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      The Malnutrition Universal Screening Tool (MUST) and a nutrition education program for high risk cancer patients: strategies to improve dietary intake in cancer patients

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          Abstract

          Four hundred and forty-four high-risk oncology patients with malnutrition participated in this study aimed at assessing the effectiveness of nutrition education on improving an oncology patient’s dietary intake. We used a nutritional risk screening to select oncology patients in need of nutritional care. Team Nutrition provides technical assistance for foodservice, nutrition education for patients and their caregivers, and support for healthy eating and physical activity to improve their diets and their lives. The average contribution of protein and total energy of each patient increased after imparting the nutritional education to them. Thus, nutritional education is an effective measure to bring about a favorable and significant change in oncology patients’ nutrient intake.

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          What is subjective global assessment of nutritional status?

          A Detsky, McLaughlin, J J Baker … (1987)
          Article 0 comments Cited 293 times – based on 0 reviews     Review now
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            Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the 'malnutrition universal screening tool' ('MUST') for adults.

            Rebecca J Stratton, Annemarie Hackston, David Longmore … (2004)
            The 'malnutrition universal screening tool' ('MUST') for adults has been developed for all health care settings and patient groups, but ease of use and agreement with other published tools when screening to identify malnutrition requires investigation. The present study assessed the agreement and the prevalence of malnutrition risk between 'MUST' and a variety of other tools in the same patients and compared the ease of using these tools. Groups of patients were consecutively screened using 'MUST' and: (1) MEREC Bulletin (MEREC) and Hickson and Hill (HH) tools (fifty gastroenterology outpatients); (2) nutrition risk score (NRS) and malnutrition screening tool (MST; seventy-five medical inpatients); (3) short-form mini nutritional assessment (MNA-tool; eighty-six elderly and eighty-five surgical inpatients); (4) subjective global assessment (SGA; fifty medical inpatients); (5) Doyle undernutrition risk score (URS; fifty-two surgical inpatients). Using 'MUST', the prevalence of malnutrition risk ranged from 19-60% in inpatients and 30% in outpatients. 'MUST' had 'excellent' agreement (kappa 0.775-0.893) with MEREC, NRS and SGA tools, 'fair-good' agreement (kappa 0.551-0.711) with HH, MST and MNA-tool tools and 'poor' agreement with the URS tool (kappa 0.255). When categorisation of malnutrition risk differed between tools, it did not do so systematically, except between 'MUST' and MNA-tool (P=0.0005) and URS (P=0.039). 'MUST' and MST were the easiest, quickest tools to complete (3-5 min). The present investigation suggested a high prevalence of malnutrition in hospital inpatients and outpatients (19-60% with 'MUST') and 'fair-good' to 'excellent' agreement beyond chance between 'MUST' and most other tools studied. 'MUST' was quick and easy to use in these patient groups.
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              ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.

              F. Bozzetti, J. Arends, K Lundholm … (2009)
              Parenteral nutrition offers the possibility of increasing or ensuring nutrient intake in patients in whom normal food intake is inadequate and enteral nutrition is not feasible, is contraindicated or is not accepted by the patient. These guidelines are intended to provide evidence-based recommendations for the use of parenteral nutrition in cancer patients. They were developed by an interdisciplinary expert group in accordance with accepted standards, are based on the most relevant publications of the last 30 years and share many of the conclusions of the ESPEN guidelines on enteral nutrition in oncology. Under-nutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis and, per se, responsible for excess morbidity and mortality. Many indications for parenteral nutrition parallel those for enteral nutrition (weight loss or reduction in food intake for more than 7-10 days), but only those who, for whatever reason cannot be fed orally or enterally, are candidates to receive parenteral nutrition. A standard nutritional regimen may be recommended for short-term parenteral nutrition, while in cachectic patients receiving intravenous feeding for several weeks a high fat-to-glucose ratio may be advised because these patients maintain a high capacity to metabolize fats. The limited nutritional response to the parenteral nutrition reflects more the presence of metabolic derangements which are characteristic of the cachexia syndrome (or merely the short duration of the nutritional support) rather than the inadequacy of the nutritional regimen. Perioperative parenteral nutrition is only recommended in malnourished patients if enteral nutrition is not feasible. In non-surgical well-nourished oncologic patients routine parenteral nutrition is not recommended because it has proved to offer no advantage and is associated with increased morbidity. A benefit, however, is reported in patients undergoing hematopoietic stem cell transplantation. Short-term parenteral nutrition is however commonly accepted in patients with acute gastrointestinal complications from chemotherapy and radiotherapy, and long-term (home) parenteral nutrition will sometimes be a life-saving maneuver in patients with sub acute/chronic radiation enteropathy. In incurable cancer patients home parenteral nutrition may be recommended in hypophagic/(sub)obstructed patients (if there is an acceptable performance status) if they are expected to die from starvation/under nutrition prior to tumor spread.
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                Author and article information

                Contributors
                Pei-Chun Chao: cshc029@csh.org.tw
                Journal
                Journal ID (nlm-ta): Biomedicine (Taipei)
                Journal ID (iso-abbrev): Biomedicine (Taipei)
                Title: BioMedicine
                Publisher: China Medical University (Taichung )
                ISSN (Print): 2211-8020
                ISSN (Electronic): 2211-8039
                Publication date (Electronic): 8 August 2015
                Publication date PMC-release: 8 August 2015
                Publication date Collection: September 2015
                Volume: 5
                Issue: 3
                Electronic Location Identifier: 17
                Affiliations
                [ ]School of Health Diet and Industry Management, Chung Shan Medical University, 402 Taichung, Taiwan
                [ ]Department of Nutrition, Chung Shan Medical University Hospital, 402 Taichung, Taiwan
                [ ]Department of Parenteral Nutrition, Chung Shan Medical University Hospital, 402 Taichung, Taiwan
                Article
                Publisher ID: 17
                DOI: 10.7603/s40681-015-0017-6
                PMC ID: 4532677
                PubMed ID: 26264480
                SO-VID: 3c514798-f10f-4701-a47c-2d05e84172a8
                Copyright © © China Medical University 2015
                History
                Date received : 7 May 2015
                Date accepted : 29 June 2015
                Categories
                Subject: Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                Keywords: oncology,malnutrition,nutrition education
                Data availability:
                Keywords: oncology, malnutrition, nutrition education

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