Clinical malnutrition in adults: assessment and implications
Date
2023
Authors
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Publisher
University of Delaware
Abstract
Nutrition assessment is an important aspect of patient care, as poor nutritional status can negatively impact patient outcomes. There are inconsistencies and subjective elements across sets of diagnostic criteria for malnutrition that can lead to errors in the identification of those with poor nutritional status. The primary purpose of this dissertation was to explore: the characteristics of patients with malnutrition; muscular assessment as a component of nutritional status; and the utility of chest CT as a nutrition assessment tool. ☐ The first paper was a retrospective study conducted at Christiana Care Health System that aimed to determine characteristics of patients with malnutrition, specifically, starvation-related malnutrition (SRM), and to describe characteristics of patients that were readmitted to the hospital with SRM. Findings from this study indicate that the elevated prevalence of substance abuse disorder and psychiatric disease in patients with SRM impart relevant targets for treatment to improve patient outcomes. ☐ The second paper, a systematic review, describes body composition and functional assessments of muscle in clinical settings for nutrition assessment. Bioimpedance methods were the most common body composition assessment, and handgrip strength is the most often used functional status assessment; however, these methods are being used with various procedures and interpretation methods. There is a need for further validation and the evolution of standardized assessment protocols in clinical settings. ☐ The third paper was a retrospective study conducted at Christiana Care Health Systems, with the novel goal of determining the associations between CT measures of pectoralis muscle size and quality, and the diagnosis of malnutrition in mechanically ventilated adult patients. Patients with malnutrition had significantly lower pectoralis muscle size and pectoralis muscle index than patients without malnutrition. Further research is needed in larger sample sizes to corroborate these findings, with the ultimate goal of validating CT derived pectoralis muscle measures. ☐ Overall, this dissertation explored aspects of clinical nutrition assessment, including identification of malnutrition and the use of body composition assessment methods to contribute to the determination of nutritional status. This research moves the field of nutrition assessment closer to the development of standardized assessment protocols that include objective measures of muscularity.
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Keywords
Body composition, Clinical nutrition, Malnutrition, Nutrition assessment, Muscular assessment