This document discusses malnutrition in hospitalized patients. It provides background on malnutrition, its causes and symptoms. It then summarizes several studies that were conducted to better understand malnutrition in hospitals. The studies looked at factors like food intake, nutritional status, reasons for poor intake, and interventions to address malnutrition. They involved patients from a range of age groups, from infants to the elderly. The studies highlighted how common malnutrition is in hospitals and its negative impacts on patient outcomes like increased mortality. They stressed the importance of early identification and treatment of malnutrition.
The presentation has three parts: UNITE for Diabetes Philippines CPG recommendations on medical nutrition therapy (MNT), improving adherence to MNT and use of SMS.
The presentation has three parts: UNITE for Diabetes Philippines CPG recommendations on medical nutrition therapy (MNT), improving adherence to MNT and use of SMS.
Nutrition during pregnancy
Nutrition before pregnancy
unhealthy eating trends
Nutrition during pregnancy
important of good Nutrition during pregnancy
Key Nutrition during pregnancy
Optimal weight gain during pregnancy
1st trimester
2nd trimester
3rd trimester
Nutrition during lactation
protein
Sources of vitamins
Nutrition requirements increases tremendously during pregnancy and lactation as the expectant or nursing mother not only has to nourish herself but also growing foetus and the infant who is being breast fed
Dr Somendra Shukla Pediatrician Gurgaon
MBBS, DNB (Pediatrics), MNAMS, MRCPCH (UK), Fellow Neonatology (NNF)
www.drsomendrashukla.com
Dr. Somendra shukla is a one of the best Pediatrician & neonatologist at Gurgaon. He has vast expierence of 9 yrs in neonatology & pediatrics. He has cleared the prestigious Diplomate of National Board (DNB) and royal college of pediatrics, ondon (MRCPCH) examinations in pediatrics. He has worked and honed up her skills with some of the top corporates institutes of India such as Fortis hospital, moolchand medcity and paras hospital. He has also done his Fellowship in neonatology awarded by prestigious National neonatology forum of India.
He is a member of IAP and NNF and has attended various seminars and workshops and has presented several papers in various national conferences and conducted CMEs.
He is an expert in newborn intensive care including care of ventilated and extremely low birth weight babies (<1000g><750g). He has also been trained in cranial Ultrasonography and Echo studies in neonates.
A presentation I made for a graduate-level Maternal & Childhood Nutrition course. This PowerPoint focuses on the important role good nutrition can play in this age group, as well as nutrition programs for this age group.
Right nutrition in early days of life is very important. Nutritional requirements are different for kids and adults in the family. They are in their growing age, they need balanced nutrition but not only high calorie foods, In growing years different age groups have different requirements. Discussion with experts helps in dealing with the situation.
This pilot study describe the malnutrition with its double burden ( overweight and under weight ) among Egyptian population and its effect on public health.
This poster published in Duphat conference in Dubai
Nutrition during pregnancy
Nutrition before pregnancy
unhealthy eating trends
Nutrition during pregnancy
important of good Nutrition during pregnancy
Key Nutrition during pregnancy
Optimal weight gain during pregnancy
1st trimester
2nd trimester
3rd trimester
Nutrition during lactation
protein
Sources of vitamins
Nutrition requirements increases tremendously during pregnancy and lactation as the expectant or nursing mother not only has to nourish herself but also growing foetus and the infant who is being breast fed
Dr Somendra Shukla Pediatrician Gurgaon
MBBS, DNB (Pediatrics), MNAMS, MRCPCH (UK), Fellow Neonatology (NNF)
www.drsomendrashukla.com
Dr. Somendra shukla is a one of the best Pediatrician & neonatologist at Gurgaon. He has vast expierence of 9 yrs in neonatology & pediatrics. He has cleared the prestigious Diplomate of National Board (DNB) and royal college of pediatrics, ondon (MRCPCH) examinations in pediatrics. He has worked and honed up her skills with some of the top corporates institutes of India such as Fortis hospital, moolchand medcity and paras hospital. He has also done his Fellowship in neonatology awarded by prestigious National neonatology forum of India.
He is a member of IAP and NNF and has attended various seminars and workshops and has presented several papers in various national conferences and conducted CMEs.
He is an expert in newborn intensive care including care of ventilated and extremely low birth weight babies (<1000g><750g). He has also been trained in cranial Ultrasonography and Echo studies in neonates.
A presentation I made for a graduate-level Maternal & Childhood Nutrition course. This PowerPoint focuses on the important role good nutrition can play in this age group, as well as nutrition programs for this age group.
Right nutrition in early days of life is very important. Nutritional requirements are different for kids and adults in the family. They are in their growing age, they need balanced nutrition but not only high calorie foods, In growing years different age groups have different requirements. Discussion with experts helps in dealing with the situation.
This pilot study describe the malnutrition with its double burden ( overweight and under weight ) among Egyptian population and its effect on public health.
This poster published in Duphat conference in Dubai
1 Running head NUTRITION FINAL RESEARCH PAPER HCG D.docxkarisariddell
1
Running head: NUTRITION FINAL RESEARCH PAPER
HCG Diet and Cystic Fibrosis
West Coast University
Orange County
Your Name Here
NURS 225: Nutrition in Health and Disease
2017
2
NUTRITION FINAL RESEARCH PAPER
Topic # 1: HCG Diet
Part I, Criteria # 1: Identification of Nutrients
According to the Dudek (2016), the RDAs represent the average daily-recommended
intake to meet the nutrient requirements of 97% to 98% of healthy individuals by life stage and
gender. When estimating the nutritional needs of people with health disorders, health
professionals use the RDA’s as a starting point and adjust them according to the individual’s
need (Dudek, 2013). Even though HCG is a hormone injection program, there are extremely
strict and limited food choice to their diet plan such as: 500 calories limit per day, no cosmetic
products that contain fat in them, 2 small apples are not an expectable exchange for 1 apple.
