Macronutrient Metabolism
A Chronic Disease
B Starvation
C Acute Inflammation/Injury
III Macronutrient Requirements
A Energy
1 Calorimetry
2 Predictive Equations
3 Weight-Based
B Protein
1 Nitrogen Balance
2 Weight-Based
C Dietary Reference Intakes
IV Macronutrient Intake
A Intake Trends in Healthcare Settings
B Intake Assessment Tools
1 Weighed Food Journal
2 Food Diary/Journal
3 24-Hour Diet Recall
4 Food Frequency Questionnaire
5 Technological Approaches
V Conclusion
References
9 Vitamin Deficiencies – Diagnosis and Treatment
I Introduction
II Fat-Soluble Vitamins
A Vitamin A
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
B Vitamin D
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
C Vitamin E
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
D Vitamin K
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
III Water-Soluble Vitamins
A Thiamin (Vitamin B1)
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
B Riboflavin (Vitamin B2)
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
C Niacin (Vitamin B3)
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
D Pantothenic Acid (Vitamin B5)
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
E Pyridoxine (Vitamin B6)
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
F Biotin (Vitamin B7)
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
G Folic Acid
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
H Cyanocobalamin (Vitamin B12)
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
I Vitamin C
1 Deficiency Risk Factors
2 Diagnosis: Biochemical and Physical Signs
3 Treatment
IV Conclusion
References
10 Trace Mineral Deficiencies – Diagnosis and Treatment
I Introduction
II Iron
A Deficiency Risk Factors
B Biochemical Assessment
C Physical Signs and Symptoms
D Treatment
III Zinc
A Deficiency Risk Factors
B Biochemical Assessment
C Physical Signs and Symptoms
D Treatment
IV Iodine
A Deficiency Risk Factors
B Biochemical Assessment
C Physical Signs and Symptoms
D Treatment
V Selenium
A Deficiency Risk Factors
B Biochemical Assessment
C Physical Signs and Symptoms
D Treatment
VI Copper
A Deficiency Risk Factors
B Biochemical Assessment
C Physical Signs and Symptoms
D Treatment
VII Manganese
A Deficiency Risk Factors
B Biochemical Assessment
C Physical Signs and Symptoms
D Treatment
VIII Trace Elements and Parenteral Nutrition
IX Conclusion
References
11 Treatment – Acute Illness-Related Malnutrition
I Introduction
II Nutrition Therapy: Timing and Modality
A Enteral Nutrition
B Parenteral Nutrition
III Estimating Nutrient Needs
A Energy
B Protein
IV Individualized Approach to Feeding the Critically Ill
A Sepsis
B Surgery
C Obesity
V Monitoring and Evaluation
VI Beyond the ICU
VII Conclusion
References
12 Treatment – Chronic Illness-Related Malnutrition
I Introduction
II Etiology
A Inadequate Oral Intake
1 Anorexia
2 Dyspnea and Fatigue
3 Dysphagia
4 Difficulty Chewing
5 Other Gastrointestinal Symptoms
B Metabolic Changes
C Nutrient Absorption
III Medical Nutrition Therapy
A Nutrient Delivery
1 Food
2 Oral Nutrition Supplements
3 Enteral Nutrition
4 Parenteral Nutrition
B Nutrition Education and Counseling
C Coordination of Nutrition Care
IV Pharmacological Interventions
V Conclusion
References
13 Treatment – Social/Environmental-Related Malnutrition
I Introduction
II Food Insecurity
A Factors Associated With Food Insecurity
B Identification of Food Insecurity
C Interventions
1 Supplemental Nutrition Assistance Program
2 Women, Infants, and Children
3 Food Banks and Pantries
4 Food Pharmacies
5 Medically Tailored Meals
III Mental Disorders
A Substance Use Disorders
B Feeding and Eating Disorders
1 Anorexia Nervosa
2 Bulimia Nervosa
3 Avoidant/Restrictive Food Intake Disorder
C Concurrent SUD and FED
IV Conclusion
References
14 Healthcare Payment Systems
I Introduction
II Background Information
III Inpatient – Acute Care
A MS-DRG Assignment
B Malnutrition Coding
C Medicare Payment
D All Patient Refined–Diagnosis–Related Group (APR-DRG) Assignment
E Severity of Illness and Risk of Mortality
F Medicare Payment Adjustments
G Case Mix Index
H Influence of Malnutrition Coding On Hospital Payment
1 Malnutrition Coding Denials
2 Auditing Severe Malnutrition Codes
3 Malnutrition Documentation
IV Skilled Nursing Facilities
V Outpatient Hospital-Based Clinics
VI Conclusion
References
15 Tying Things Together
I Introduction
II Regulatory Efforts to Address Malnutrition
III Implementing a Malnutrition Program
A Nutrition Screening Process
B Nutrition Assessment Methodology
C Documentation and Communication of Nutrition Diagnosis
D Leveraging the Electronic Health Record
E Education of Healthcare Team Members
IV Evidence Supporting Quality Improvement in Malnutrition Care
V CONCLUSION
References
Index