NutritionDay

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An initiative to raise awareness of disease-associated malnutrition

nutritionDay worldwide is the largest global study to date on the nutritional situation in hospitals and nursing homes with the aim of raising awareness of malnutrition among patients and the elderly .

background

In 1977, malnutrition was diagnosed in surgical patients.

However, malnutrition in the public health sector is still an underestimated problem with economically relevant effects.

A study conducted in the UK in 2005 estimated the cost of malnutrition to be around € 10.6 billion, double the cost of obesity (€ 5.1 billion).

Due to their age and state of health, hospitalized patients and nursing home residents in particular have an increased risk of malnutrition. Illness-related malnutrition has a significant influence on the length of hospital stay and on morbidity and mortality rates of hospital patients. Studies have shown that around 31% of hospitalized patients are malnourished or at risk.

Previous nutritionDay studies have shown that malnutrition is still a neglected topic in hospitals and nursing homes around the world and leads to higher infection rates, poor wound healing , more frequent cardiac complications and thus longer hospital stays.

Obesity and malnutrition

Worldwide, the focus in healthcare is on increasing obesity rates .

The "nutritionDay worldwide" shows that the prevalence of disease-associated malnutrition is unacceptably high.

It has long been assumed that only patients with a body weight that is too low or a body mass index (BMI <18.5 kg / m²) are malnourished. Studies indicate, however, that the BMI is not always a good reference value to determine malnutrition. In patients with a high body fat percentage, it was found that the sensitivity of the BMI is reduced and that this parameter is therefore inadequate as a measured variable.

Malnutrition in the hospital

The problem of malnutrition in hospitals is also dealt with in a resolution of the Council of Europe ("Resolution ResAP (2003) 3 on food and nutrition in hospitals").

It was signed by 18 states. The resolutions of the Council of Europe are political declarations of will. However, they have no compelling, at most normative, influence on practice in the member states. The solution to this problem begins with sensitizing all those involved (treating staff, patients, relatives, hospital administrators, political leaders) to the interrelationship between nutrition and recovery . Recognizing the interaction is made more difficult by the fact that (in contrast to medication) the connection between nutrition and recovery is not immediately visible.

The nutritionDay worldwide project

The "nutritionDay worldwide" was organized by the Austrian " Arbeitsgemeinschaft für Klinische Nutrition " ( AKE ) together with the "European Society of Clinical Nutrition" (ESPEN) under the direction of ao Univ. Prof. Dr. Michael Hiesmayr ( Medical University of Vienna ) to reduce the problem of disease-associated malnutrition.

The “nutritionDay worldwide” project aims to create a global map that shows the prevalence of malnutrition, the nutritional status of patients and the nutritional care structures in hospitals and nursing homes. At the same time, the aim of the project is to emphasize the importance of adequate clinical nutrition in hospitals and nursing homes and to raise awareness of this.

NutritionDay took place for the first time in hospitals in German-speaking countries in January 2006. In 2007 the project was expanded to include nursing homes and intensive care units and has been carried out annually in all 3 settings since then. In 2012 the “oncology nutritionDay” was carried out as the first disease-related nutritionDay.

The audit collects nutritional information at the ward or patient level. Information about the nutritional status of the participating patients is collected using four questionnaires . This survey takes place worldwide on a defined day of the year.

The hospital ward is of particular interest as an independent organizational unit . Due to the specific processes prevailing on site or the corporate culture in which the survey is carried out, these characteristics have different effects on the result of the survey.

Transnational approach

Hospitals and nursing homes from 51 countries around the world have so far participated in nutritionDay

Hospitals and nursing homes from 51 countries worldwide have so far participated in nutritionDay. Over 132,000 patient and resident data could be collected.

The questionnaires are available in over 30 languages ​​and thus make it possible to take into account often disadvantaged groups (e.g. people who do not speak the national language ).

Process of the audit

On a key date in November, the nutritional situation of patients and nursing home residents as well as relevant nutrition-related supply structures are recorded in participating hospital wards and care facilities, thus ascertaining the current situation. After a defined period of time, the whereabouts of the patient or resident are recorded with an “ outcome evaluation ”.

The collected data are entered in a database by the station staff . After entering the data, each station receives a station-related results report in which its own data is compared with that of the same subject. This benchmarking enables a performance comparison and the chance to initiate improvements through repeated participation. By participating in the project several times, measures can be evaluated and successes made visible. Participation is voluntary and free.

nutritionDay questionnaires

Using four to five questionnaires , information is collected from participating hospital wards or nursing homes and their patients or residents. One focus of the survey is on the one hand the nutrition-related supply structure, the health status of the residents as well as their weight behavior and food consumption. On the other hand, the ward as a direct care unit for a group of patients with all their specific characteristics, their professional groups , their patient population and the local culture is also of great interest.