Table 1 below lists some foods that patients are allowed to choose from for daily intake
(Simeons, 2016).
Table 1 The Original HCG Diet Protocol by Dr. Simeons
3
NUTRITION FINAL RESEARCH PAPER
Due to such strict rules and limitation on food selection, patients would end up with deficiency in
two important macronutrients such as carbohydrate and fat. As we can see, if we plug in some
foods from Table 1 above into MyFitnessPal website we would end up with 509 calories, which
is very close to what the HCG program requires (Lose weight with MyFitnessPal. Retrieved
from http://www.myfitnesspal.com/). However, if we look at the amount of carbohydrate
remaining, it is obvious that patients only consume 50% of their daily-recommended calories.
Carbohydrate is a macronutrient that is important in providing energy for the daily living.
Clearly, patients using HCG program are very limited on fat consumption. According to
example below, if we follow The Original HCG Diet Protocol by Dr. Simeons, we would end up
with only 5 grams from fat when the daily-recommended intake is 40 grams. Fats come in
multiple different forms. While some are bad and should be limited, some are essential for the
body; therefore, limiting the amount of fat consumption to almost completely nothing is not a
good diet plan. On the other side, this program provides a very sufficient amount of protein to
the patients. As we can see from Table 2 below, patient fulfilled the amount of daily-
recommended requirement, 60 grams, with the additional 4 grams. This might be also the key
element to the program that claims that by injecting HCG, patients will not feel hungry. It might
be because the high amount of protein patients consume that make them feel less hungry.
4
NUTRITION FINAL RESEARCH PAPER
Table 2 Patient Food Diary from MyFitnessPal Showing Daily Intake Goals versus RDAs.
Part I, Criteria # 2: RDA Approval Analysis
As mentioned previously, Recommended Dietary Allowa.
1 Running head NUTRITION FINAL RESEARCH PAPER HCG D.docxjeremylockett77
1
Running head: NUTRITION FINAL RESEARCH PAPER
HCG Diet and Cystic Fibrosis
West Coast University
Orange County
Your Name Here
NURS 225: Nutrition in Health and Disease
2017
2
NUTRITION FINAL RESEARCH PAPER
Topic # 1: HCG Diet
Part I, Criteria # 1: Identification of Nutrients
According to the Dudek (2016), the RDAs represent the average daily-recommended
intake to meet the nutrient requirements of 97% to 98% of healthy individuals by life stage and
gender. When estimating the nutritional needs of people with health disorders, health
professionals use the RDA’s as a starting point and adjust them according to the individual’s
need (Dudek, 2013). Even though HCG is a hormone injection program, there are extremely
strict and limited food choice to their diet plan such as: 500 calories limit per day, no cosmetic
products that contain fat in them, 2 small apples are not an expectable exchange for 1 apple.
Table 1 below lists some foods that patients are allowed to choose from for daily intake
(Simeons, 2016).
Table 1 The Original HCG Diet Protocol by Dr. Simeons
3
NUTRITION FINAL RESEARCH PAPER
Due to such strict rules and limitation on food selection, patients would end up with deficiency in
two important macronutrients such as carbohydrate and fat. As we can see, if we plug in some
foods from Table 1 above into MyFitnessPal website we would end up with 509 calories, which
is very close to what the HCG program requires (Lose weight with MyFitnessPal. Retrieved
from http://www.myfitnesspal.com/). However, if we look at the amount of carbohydrate
remaining, it is obvious that patients only consume 50% of their daily-recommended calories.
Carbohydrate is a macronutrient that is important in providing energy for the daily living.
Clearly, patients using HCG program are very limited on fat consumption. According to
example below, if we follow The Original HCG Diet Protocol by Dr. Simeons, we would end up
with only 5 grams from fat when the daily-recommended intake is 40 grams. Fats come in
multiple different forms. While some are bad and should be limited, some are essential for the
body; therefore, limiting the amount of fat consumption to almost completely nothing is not a
good diet plan. On the other side, this program provides a very sufficient amount of protein to
the patients. As we can see from Table 2 below, patient fulfilled the amount of daily-
recommended requirement, 60 grams, with the additional 4 grams. This might be also the key
element to the program that claims that by injecting HCG, patients will not feel hungry. It might
be because the high amount of protein patients consume that make them feel less hungry.
4
NUTRITION FINAL RESEARCH PAPER
Table 2 Patient Food Diary from MyFitnessPal Showing Daily Intake Goals versus RDAs.
Part I, Criteria # 2: RDA Approval Analysis
As mentioned previously, Recommended Dietary Allowa ...
PERSPECTIVEUnderstanding Nutritional Epidemiology and Its.docxmattjtoni51554
PERSPECTIVE
Understanding Nutritional Epidemiology and Its
Role in Policy1,2
Ambika Satija,3,4 Edward Yu,3 Walter C Willett,3–5 and Frank B Hu3–5*
3Department of Nutrition and 4Department of Epidemiology, Harvard School of Public Health, Boston, MA; and 5Channing
Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
ABSTRACT
Nutritional epidemiology has recently been criticized on several fronts, including the inability to measure diet accurately, and for its reliance
on observational studies to address etiologic questions. In addition, several recent meta-analyses with serious methodologic flaws have arrived
at erroneous or misleading conclusions, reigniting controversy over formerly settled debates. All of this has raised questions regarding the
ability of nutritional epidemiologic studies to inform policy. These criticisms, to a large degree, stem from a misunderstanding of the
methodologic issues of the field and the inappropriate use of the drug trial paradigm in nutrition research. The exposure of interest in
nutritional epidemiology is human diet, which is a complex system of interacting components that cumulatively affect health. Consequently,
nutritional epidemiology constantly faces a unique set of challenges and continually develops specific methodologies to address these.
