Table 24Nutrition screening

Bibliographic referenceStudy TypeEvidence levelNo. of patientsPatients characteristicsInterventionComparisonLength of follow upOutcome measuresEffect sizeComments (including source of funding)
Jordan et al 2003177Non-randomised controlled before-after study2 + 2 wards; 175 out of possible 628; recruited over two separate one month periodsMean age 67

Hospitalised for 1–56 days
Screening tool:
Nursing Nutritional
Screening Tool
Usual careUntil dischargeNursing sdocumentation; patient care at mealtime; dietitian referralWeight recording:
Intervention ward:
26.1% before; 71.9% after
Of 12 stayed for ten days, 2 were recorded weekly.
Control ward: 29.6% before; 7.9% after.
Screening tool was notrecorded for 7 out of 64 post-intervention.
Care at mealtimes: No observed change due to intervention
Referral to dietitian (no change):
Intervention ward: 15.2% before; 9.4% after

Control:
18.5% before; 10.5% after
Funding: Dyfed NHS Research and Development Consortium
Moore et al 1997237Clustered randomised trial26 practices/261 patients

Intervention: n=112

Control: n=149
Age >=70; visiting practices; not acutely or terminally ill, English speaking, able to answer questions

Sample probably healthier than general population, but no difference between control and intervention groups.
Intervention group: patients administered with screening at a new visit for 8 common elderly ailments; short tool. Their physicians given pertinent clinical summaries.
Education was given to the doctors and they were contacted regularly
Weight (<100 lb) or losing 10 lb within the past 6 months to specify as at nutrition risk

Comparison: usual care
1 month for condition specific intervention

6 months for patient outcome
Nutritional intervention/patient health outcome (MOS SF36)70% of the doctors reported screening for nutrition) among the highest in 8 diseases): suggests acceptability of tool.

Detection of nutritional problem: 0 (−1 to 1); 5% in intervention and 5% control.

Nutritional intervention: 0 (−4 to 4 ); 4% in intervention and 4% in control.

General health: no significant difference between the groups (multiple items)
Study of 8 screening at the same time. This makes it more an effectiveness study, than if it was only nutrition screening. Because this is more similar to what happens in reality within general practice.
Seems to be of good quality. Patient level analysis could have been improved by multi-levelling. Though it would have made it even less likely to detect a significant difference

Funding: Robert Wood Johnson Clinical Scholars Program; the National Institute on Aging Geriatric Academic Program
Rypkema et al 2004299Prospective cohort analysis in two hospitals298 subjects

Intervention: n=140

Control: n=158
Patients aged over 60 admitted to hospital geriatric units for >2 days and <150 daysProtocol, which includes screening for malnutrition (MNA-sf), dysphagia and dehydration on admission followed by immediate interventions (including menu modification or supplements)Standard careNot reportedAverage weight change (kg) (mean ± SEM):Control (n=140): −0.76 ± 0.28 (decreased)
Intervention (n=105): 0.92 ± 0.27 (gained)
[p<0.001]
Funding: Research grant from the Dutch Universities (VAZ) & partly by Nutricia, Inc.
No. of patients with >3% weight loss during admission:Intervention: 11/105
Control: 42/140
[p<0.001]
Difference: 65% reduction
LOS (days) (mean ± SEM):Control (n=158): 32.7 ± 1.8
Intervention (n=140): 31.1 ± 1.9
[p<0.51]
Analysis was repeated excluding patients with oedema or heart failure
Average weight change (kg) (mean ± SEM):Control (n=140): 0.00 ± 0.3 (decreased)
Intervention (n=105): 1.0 ± 0.3 (gained)
[p<0.017]
No. of patients with >3% weight loss during admission:Intervention: 5/71
Control: 14/72
[p=0.025]
No. of nosocomial infections:Intervention: 33/140
Control: 58/158
[p=0.01]
Difference: 36%
No. of pressure sores:Intervention: 23/140
Control: 33/158
[p=0.37]
LOS (days):Control (n=158): 32.7 ± 1.8
Intervention (n=140):
31.1 ± 1.9
[p<0.51]
Analysis of covariance was carried out with weight on admission as covariate –
Weight change (kg) (mean ± SEM):Patients with the lower BMI:
Control: 0.25 ± 0.61
Intervention: 1.94 ± 0.56
[p<0.039]
No. of patients with >3% weight loss:Intervention: 3/31
Control: 11/37
[p=0.011]
Weight change (kg) (mean ± SEM):Patients with the higher BMI:
Control: −0.64 ± 0.28
Intervention: 1.15 ± 0.29
[p<0.001]
No. of patients with >3% weight loss:Intervention: 7/87
Control: 37/131
[p=0.001]

From: Appendix Four, Evidence Tables

Cover of Nutrition Support for Adults
Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition.
NICE Clinical Guidelines, No. 32.
National Collaborating Centre for Acute Care (UK).
Copyright © 2006, National Collaborating Centre for Acute Care.

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