The direct questioning by means of questionnaires is a specific feature of the “nutritionDay” project. On the one hand, the eating habits of the day on which the survey is carried out are recorded ("How much of your lunch / dinner did you eat today?"). On the other hand, the reasons why some patients do not consume food are also important.

nutritionDay oncology

Nutritional therapy plays an important role, especially in cancer patients. Studies have shown that cancer patients who maintain their weight have better prognoses than cancer patients who lose weight. Specifically, fewer side effects were found in patients with constant weight, patients respond more frequently to therapies and report a higher level of activity and a better quality of life.

In addition, the survival rate of patients with constant body weight is higher compared to those with weight loss.

NutritionDay has taken the importance of nutritional therapy for cancer patients as an opportunity to choose an oncological focus in 2012 and 2013 .

For "nutritionDay oncology", three additional questionnaires are filled out and nutritional data on patients with cancer are recorded.

The data obtained from “nutritionDay oncology” are used as the basis for the creation of the ESPEN guidelines in order to make it easier for nutritional medical specialists to optimize nutritional therapy for oncological patients.

Goals of nutritionDay

The aim of the project is the knowledge about and awareness for the problem to improve the patient-related malnutrition, attention to increase it and to promote a safe nutritional care.

  • Raising awareness of the relationship between food intake and recovery . Target groups are health professionals as well as patients, their relatives and political and economic decision-makers.
  • Gaining knowledge about insufficient food intake in connection with risk factors , medical specialty, organizational units and countries in hospitals worldwide.
  • Alleviate human suffering and reduce costs to the community .
  • Initiation of research projects for "Eating in spite of illness" and optimal use of the possibilities of artificial nutrition.

Health facility benefits

  • By participating in the project, the stations receive a benchmark of their stations with other, comparable stations worldwide and can derive individual action needs from this.
  • In the event of repeated participation, quality improvements and increases in effectiveness can be determined and measures evaluated in the sense of quality management.
  • Participation promotes good nutrition in your facility and increases awareness of nutrition and malnutrition.
  • Repeated participation documents the development of the nutritional situation in your facility over the years and provides an anonymous international comparison within a discipline.

Results from the nutritionDay study

The “nutritionDay” project shows, among other things, what effects nutrition has on the outcome of hospitalized patients and their health status. These and other results of the nutritionday audit were published in studies on nutritionDay in 2009 and 2010.

The study by Hiesmayr et al. (2009) found that less than 50% of the patients treated in European hospitals and participating in nutritionDay consumed less than the portion they received. The study also showed a relationship between reduced food consumption and increased mortality in the outcome after a period of 30 days. For this reason, reduced food intake can be viewed as a risk factor for increased mortality.

In 2009 Valentini et al. Patients in nursing homes who took part in the “nutritionDay” project for the first time. Analysis of the 2007 data revealed that the project is causing behavioral changes and raising awareness of malnutrition .

Schindler et al. investigated in their study how the risk of malnutrition is assessed and managed in European hospitals. Data from the nutritionDay survey from 2007 and 2008 showed that there are major differences in the assessment and management of malnutrition in countries and departments and that often the patients were unable to achieve the required energy requirements .

Individual evidence

  1. ^ Hill GL, Blackett RL, Pickford I, et al., Malnutrition in surgical patients. An unrecognized problem. The Lancet . 1977; 1 (8013): 689-92.
  2. ↑ Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27: 5-15.
  3. ↑ Stratton, IM, et al., The cost of disease related malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults., De. M. Elia. BAPEN. 2005.
  4. ↑ Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27: 5-15.
  5. ↑ Valentini L, Schindler K, Schlaffer R, et al., The first nutritionDay in nursing homes: Participation may improve malnutrition awareness. Clin. Nutr. 2009; 28 (2): 109-116.
  6. ↑ Hiesmayr M, Schindler K, Pernicka E, et al., Decreased food intake is a risk factor for mortality in hospitalized patients: The NutritionDay survey 2006. Clin. Nutr. 2009; 28 (5): 484-491.
  7. ↑ Schindler K, Pernicka E, Laviano A, et al., How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patient findings from the 2007-2008 cross-sectional nutrition Day survey. Clin. Nutr. 2010; 29 (5): 552-559.
  8. ↑ Kyle UG, Pirlich M, Lochs H, Schuetz T, Pichard C., Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study. Clin Nutr. 2005; 24 (1): 133-42.
  9. ^ Council of Europe, Committee of Ministers Resolution Res AP (2003) 3 on food and nutritional care in hospitals: https://wcd.coe.int/ViewDoc.jsp?id=85747
  10. ↑ Andreyev HJN, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 1998; 34 (4): 503-9.
  11. ↑ a b Hiesmayr M, Schindler K, Pernicka E, et al., Decreased food intake is a risk factor for mortality in hospitalized patients: The NutritionDay survey 2006. Clin. Nutr. 2009; 28 (5): 484-491.
  12. ↑ Valentini L, Schindler K, Schlaffer R, et al., The first nutritionDay in nursing homes: Participation may improve malnutrition awareness. Clin. Nutr. 2009; 28 (2): 109-116.
  13. ↑ Schindler K, Pernicka E, Laviano A, et al., How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patient findings from the 2007-2008 cross-sectional nutrition Day survey. Clin. Nutr. 2010; 29 (5): 552-559.

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