Misunderstanding these issues can lead to the nonconstructive and sometimes naive criticisms we see today. This article aims to clarify common
misunderstandings of nutritional epidemiology, address challenges to the field, and discuss the utility of nutritional science in guiding policy
by focusing on 5 broad questions commonly asked of the field. Adv Nutr 2015;6:5–18.
Keywords: dietary assessment, food policy, meta-analysis, nutritional epidemiology, randomized controlled trials, prospective cohort studies
Introduction
Epidemiology has long had its share of skeptics, with Taubes’
1995 article being the most well-known (1). However, more
recent commentaries have attacked nutritional epidemiol-
ogy on several fronts. Ioannidis (2) criticizes the observa-
tional nature of epidemiologic studies and small trials,
stating that “definitive solutions won’t come from another
million observational papers or small randomized trials.”
He refers to an article by Archer et al. (3), which calls into
question the validity of data from the NHANES and suggests
that “the ability to estimate population trends in caloric
intake and generate empirically supported public policy rel-
evant to diet-health relations from US nutritional sur-
veillance is extremely limited.” Furthermore, questionably
designed and executed meta-analyses have disseminated
conflicting messages about nutrition and health, such as
the conclusion that being overweight lowers the risk of all-
cause mortality (4) and that replacing saturated fat with
polyunsaturated fats has no substantial impact on cardiovas-
cular risk (5). Such conclusions are not only confusing but
also dangero.
Adequacy of Enteral Nutritional Therapy Offered to Patients in an Intensive C...asclepiuspdfs
Introduction: Malnutrition is a common framework in hospitalized patients. Enteral nutritional therapy (ENT) is the most commonly used strategy to treat malnutrition. However, complications related to ENT can make it impossible to reach the nutritional requirements of the patient. Objectives: The objectives of the study are to evaluate the nutritional status of patients receiving exclusive ENT and to assess the adequacy of ENT in an intensive care unit (ICU). Materials and Methods: Retrospective study conducted in an ICU of a private hospital in Cuiabá/MT/Brazil between 2015 and 2016. The sample consisted of 115 patients >18 years of age in exclusive ENT. The nutritional status was evaluated using anthropometric, clinical, dietary, and biochemical measurements, and it was categorized by the subjective global assessment. The calorie and protein requirements were calculated according to the hospital protocol
The Journal of NutritionSymposium Nutritional Experiences.docxarnoldmeredith47041
The Journal of Nutrition
Symposium: Nutritional Experiences in Early Life as Determinants of the
Adult Metabolic Phenotype
Mechanisms Linking Suboptimal
Early Nutrition and Increased Risk of
Type 2 Diabetes and Obesity1–3
Malgorzata S. Martin-Gronert and Susan E. Ozanne*
Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Addenbrooke’s Hospital,
Cambridge CB2 0QQ, UK
Abstract
Epidemiological studies have revealed a relationship between poor early growth and development of type 2 diabetes and
other features of metabolic syndrome. The mechanistic basis of this relationship is not known. However, compelling
evidence suggests that early environmental factors, including nutrition, play an important role. Studies of individuals in
utero during a period of famine showed a direct relationship between maternal nutrition and glucose tolerance. Further
evidence has come from studies of monozygotic twins who were discordant for type 2 diabetes. Nutrition during the early
postnatal period has also been shown to have long-term consequences on metabolic health. Excess nutrition and
accelerated growth during the neonatal period has been suggested to be particularly detrimental. Animal models, including
maternal protein restriction, have been developed to elucidate mechanisms linking the early environment and future
disease susceptibility. Maternal protein restriction in rats leads to a low birth weight and development of type 2 diabetes in
the offspring. This is associated with b cell dysfunction and insulin resistance. The latter is associated with changes in
expression of key components of the insulin-signaling cascade in muscle and adipocytes similar to that observed in tissue
from young men with a low birth weight. These differences occur prior to development of disease and thus may represent
molecular markers of early growth restriction and disease risk. The fundamental mechanisms by which these
programmed changes occur remain to be fully defined but are thought to involve epigenetic mechanisms. J. Nutr. 140:
662–666, 2010.
Introduction
It is well established that poor growth in utero is associated with
increased risk of developing diseases such as type 2 diabetes in
later life (1). There is strong evidence from both human and
animal studies that the early environment and in particular early
nutrition play an important role. However, the molecular
mechanisms by which a phenomenon that occurs in early life
has a phenotypic consequence many years later are only just
starting to emerge.
Epidemiological data
The first study to link birth weight to increased risk of type 2
diabetes was conducted in a group of men born in Hertfordshire,
UK, who were 64 y old at the time of the study. Those men who
had the lowest birth weight were 6 times more likely to currently
have either impaired glucose tolerance or type 2 diabetes than
those men who were heaviest at birth (2). These findings have
been reproduce.
A Brief Review on Health Implication of Skipping Breakfast with Emphasis on Weight Gain in Adults by Elizabeth MJS* in Crimson publishers: Journal of Physical Medicine
Regular eating of breakfast contributes to the nutritional health of an individual. Some people skipped breakfast because of the desire to lose weight. An individual that consumed breakfast regularly is more likely to exhibit high level of physical activity and cardio-respiratory fitness. This short review aims to examine health implication of skipping breakfast with emphasis on weight gain in adults. Skipping breakfast is a wrong step in weight loss management as several available literature links irregular consumptions of breakfast to weight gain. Skipping breakfast over an extended period has a negative effect on cardiometabolic risk profile. It increases the risk of developing metabolic syndrome that increases the risk of cardiovascular diseases and type 2 diabetes mellitus development. Consumption of breakfast regularly has been found to be an alternative means of weight management. Future research is needed to examine eating and time of breakfast as well as types of breakfast adults’ in developing countries consumed in relation to their body mass index.
https://crimsonpublishers.com/epmr/fulltext/EPMR.000531.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more articles in Examines in Physical Medicine & Rehabilitation
Please click on: https://crimsonpublishers.com/epmr/
For more details track the below URL
https://www.linkedin.com/company/crimsonpublishers
medical nutrition products - rol van medische voedingtcnn
De rol van medische voeding
Nutricia Advanced Medical Nutrition heeft als missie: "Herstel en welzijn begint voor iedere patiënt die het nodig heeft met Nutricia Advanced Medical Nutrition" Dat betekent voor Nutricia dat medische voeding een essentieel onderdeel is van medische behandelingen.
