Adult Malnutrition: Diagnosis and Treatment

Description

Malnutrition is a global health problem and results in significant clinical and financial consequences for people, communities, and healthcare institutions. Causes of malnutrition are often complex and multifactorial, and can include acute illness or injury, chronic disease, and a variety of socioeconomic factors. While many professional articles have been published on malnutrition, there is no single source of information that encompasses all aspects of the condition. Adult Malnutrition: Diagnosis and Treatment reviews the risk factors and etiologies of malnutrition, as well as screening, assessment, diagnosis, and treatment to aid healthcare professionals in the identification and successful care of individuals with this condition in a variety of settings. Features Discusses how to identify malnutrition risks through the use of validated nutrition screening tools in diverse settings Provides detailed instructions on conducting a nutrition-focused physical exam, including illustrations depicting differing degrees of muscle wasting and fat loss Presents information on risk factors, diagnosis, and treatment of vitamin and mineral deficiencies, including photos illustrating signs of deficiency to aid in diagnosis Details treatments for malnutrition related to acute illness/injury, chronic illness, social/environmental circumstances, or starvation Reviews challenges and potential solutions to malnutrition identification and treatment in healthcare institutions Edited by Jennifer Doley, MBA, RDN, CNSC, FAND, and Mary Marian, DCN, RDN, CSO, FAND, FASPEN, this book serves asa key text for registered dietitian nutritionists, health practitioners, and clinicians. 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