Optimizing protein and energy intake in hospitals by improving individualized meal serving, hosting and the eating environment.

OBJECTIVE: Optimizing protein and energy intake by food in nutritional risk patients is difficult. The aim of this study was to improve the ≥75% of energy and protein requirements. We would like to see nurses take on the role of hosting the nutritional-risk patients, including focusing on bringing nutrition to the forefront in the collaboration between nurses and patients. METHODS: This was an interventional study that included patients admitted to the Departments of Infectious Diseases, Hematology, and Heart-Lung Surgery in a baseline and follow-up investigation. It included 24-h food intake registrations (FRs) for 3 d consecutively, a questionnaire, and a semistructured patient interview. The interventions included in this study helped to improve the eating environment and serving, integrated nutrition into the nurse-patient welcome interview, and targeted individual preferences and challenges for eating. RESULTS: The study comprised 76 24-h FRs at baseline and 108 FRs at follow-up. The total group had improved food intake; 75% of individual energy requirements were met by (67.6% vs. 40%; P = 0.036) and the Heart-Lung Surgery group (85.7 vs. 38.5; P = 0.036). This was not reflected for protein (NS). Energy intake improved for the entire group, albeit not significantly (P = 0.862). Patients reported being happy with the interventions regarding individualized food serving, nurse communication, and improved meal environments. CONCLUSION: Only insignificant improvements to overall energy intake were seen in two of the three departments and in the overall group, and no statistical or clinically significant improvements to protein intake were observed. The relative risk of meeting 75% of energy requirements was improved in the overall group and in patients in the Department of Heart-Lung Surgery. This did not include the meeting of protein requirements. Improvements were welcomed by patients and staff. Focus on individualized nutrition from the nursing staff also improved.

Ability of different screening tools to predict positive effect on nutritional intervention among the elderly in primary health care.

OBJECTIVE: Routine identification of nutritional risk screening is paramount as the first stage in nutritional treatment of the elderly. The major focus of former validation studies of screening tools has been on the ability to predict undernutrition. The aim of this study was to validate Mini Nutritional Assessment-Short Form (MNA-SF), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening 2002 (NRS-2002), Body Mass Index (BMI) <24, and the Eating Validation Scheme (EVS), using published randomized controlled trials of nutritional intervention among old people in primary health care, in order to evaluate whether they were capable of distinguishing those with a positive benefit from those that showed no benefit of nutritional intervention. METHODS: The methods used were a literature search; classification of participants with respect to nutritional risk according to the different nutritional screening tools; and validation (i.e., evaluation of whether the different tools were capable of distinguishing those with a positive benefit from those that showed no benefit of nutritional intervention by assessing the positive [PPV] and negative [NPV] predictive values). RESULTS: MNA-SF, NRS-2002, BMI <24 and EVS had the highest PPV (0.75) and EVS the highest NPV (0.74) with regard to function-the primary clinical outcome. CONCLUSION: Overall EVS seemed most capable of distinguishing those clients and residents with a positive benefit from those that showed no benefit of nutritional intervention. The findings should be confirmed in further validation and intervention studies.