Voor oudere patiënten kan het lastig zijn om voldoende te blijven eten. Terwijl goede voeding voor hen juist extra belangrijk is.
Assignment #1 – This assignment should help you to organize your t.docxdavezstarr61655
Assignment #1 – This assignment should help you to organize your thoughts about your research. Take time to really think about the questions – this effort will make writing the actual paper much easier. Please complete this worksheet and submit on Bb. You need to submit only once per pair (make sure I know who you are working with!).
1. With your partner, develop a research question. Write your research question here:
*Please ensure that the question is not answered by the book’s author.
Question is. "How has the development in human society led to the increased frequency of obesity?"
2. Why do you have this question? Please write a paragraph or two explaining your interest in this question. Give specific information from the book that leads you to ask this question (include page numbers). Explain how this information relates to your question.
Obesity in the whole world has become a public health problem in that it has raised concern. About 700 million people aged 15 years and above in the entire world are obese. The prevalence rate of based on years past shows a rapid increase of obesity in developed countries mainly Pacific region. Various cancers, cardiovascular diseases-morbidities, type II diabetes are some of the factors which lead to morbidity and mortality; this is based on literature on body exhaustive.
A public health strategy is, therefore, to be developed based on prevention of obesity rate of increase. The development and also the process of policies on preventing obesity should target factors which tend to contribute to obesity. Moreover, it should target barriers to lifestyle changes which are personal and also environmental and levels socioeconomic.
There are etiologies which contribute to obesity in which this etiologies are multifactorial,some if these factors include sedentary lifestyle, adverse socio-economic conditions which are there in developed countries, high rate of energy dense food, rigid restraint, alcohol, large portion sizes and food ratio which are prepared outside home (mostly in developed countries) page 70 (International journal of environmental research and public health).
There is a proposed framework by sacks (2009) where a suggestion is made that there should be policy actions and implementation of health strategies to preventing obesity. These factors target environments, behaviors directly influencing people, physical activity settings, food environments and also the socioeconomic environments.
3. What do you need to learn as a biologist to understand your question in the context of human evolution?
Obesity, diabetes and also metabolic syndrome has become a worldwide health concern due to that they are growing rapidly, and their causes are not fully understood. Therefore a research into the obesity epidemic etiology is highly appreciated depending on the evolutionary roots of metabolic control. Thrifty gene hypothesis argues that obesity is an evolutionary roots of metabolic control .
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Malnutrition is a condition in which your body is not getting enough nutrients; and is a
result of an inadequate or unbalanced diet, problems with digestion or absorption, and certain
medical conditions (1). Symptoms of malnutrition vary but can include the following: fatigue,
dizziness, weight loss, loss of hair, lack of menstruation, and lack of growth in children (1).
Tests to determine malnutrition are nutritional assessments and blood work (1). Depending
on the severity of the condition, treatment typically consists of replacing lost nutrients, treating
the symptoms, and treating any medical conditions associated (1). If left untreated,
malnutrition can lead to possible complications such as mental or physical disabilities, illness,
and even death (1). In a clinical setting, poor nutritional status in a patient has been
established as an indicator for an increase in complications (2). In addition, poor nutritional
status has also been associated with higher rates of infection, poor wound healing, longer
hospital stays, and even cardiac complications (2). Current interventions such as protected
meal times, more menu items, additional snacks, encouraging patients to eat, and even sip
feedings have been used to prevent weight loss(2), but the best way to prevent malnutrition
is through eating a well balanced diet (1).
In 2009, the European Society for Clinical Nutrition and Metabolism published a
multinational one-day cross-sectional survey referred to as NutritionDay (2). The survey,
which involved 25 countries, took place on January 19th, 2006 and involved 16,455 adult
hospitalized patients (2). The main focus of the survey was the effect of food intake and
nutritional factors on death in a hospital setting (2). NutritionDay utilized members of the
interdisciplinary team and patients which filled out three questionnaires to obtain data (2).
Pg. 2
3. The first questionnaire described the facility where the patient was staying, the second was
the caregiver's view of the patient (age, height, weight, medical condition, comorbidities, and
type of nutritional intake), and the third questionnaire allowed patients to report their food
intake on NutritionDay (2). The outcome assessment following NutritionDay lasted for 30
days to determine the odds ratio for dying (the effect of the amount of the meal eaten on
mortality) (2). Food intakes on NutritionDay showed that less than half of the patients finished
their meals (2). Patients that reported eating less than half of their meals, or nothing at all,
commonly stated the reason was “not being hungry,” “don't like the taste,” “normally eating
less,” “don't want to eat,” and “having nausea (2).” During the 30 day outcome assessment,
20% of patients who did not eat at all started receiving artificial nutrition, and 5-8% who ate
less than half of their meals also received artificial nutrition (2). At the end of the study 634
patients (3.9%) died, and the odds ratio for dying increased as the amount of food consumed
on NutritionDay decreased (2). The study concludes that decreased food intake and altered
nutrition status remains to be a problem within European hospitals (2). As a result, patients
are at higher risk for mortality and macro/micro nutrient deficiencies (2). Just like vital signs,
the study suggests the fractions of meals eaten, for at least one meal, should be recorded in
patient charts and may even trigger early nutrition intervention (2).
