Skip to main content Accessibility help
×
Home

Elucidating effective ways to identify and treat malnutrition

  • Rebecca J. Stratton (a1)

Abstract

There is a clear rationale for elucidating effective ways of identifying and treating disease-related malnutrition (DRM), given the physiological and financial consequences of this common condition and its treatability. Evidence indicates the efficacy of nutritional support methods (oral, tube and intravenous) in increasing total nutritional intake while having little effect on appetite, satiety, appetite mediators (e.g. leptin) and voluntary food intake. When used as the only source of nutrition, artificial nutrition can effectively maintain nutritional intake, and yet many patients find enteral or parenteral feeding alone is unable to relieve distressing appetite sensations, and unusual temporal patterns (including dissociation between hunger and desire to eat) occur. Despite the positive impact of these feeding methods on intake, controversy about whether nutritional support can affect patient outcome has remained. Systematic reviews and meta-analyses indicate that improvements in function and clinical (mortality, complication rates) outcome can occur in a number of patient groups (including hospitalised patients, the elderly, patients who have had gastrointestinal surgery, patients at risk of pressure ulcers). In order to target those patients who will benefit from nutritional support, and overcome the ongoing problem of poor detection and recognition of DRM, simple routine screening to identify risk followed by practical evidence-based treatment is recommended.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Elucidating effective ways to identify and treat malnutrition
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Elucidating effective ways to identify and treat malnutrition
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Elucidating effective ways to identify and treat malnutrition
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: Dr R. J. Stratton, fax + 44 23 80794945, R.J.Stratton@soton.ac.uk

