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      Prevalencia de la desnutrición al ingreso en los pacientes del Hospital General Nuestra Señora del Prado, Talavera de la Reina Translated title: Malnutrition prevalence at admission to Hospital General Nuestra Señora del Prado, Talavera de la Reina

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          Abstract

          Resumen Introducción: la malnutrición es un problema global. En los países desarrollados no puede ignorarse la desnutrición debida a las alteraciones en los hábitos alimentarios de la población o a la presencia de enfermedades, lo que afecta de forma destacable a los pacientes hospitalizados. Objetivo: determinar la prevalencia del riesgo de desnutrición al ingreso en el Hospital General Nuestra Señora del Prado de Talavera de la Reina (Toledo, España). Métodos: estudio observacional, transversal y descriptivo. Desde septiembre de 2017 a octubre de 2018, a todos los pacientes que ingresaban en el hospital y cumplían los criterios de selección se les realizó un cribado nutricional mediante el test NRS-2002®. Se recogieron datos antropométricos y clínicos de los pacientes en riesgo nutricional (puntuación NRS-2002® ≥ 3). Se diagnosticó la desnutrición observada según su tipología y gravedad, emitiendo indicaciones nutricionales recogidas en el informe al clínico y en el informe al alta. Resultados: en total, 476 pacientes realizaron el test NRS-2002®, detectándose riesgo de desnutrición al ingreso en 137 (28,8 %; IC 95 %: 24,8 % a 33,0 %). El IMC promedio (DE) de estos fue de 24,6 (,) kg/m2. La dietista-nutricionista recomendó al 78,4 % de los pacientes una suplementación nutricional, y en el 82,1 % de los casos la codificación del estado nutricional (CIE-10). En el informe de alta se omitieron más del 70 % de estas recomendaciones. Conclusiones: el 28,8 % de los pacientes analizados estaban en riesgo de desnutrición o desnutridos al ingreso. La desnutrición hospitalaria continúa siendo un problema en la actualidad, por lo que resulta de vital importancia incluir métodos de cribado al ingreso que permitan una intervención nutricional precoz en el paciente hospitalizado, así como la incorporación de personal sanitario formado para su realización.

          Translated abstract

          Abstract Introduction: malnutrition is a global problem. In developed countries, malnutrition due to alterations in the population's eating habits or the presence of disease cannot be ignored, and affects hospitalized patients in particular. Objective: to determine the prevalence of malnutrition risk upon admission to Hospital General Nuestra Señora del Prado in Talavera de la Reina (Toledo, Spain). Methods: this was an observational, cross-sectional, descriptive study. From September 2017 to October 2018 all patients admitted to hospital who met the selection criteria were assessed for nutritional status using the NRS-2002® test. Anthropometric and clinical data were collected from patients at nutritional risk (NRS-2002® score ≥ 3). The malnutrition observed was diagnosed according to type and severity, and nutritional indications were given, which were recorded in the report to the clinician and in the discharge report. Results: a total of 476 patients took the NRS-2002® test, which detected risk of malnutrition upon admission in 137 (28.8 %; 95 % CI: 24.8 % to 33.0 %). Average BMI (SD) was 24.6 (5.4) kg/m2. The dietitian-nutritionist recommended nutritional supplementation for 78.4 % of patients, and coding of nutritional status (ICD-10) for 82.1 %. In the discharge report, more than 70 % of these recommendations were omitted. Conclusions: in all, 28.8 % of the patients analyzed were at risk of malnutrition or undernourished on admission. Hospital malnutrition continues to be a problem, so it is vitally important that screening methods be included at admission to allow early nutritional intervention in hospitalized patients, and that trained healthcare personnel be incorporated to this end.

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          Most cited references31

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          ESPEN guidelines on definitions and terminology of clinical nutrition.

          A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.
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            Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.

            A system for screening of nutritional risk is described. It is based on the concept that nutritional support is indicated in patients who are severely ill with increased nutritional requirements, or who are severely undernourished, or who have certain degrees of severity of disease in combination with certain degrees of undernutrition. Degrees of severity of disease and undernutrition were defined as absent, mild, moderate or severe from data sets in a selected number of randomized controlled trials (RCTs) and converted to a numeric score. After completion, the screening system was validated against all published RCTs known to us of nutritional support vs spontaneous intake to investigate whether the screening system could distinguish between trials with a positive outcome and trials with no effect on outcome. The total number of randomized trials identified was 128. In each trial, the group of patients was classified with respect to nutritional status and severity of disease, and it was determined whether the effect of nutritional intervention on clinical outcome was positive or absent. Among 75 studies of patients classified as being nutritionally at-risk, 43 showed a positive effect of nutritional support on clinical outcome. Among 53 studies of patients not considered to be nutritionally at-risk, 14 showed a positive effect (P=0.0006). This corresponded to a likelihood ratio (true positive/false positive) of 1.7 (95% CI: 2.3-1.2). For 71 studies of parenteral nutrition, the likelihood ratio was 1.4 (1.9-1.0), and for 56 studies of enteral or oral nutrition the likelihood ratio was 2.9 (5.9-1.4). The screening system appears to be able to distinguish between trials with a positive effect vs no effect, and it can therefore probably also identify patients who are likely to benefit from nutritional support.
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              GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community *

              Summary Rationale This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. Methods In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face‐to‐face meetings, telephone conferences, and e‐mail communications. Results A two‐step approach for the malnutrition diagnosis was selected, i.e., first screening to identify “at risk” status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology‐related diagnosis categories. Conclusion A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re‐considered every 3–5 years.
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                Author and article information

                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                April 2021
                : 38
                : 2
                : 298-305
                Affiliations
                [2] Talavera de la Reina Toledo orgnameHospital General Nuestra Señora del Prado orgdiv1Gerencia de Atención Integrada orgdiv2Unidad de Apoyo a la Investigación España
                [1] Talavera de la Reina Toledo orgnameHospital General Nuestra Señora del Prado orgdiv1Sección de Endocrinología y Nutrición España
                Article
                S0212-16112021000200298 S0212-1611(21)03800200298
                10.20960/nh.03263
                741951d7-7e75-4981-bac9-dd761753b639

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 12 October 2020
                : 31 July 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 8
                Product

                SciELO Spain

                Categories
                Trabajos Originales

                CIE-10,Prevalence,Hospital malnutrition,NRS-2002 test,ICD-10,Prevalencia,Desnutrición hospitalaria,Test NRS-2002

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