In 2008, The Journal of Nutrition, Health, and Aging published the article titled, “ Why
Don't Elderly Hospital Inpatients Eat Adequately (3)?” The article states that malnutrition is
common in elderly hospitalized patients, which in turn results in poor clinical outcomes (3).
The objective of the study was to gain an understanding of why poor nutrition intake in the
elderly population occurs in a hospitalized setting, and what are the consequences of poor
intake(3). For the duration of 4 weeks, 100 patients (mean age of 81.7 years) were observed
Pg. 3
4. twice a week from admission to discharge; and their intake was reported through
observations, food-charts, case-notes, and through interviews with the patient/caregivers (3).
Additionally, reasons for inadequate intake was recorded (3). From the data provided it was
determined whether the patient ate at least ¾ of their diet along with prescribed supplements,
and if the patients ate less than this amount, inadequate nutrition was documented (3). The
results of the study showed that upon admission, 21 patients were malnourished (based on
height and weight below the 10th percentile), 3 patients became malnourished during their
stay at the hospital, and 67% of patients were reported to be eating inadequately (285/425
assessments were made) (3). The most common reasons for inadequate intake during the
earlier part of the patients' hospital stay was the following: acute illness, anorexia, oral
problems, and catering limitations (3). Throughout the duration of the study, the most
common reason for inadequate intake were: confusion, low mood, and dysphagia (3).
Moreover, in comparison to well nourished patients, malnourished patients had a higher
number of oral problems (3).
Ney D et al., published a review titled, “Senescent Swallowing: Impact, Strategies, and
Interventions,” which discussed the increased risk of oral problems accompanied by age (4).
Dysphagia, difficulty swallowing, occurs in the elderly population and is a result of the loss of
skeletal muscle mass and strength (4). Patients will often develop a fear of eating, an
impaired ability to eat, or even anorexia (4). Dysphagia plays an important role on the effects
of a patients nutrition status and if untreated or undiagnosed, it can lead to dehydration or
malnutrition (4). Specifically, dysphagia can lead to an increased risk of protein-energy
malnutrition that often leads to weight loss, muscle breakdown, dehydration, fatigue,
aspiration pneumonia, and an overall decline in the patients ability to function (4). The review
Pg. 4
5. discussed a recent study that identified dysphagia and the loss of skeletal muscle
mass/strength as a predictive of hospital acquired infections (4). In addition, untreated or
undiagnosed dysphagia, which progressed to protein-energy malnutrition, increased the
morbidity and mortality rates of patients in a clinical setting (4).
Not only is malnutrition a concern in the elderly population, but also in infants and
children. Barron M et al., wrote an article titled, “ Nutritional Issues in Infants With Cancer,”
which states that cancer and cancer therapies can also play a role in malnutrition in children
and infants, especially since they have limited energy reserves (5). Furthermore, chronic
malnutrition can effect weight gain, growth, daily interactions, and overall quality of life (5).
Undernutrition, which can lead to malnutrition (prolonged slow weight gain compared to
growth), is a concern for infants since the first two years of life consist of rapid weight gain
and growth (5). By age three, if a child is still malnourished brain growth can be effected (5).
In a hospital setting, for children with cancer, G-tube feedings have been an effective
intervention for weight gain, if the gut is functioning (5). Each feeding is individualized for
feeding schedules and formulas, and frequent adjustments may need to be made in order to
achieve effective weight gain (5). Typically, patients will eat during the day and feeds will be
supplemental (5). In the case of chemotherapy, which can decrease a patient's appetite, tube
feeds will be increased to make up for the decrease in oral intake (5). If the gut is
nonfunctioning, total parenteral nutrition (TPN) has also been proven to be an effective
intervention for weight gain in children, specifically cancer patients (5). However, adequate
caloric and protein intake must be met, and it is important to calculate the amount of TPN
actually received rather than what was ordered (5). In conclusion, adequate intake is crucial
for growth and development for infants and children, cancer and chemotherapy can cause
Pg. 5
6. adverse effects on food intake, if intake is inadequate, consider G-tube feedings or TPN as a
supplementation (5).
In 2008, the study titled, “ Refeeding syndrome: A potentially fatal condition but remains
underdiagnosed and undertreated,” discussed two case studies that involved a 70 year old
woman and a 15 year old girl diagnosed with refeeding syndrome (6). Refeeding syndrome
can occur in patients that have kwashiorkor, marasmus, anorexia nervosa, chronic
malnutrition, chronic alcoholism, chronic diarrhea and vomiting, oncology patients, some post-
op patients, or those who have fasted for prolonged periods of time (7). In a clinical setting,
after a period of starvation and weight loss, patients that begin enteral or parental nutrition
can experience abnormalities in electrolyte levels, glucose metabolism, and vitamin deficiency
(thiamine is a common deficiency) (7). Furthermore, intracellular (cation and anion)
imbalances such as hypophosphatemia, hypomagnesemia, hypokalemia occur during
refeeding syndrome (7). Refeeding syndrome usually occurs within the first few days of
refeeding, and clinical features are nonspecific and can be unrecognizable (7). Case 1
involved a 70 year old woman with dysphagia, shortness of breath, lethargy, and ill health for
the the past four months (6). She had lost weight, the amount unknown, and had been
drowsy and breathless four days prior to admission (6). Her clinical examination did not show
any abnormal blood tests, and her cardiovascular, pulmonary, and abdominal examinations
were unremarkable (6). However, she appeared to have decreased respiratory function and a
high WBC count and she was transferred to the ICU (6). The patient was placed on a high-
energy feeding and twelve hours later she developed a cardiac arrest, but was successfully
resuscitated (6). Over the next few days she remained drowsy, weak, and had severe muscle
weakness (6). A consultation by the clinical nutrition team was ordered, and she was
Pg. 6
7. diagnosed with severe malnutrition complicated by refeeding syndrome with
hypophosphatemia, hypocalcemia, and hypokalemia (which led to worsening of her
respiratory function) (6). Her feedings were changed to high-protein, high-fat, and low
carbohydrate and she was given calcium, phosphate, magnesium, and potassium infusion
until her biochemistry values were within normal limits (6). Three days later she was weaned
from the ventilator and transferred out of the ICU (6). Shortly there after she was sent home
on a normal diet plus oral nutrition supplements (6). Case 2 involved a 15 year old girl who
recently had a total colectomy due to severe ulcerative colitis and was admitted to the hospital
with a 10 day history of nausea and vomiting, lower abdominal pain, severe diarrhea, and
poor oral intake which led to a significant amount of weight loss (6). Upon admission, she
weighed 25 kg, 146 cm tall, and her BMI was <11.7 (severely malnourished) (6). Her sodium
level was 131 mmol/L, potassium was 3.3 mmol/L, and her C-reactive protein was elevated
(6). In addition, her electrolytes concentrations were low baseline, altogether this put her at
high risk for refeeding syndrome(6). The patient was started on IV fluids, potassium
supplements, antibiotics, and a nutrition consult was ordered (6). She was than started on a
low-calorie feeding through an NG tube and the feedings were gradually increased over a 4
day period (6). At the same time she was also given B-vitamin supplements including
thiamine plus other multivitamins and trace elements, and her electrolytes were closely
monitored over the next four days (6). The patients diarrhea ended and her weight increased
by 4 kg (6). She was sent home on night tube feeds and free PO intake during the day (6).