References

Hide All
Blundell, JE (1979) Hunger, appetite and satiety – constructs in search of identities. In Nutrition and Lifestyles, pp. 2142 [Turner, M, editor]. London: Applied Science Publishers.
British Dietetic Association (1999) Nutrition Screening Tools. Professional Development Committee Briefing Paper no. 9. Birmingham: British Dietetic Association.
Council of Europe (2002) Food and Nutritional Care in Hospitals: How to Prevent Undernutrition. Report and Recommendations of the Committee of Experts on Nutrition, Food Safety and Consumer Protection. Strasbourg: Council of Europe.
Department of Health Department of Health (2001a) Essence of Care – Patient Focused Benchmarking for Healthcare Practitioners London: Department of Health
Department of Health Department of Health (2001b) National Service Framework for Older People London: Department of Health
Department of Health Department of Health (2003) Prescription Cost Analysis: England 2003 London: Department of Health www.publications.doh.gov.uk/stats/pca 2003
Department of Health Department of Health (1998) Clinical Effectiveness Reference Pack London: Department of Health
Elia, M (2003) Screening for Malnutrition: A Multidisciplinary Responsibility. Development and Use of the Malnutrition Universal Screening Tool (‘MUST’) for Adults Redditch, Worcs BAPEN
Elia, M, Pang, F, Russell, C, Green, C & Stratton, RJ (2005) The Cost of Malnutrition in the UK and the Economic Case for Oral Nutritional Supplementation (ONS) in Adults Redditch, Worcs BAPEN In the Press
Elia, M & Stratton, RJ (2005) Nutritional support in the home setting. In Encyclopaedia of Human Nutrition [Caballero, B, Allen, L, editors]. Prentice A Oxford: Elsevier In the Press.
Gibney, E, Elia, M, Jebb, SA, Murgatroyd, PR & Jennings, G (1997) Total energy expenditure in patients with small-cell lung cancer: results of a validated study using the bicarbonate-urea method. Metabolism 46, 14121417
Jebb, SA (1997) Energy metabolism in cancer and human immunodeficiency virus infection. Proceedings of the Nutrition Society 56, 763775
King, CL, Elia, M, Stroud, MA & Stratton, RJ (2003) The predictive validity of the malnutrition universal screening tool (MUST) with regard to mortality and length of stay in elderly inpatients. Clinical Nutrition 22 S4
Kondrup, J, Allison, SP, Elia, M, Vellas, B & Plauth, M (2003) ESPEN guidelines for nutrition screening 2002. Clinical Nutrition 22, 415421
Landis, JR & Koch, GG (1977) The measurement of observer agreement for categorical data. Biometrics 33, 159174
Lewis, SJ, Egger, M, Sylvester, PA & Thomas, S (2001) Early enteral feeding versus ‘nil by mouth’ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. British Medical Journal 323, 773776
McWhirter, JP & Pennington, CR (1994) Incidence and recognition of malnutrition in hospital. British Medical Journal 308, 945948
Milne, AC, Potter, J & Avenell, A (2002) Protein and Energy Supplementation in Elderly People at Risk from Malnutrition Oxford Cochrane Update Software
Plata-Salaman, C (1996) Anorexia during acute and chronic disease. Nutrition 12, 6978
Royal College of General Practitioners Clinical, Guidelines Working Group (1995) The Development and Implementation of Guidelines. Report from General Practice 26. London: Royal College of General Practitioners
Royal College, of Physicians (2002) Nutrition and Patients. A Doctor's Responsibility. Report of a Working Party of the Royal College of Physicians. London: Royal College of Physicians.
Scottish Intercollegiate, Guideline Network (1999) SIGN Guidelines: An Introduction to SIGN Methodology for the Development of Evidence-based Clinical Guidelines Edinburgh SIGN
Shekelle, PG, Woolf, SH, Eccles, M & Grimshaw, J (1999) Clinical guidelines: developing guidelines. British Medical Journal 18, 593596
Stratton, RJ (1999) Artificial nutrition, appetite and food intake in health and disease. PhD Thesis, University of Cambridge.
Stratton, RJ, Dewit, O, Crowe, E, Jennings, G, Villar, RN & Elia, M (1997) Plasma leptin, energy intake and hunger following total hip replacement surgery. Clinical Science 93, 113117
Stratton, RJ, Dixon, R, Longmore, D, Stroud, M & Elia, M (2003a) Effect of recalled weight and height on malnutrition risk. Clinical Nutrition 22, S910
Stratton, RJ, Ek, A-C, Engfer, M, Moore, Z, Rigby, P, Wolfe, R & Elia, M (2005) Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis Ageing Research Reviews.
Stratton, RJ & Elia, M (1999a) A critical, systematic analysis of the use of oral nutritional supplements in the community. Clinical Nutrition 18, 2984
Stratton, RJ & Elia, M (1999b) The effects of enteral tube feeding and parenteral nutrition on appetite sensations and food intake in health and disease. Clinical Nutrition 18, 6370
Stratton, RJ & Elia, M (2005) Meta-analysis suggests post-operative enteral nutritional support reduces complication rates in patients undergoing gastrointestinal surgery. Proceedings of the Nutrition Society 64 In the Press
Stratton, RJ, Green, CJ & Elia, M (2003b) Disease-related Malnutrition: An Evidence Based Approach to Treatment Wallingford, Oxon Published on behalf of The Nutrition Society by CABI Publishing
Stratton, RJ, Green, CJ & Elia, M (2004a) Simple cost analysis of changes in hospital length of stay with oral nutritional supplements from randomised controlled trials. Clinical Nutrition 23, 906907
Stratton, RJ, Hackston, A, Longmore, D, Dixon, R, Price, S, Stroud, M, King, C & Elia, M (2004b) Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults. British Journal of Nutrition 92, 799808
Stratton, RJ, King, C, Stubbs, S, Wood, C, Stroud, M & Elia, M (2004c) Cost of disease-related malnutrition in hospital according to ‘MUST’ and specialty. Clinical Nutrition 23, 918
Stratton, RJ, Nugent, A & Elia, M (1999a) The value of modified sham feeding as a model to study pre-absorptive changes in appetite sensations. Proceedings of the Nutrition Society 58 126A
Stratton, RJ, Nugent, A, Rutgers, C & Elia, M (1999b) The effect of chewing nutritive and non-nutritive material (modified sham feeding model) on subsequent appetite sensations and food intake. Proceedings of the Nutrition Society 58 20A
Stratton, RJ, Stubbs, RJ, Cole, TJ & Elia, M (1998a) Impact of bolus feeding via nasogastric tube on appetite and food intake in humans. Clinical Nutrition 17, 3
Stratton, RJ, Stubbs, RJ & Elia, M (1998b) Inter-relationship between circulating leptin concentrations, hunger and energy intake in healthy subjects receiving tube feeding. Journal of Parenteral and Enteral Nutrition 22, 335339
Stratton, RJ, Stubbs, RJ & Elia, M (2000) Impact of nasogastric feeding duration on appetite and food intake. Clinical Nutrition 19, 54
Stratton, RJ, Stubbs, RJ & Elia, M (2003c) Short-term continuous enteral tube feeding schedules do not suppress appetite and food intake in healthy men in a placebo-controlled trial. Journal of Nutrition 133, 25702576
Stratton, RJ, Thompson, RL, Margetts, BM, Stroud, M, Jackson, AA & Elia, M (2002) Health care utilisation according to malnutrition risk in the elderly: an analysis of data from the National Diet and Nutrition Survey. Proceedings of the Nutrition Society 61 20A
Stubbs, RJ (1999) Peripheral signals affecting food intake. Nutrition 15, 614625
Wood, C, Stubbs, S, Warwick, H, Dunnachie, A, Elia, M & Stratton, RJ (2004) Malnutrition risk and health care utilisation in orthopaedic patients. Proceedings of the Nutrition Society 63 20A

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed