Creating a clinical nutrition registry: prospects, problems and preliminary results
There is a tremendous gap in the information available to support the practice of hospital-based dietitians and to address the issue of how the risk of developing protein-energy malnutrition can be avoided in the majority of patients. This article describes the rationale and benefits of creating a nutrition registry of within-hospital clinical nutrition care. A nutrition registry is made up of observational data, collected on an ongoing basis, of nutritional interventions provided to hospitalized patients. It is the first step in data gathering to demonstrate the effectiveness of clinical nutrition interventions. The methods and preliminary results of a nutrition registry that was established at The University of Illinois Medical Center, Chicago, III, are presented. Using subjective global assessment, 55% (257 of 467) of patients at admission and 60% (280 of 467) of patients at discharge were moderately or severely malnourished. Patients that were normal nourished at admission and became moderately or severely malnourished had higher hospital charges ($40,329 for moderately malnourished patients, $76,598 for severely malnourished patients) than those that remained normal nourished ($28,368). This pattern held independent of admission nutritional status. Major challenges in implementation of a registry into the responsibilities of the staff dietitian are reviewed. The conclusion of this study is that nutrition registries can be established and will provide the much needed baseline data to document the impact of nutrition interventions on outcomes of medical care.
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ABSTRACT: To verify whether malnourished inpatients receiving a typical Brazilian diet meet their food requirements.
Thirty-five consecutive surgical and medical hospitalized adults, able to feed themselves, received rice and beans based diets for 3 consecutive days. All served food was weighed before and after the meals. Nutrient intake was determined and results compared to American Recommended Dietary Allowances (RDA). Malnutrition was defined by the presence of at least one of these criteria: body mass index &lE 18.5 kg/m(2); height-creatinine index < 70%; or albumin level < 3. 5 g/dl.
Malnourished and non-malnourished patients were paired in relation to age, gender, diagnoses and clinical parameters. Despite showing distinct anthropometric parameters and laboratory data, malnourished patients ingested enough quantities of food and met or exceeded RDA for energy and other nutrients.
Clinically-stable malnourished inpatients, supplied with rice- and beans based diets have adequate energy and nutrient intake, the same occurring for non-malnourished ones.
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ABSTRACT: The number of hospital beds needed is greatly increased by the malnutrition of patients before admission and after discharge. Malnourished patients spend longer in hospital and are more likely to die following surgery or other treatment. Extensive studies show that low blood serum albumin, indicating protein deficiency, is a major risk factor for morbidity and mortality among hospital patients. Community food and nutrition services are extending throughout the developed world as part of public health policies. Such services can reduce costs by reducing the need for hospital beds, can reduce waiting lists and save the lives of many hospital patients. Preventive nutrition services can give financial benefits much exceeding costs.
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