Not all patients who are refed will develop refeeding syndrome; however, these two cases
show the importance of considering refeeding sydrome when starting malnourished patient on
enteral or parental nutrition (6). Refeeding syndrome is a potentially fatal condition that
remains underdiagnosed and undertreated, but if recognized can be treated and prevented
Pg. 7
8. (6).
According to the article, “Concentrations of riboflavin and related organic acids in
children with protein-energy malnutrition,” riboflavin, flavin mononucleotide, and flavin adenin
dinucleotide concentrations have not been studied in depth in relation to malnutrition (8). The
objective of the study was to look into the effects of malnutrition on riboflavin status and
riboflavin's relation with thyroid hormones and concentrations of urinary organic acids (8).
Clinical records, anthropometric data, and plasma nutritional protein concentrations were
observed throughout the duration of the study (8). Vitamin deficiencies associated with
protein-energy malnutrition are Vitamin A,C,D,E, thiamine, and biotin (8). On the other-hand
vitamins B-12 and folate concentrations are usually found to be within normal limits or
elevated during protein-energy malnutrition (8). Sixty malnourished children from the
savannah in Benin and the coast in Togo (both areas located in western Africa) were
examined for the purpose of this study (8). Based on the Wellcome classification, which was
used to determine the types of protein-energy malnutrition; group S had 18 children
diagnosed with kwashiorkor and 12 with marasmus, and group C had 6 children with
kwashiorkor and 24 with marasmus (8). Anthropometric measurements were taken which
included weight, height, arm and head circumference, the ratio of arm to head circumference,
and body mass index was calculated (8). The weights and heights were compared to the US
National Center for Health Statistics, and overnight fasting blood and urine samples were
obtained the morning after admission of the subjects (8). The data from the control group
came from 23 healthy children of the same age from both the savannah and coastal regions
(8). In both malnourished groups the quality of their intakes were recorded , and breast milk
was the main food source for children under the age of 24 months (8). After 24 months of age
Pg. 8
9. the main food sources in the diet consisted of rice or maize pudding, vegetables, and on
occasion powdered cows milk (8). The concentrations of riboflavin in maize, millet, and cow
milk are significantly higher than the concentrations found in rice and human milk (8).
Anthropometric measurement were compared to the control group and both group S and
group C had lower averages anthropometric averages when compared (8). As for comparing
group S and group C, no significant differences were reported in their BMI values (8).
Through blood and urinary samples that results showed that children in group S were
significantly more malnourished than the children in group C (8). Low thyroid hormone
concentrations were also reported in both malnourished groups, but group S appeared to
have lower T3 and T4 concentrations; in addition, children in group S and group C reported to
have iodine intake deficiency (8). Plasma nutritional protein concentrations were lower in
malnourished children when compared to the control group, and group S showed more
significant affects than group C (8). Furthermore, in both malnourished groups plasma
inflammatory protein concentrations were higher than in the control group (8). In group S, the
children had lower plasma transferrin, albumin, and FAD, with a higher riboflavin
concentration reported in comparison to the control group (8). In addition, group C did not
have significantly lower transferrin, FAD, FMN, or riboflavin in comparison to the control group
(8). Other lab values were reported; however, overall the study shows that a relationship
between riboflavin concentrations, thyroid hormones, and plasma nutritional proteins in
relation to protein-energy malnutrition (8).
Prevention and identification of malnutrition in a clinical setting seems to be the focus
of current studies taking place. A Dutch national survey called STRONGkids was developed
as a nutritional risk screening tool to be used in a hospitalized setting, specifically for children
Pg. 9
10. (9). In 2007, a prospective observational multi-centre study was conducted in 44 Dutch
hospitals for three days, and tested the value and feasibility of the tool (9). The purpose of
STRONGkids was to develop an easy-to-use nutritional risk screening tool that will raise
awareness of nutritional risks (9). It consists of four areas: subjective global assessment,
high risk disease, nutritional intake and losses, and weight loss or poor weight increase (9).
The tool was used upon admission to the hospital in combination with a clinical view of the
child's status and the subjects had their age, sex, diagnosis, and length of stay recorded (9).
In addition, all patients had to be greater than one month of age and had to be admitted to the
pediatric ward (9). Of the 44 hospitals that participated, STRONGkids was used in 98% of the
children admitted to the hospital, and it predicted 54% were at moderate risk, 8% were at high
risk of developing malnutrition (9). The current method used is the weight for height
measurements which only predicted 19% of children admitted were at risk for malnutrition (9).
The study concluded, STRONGkids is an effective nutritional risk screening tool and will raise
awareness of the importance of nutritional status in children (9). Also, this tool can ensure
early identification of children at nutritional risk which will than ensure nutritional interventions
that can help with overall improvement in patient care (9).
In 2009, a study titled, “Decreasing Trends in Malnutrition Prevalence Rates Explained
by Regular Audits and Feedback,” was published (10). The article states that the prevalence
rates for malnourished patients in European healthcare organizations range from 10 to 60%
(10). As a result of this high prevalence rate, billions of Euros are spent each year since
malnutrition leads to increased mortality, longer hospital stays, decreased quality of life, and
increased complication rates (10). The study analyzed the trend of malnutrition prevalence
rates between 2004 and 2007 and reviewed the effects of the previous audits and feedback
Pg. 10
11. from the Dutch National Prevalence Measurement of Care Problems (LPZ); in addition, the
participation in the Dutch national improvement programs were also reviewed (10). For 3
consecutive years, a standardized questionnaire that involved measurements at institutional,
ward, and patient levels were given; and nutritional status was assessed through BMI,
unplanned weight loss, and nutritional intake (10). Recently, more attention and awareness
has been shown toward malnutrition in Dutch healthcare organizations and has triggered 2
national government-sponsored improvement programs (10). The program designed for
hospitals was launched in 2006 and is called “Eat Well to Get Well.” The aim for this program
is to improve the attitudes toward nutritional screening and provide excellent nutritional
treatment for patients (10). The other program, which was designed for nursing homes and
residential homes, was also started in 2006 and is called “Care for Better,” which focuses on
nutritional screening, a weighing policy, and improving the environment where mealtime takes
place (10). The results showed that 269 organizations (80 hospitals, 141 nursing homes, and
48 home care organizations) were reviewed and 74,496 observations were made (10).
Furthermore, 6 hospitals and 12 nursing homes were involved in the Dutch national quality
improvement programs (10). The study shows that involvement in a national improvement
program significantly reduced the prevalence rates of malnutrition in a hospital and home
care setting, but did not show improvement in nursing homes (10).
An article from the Ghana Medical Journal titled, “Malnutrition: Missed Opportunities for
Diagnosis,” studied the prevalence of wasting among children who were greater than three
years old and younger than five years old (11). This specific age group needs adequate
nutrition from macronutrients and micronutrients since the body has a high demand to ensure
optimal growth and development (11). An imbalance of nutrients whether it be inadequate
Pg. 11
12. intake or over consumption of nutrients can lead to stunting of growth (inadequate intake),
overweight, obesity, or chronic diseases such as type 2 diabetes mellitus (over consumption)
(11). Globally, 9% of children are malnourished and 54% of deaths for children under the age
of five occur because of malnutrition (11). In Ghana, growth assessments are typically done
at child welfare clinics, but usually parents will not visit these clinics after the completion of
their children's vaccination at 9 month of age, resulting in widespread cases of malnourished
children (11). Three commonly used anthropometric measurements in children are weight-
for-height, height-for-age, and weight-for-age which are used in the assessment of nutritional
status and diagnosis for malnutrition (11). However, Ghana does not routinely take these
measurements in most clinics and hospitals, or like as stated in previous text, the parents
discontinue attending the clinics (11). As a result, malnutrition is often not detected and
children are not able to have an accurate nutritional assessment (11). In 2004, between the
summer months of June and August, the children who went to the outpatient clinic at Komfo
Anokye Teaching Hospital were assessed using the weight for height measurement (11). Out
of 1182 children involved in the study, 638 were male and 444 were females, the mean age
was 24.9 months, the mean weight was 10.5 kg, and the mean height was 83.4 cm (11). The
results showed that 251 children out of 1182 children were considered wasted, 48 of the
children were severely wasted, and the overall prevalence of wasting in this study was 21.2%
(11). One out of every 5 children in Ghana are considered malnourished and this problem is
a common occurrence in developing countries (11). The United Nations Children's Fund
(UNICEF) reports that in developing countries, 27% of children under the age of 5, suffer from
wasting (11). The mortality rate in Ghana shows that 40% of mortality in children under the
age of 5 are due to malnutrition and the rate is increasing over time due to a declining
nutritional status (11).
Pg. 12
13. In 2001, an article titled, “Simple nutrition screening tools for healthcare facilities:
development and validity assessment,” was published (12). The study recognized that
dietitians cannot always carry out screening in health care facilities, and often times this
responsibility is given to the nursing staff upon admission of the patients (12). Nutrition
screening tools are used to identify individuals who are at high nutritional risk (12). In order
for the proper data to be obtained in the screenings the tools need to be simple and based on
information collected from the nursing admission questionnaire (12). The purpose of the
study was to develop and asses timely and valid tools for screening for protein-energy
malnutrition (PEM) (12). One hundred and sixty subjects were recruited for this study, from
two settings, and a dietetic technician administered the initial screening tool, which was made
up of 9 PEM risk factors (12). The subjects included 54 adults in an acute care setting, 57
elderly adults in an acute care setting, and 49 adults in a long term care setting (12). To
determine the validity of the screening tool Registered Dietitians completed comprehensive
nutritional assessments (12). The study consisted of two tools, the first tool used body mass
index (BMI) and percentage of weight loss along with classifying subject as having a high or
low PEM risk level; and the second tool utilized BMI and albumin levels ( which were available
upon admission) (12). The tools had a 75.9% or higher validity rating, except for adults in an
acute care setting (results were lower) (12). Overall, both tools proved to be helpful for
Registered Dietitians in establishing their priorities for involvement and initiating patient care
(11).
Focusing on the future of Dietetics and Nutrition, the article titled, “ Adult starvation and
disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice
Pg. 13
14. setting from the International Consensus Guideline Committee,” stated multiple definitions for
malnutrition exist in literature, which can result in confusion; and their purpose was to define
malnutrition in adults in a clinical setting (13). An International Guideline Committee was
developed (no reported conflicts of interest were reported) and consensus for the definitions
was achieved through a series of meetings held at ASPEN and ESPEN Congresses (13).
The article states that malnutrition can cause adverse side effects on clinical outcomes, and
also is measurable (13). In a clinical setting, inadequate intake in adults can be seen in
patients with medical conditions such as anorexia nervosa, in which the patient has chronic
starvation without inflammation (13). Additionally, mild or moderate inflammation is seen in
chronic conditions such as organ failure, pancreatic cancer, rheumatoid arthritis, or
sarcopenic obesity (13). Finally, inflammation can be seen in acute disease or injury stress
such as major infection, burns, trauma, or closed head injury (13). In a clinical practice
setting, disease related malnutrition is commonly seen, and currently there is no clear
consensus of how malnutrition should be defined (13). This commentary proposes a updated
and simple approach based upon etiology that incorporates the degrees of inflammation in
conjunction with malnutrition (13). Since malnutrition is often associated with inflammation
the International Guideline Committee proposed the following etiologies (13):
• Chronic starvation (ex. anorexia nervosa) without inflammation could be termed
“starvation-related malnutrition (13).”
• Chronic conditions (ex. organ failure, pancreatic cancer, rheumatoid arthritis, or
sarcopenic obesity) with mild or moderate inflammation could be termed “chronic
disease-related malnutrition (13).”
• Acute conditions (ex. major infection, burns, trauma, or closed head injury) with severe
Pg. 14
15. inflammation can be termed “acute disease or injury-related malnutrition (13).”
Internationally, malnutrition in the hospital is all too often untreated and underdiagnosed
which leads to increased cost to individuals, health care and social services, and even society
(14). Malnutrition is commonly seen in the elderly population; however, the majority of people
at risk are below the age of 65 years old (14). Socioeconomic factors (income levels, social
isolation, and substance abuse) play a role in malnutrition, and its prevalence is often found in
areas of low economic status (14). The hospital should be an institution where patients who
are malnourished upon admittance can be treated and educated on how obtain low cost food
or assistance through sources in the community through government services (14). The
future of malnutrition seems to have an increasing trend in the number of patients that will
suffer from the condition (14). Patterns effecting this trend are increases in the aging
population, increases in self-care instead of hospital care, shifts in the pattern of food
distribution, and an increase in conditions associated such as dementia, oral problems, and
stroke (14). Awareness is a starting point in the prevention of malnutrition, and members of
the multidisciplinary team need to be educated on what to look for (14). One strategy would
be to start by educating undergraduate and post graduates in the medical field on the topic
and educate them with nutritional care forms that can be used to determine malnutrition (14).
In addition, those who are currently apart of the multidisciplinary team should be trained and
equipped with the necessary tools needed to combat malnutrition (14). Also, continuing
professional requirements in this topic area should be mandatory (14). Malnutrition
is preventable and treatable. Awareness, prevention, and intervention need to be initiated in
the local community, in clinical settings, and throughout the nation.
Pg. 15
16. References:
1. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000404.htm Accessed
March 30, 2010.
2. Hiesmayr M et al. Decreased food intake is a risk factor for mortality in hospitalised
patients: The NutritionDay survey 2006. European Society for Clinical Nutrition and
Metabolism. 2009; 28: 484-491.
3. Patel M et al. (2008). Why Don't Elderly Hospital Inpatients Eat Adequately? BNET.
Available at: http://findarticles.com/p/articles/mi_7616/is_200804/ai_n32282136/ .
Accessed March 30, 2010.
4. Ney D et al. Senescent Swallowing: Impact, Strategies, and Interventions. Nutr Clin
Pract. 2009; 24; 395.
5. Barron M, Pencharz P. Nutritional Issues in Infants With Cancer. Pediatr Blood Cancer.
2007; 49: 1093-1096.
6. Gariballa S. Refeeding syndrome: A potentially fatal condition but remains
underdiagnosed and undertreated. Nutrition. 2008; 24: 604-606.
7. Willis T et al. (2004). Refeeding Syndrome in a Severely Malnourished Child:
Discussion. Medscape Today. Available at:
http://www.medscape.com/viewarticle/489090_4 . Accessed March 30, 2010.
8. Capo-chichi C et al. Concentrations of riboflavin and related organic acids in children
with protein-energy malnutrition. Am J Clin Nutr. 2000; 71: 978-986.
9. Hulst J. Dutch national survey to test the STRONGkids nutritional risk screening tool in
hospitalized children. European Society for Clinical Nutrition and Metabolism. 2010; 29:
106-111.
10. Meijers J et al. Decreasing Trends in Malnutrition Prevalence Rates Explained by
Pg. 16
17. Regular Audits and Feedback. The Journal of Nutrition. 2009; 139,7: 1381-1386.
11. Antwi S. Malnutrition: Missed Opportunities for Diagnosis. Ghana Medical Journal.
2008; 42: 101-104.
12. Laprote M et al. (2001). Simple nutrition screening toolsfor healthcare facilities:
development and valididty assessment. PubMed. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/11518553 . Accessed March 30, 2010.
13. Jensen G et al. Adult starvation and disease-related malnutrition: A proposal for
etiology-based diagnosis in the clinical practice setting from the International
Consensus Guideline Committee. Clinical Nutrition. 2010; 29: 151-153.
14. Availabe at: http://www.bapen.org.uk/pdfs/reports/advisory_group_report.pdf .
Accessed March 30, 2010.
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