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nutritional assessment

Indications: - within 48 hours of admission to the pediatric ICU [4] - assessment of undernutrition in the elderly Procedure: - Mini Nutritional Assessment allegedly determines how well the patient is eating - now first line (GRS11) [2] - calorie count for 3 days (formerly first line) [2] - seems like more direct objective measure than Mini Nutritional Assessment - may miss other unspecified factors contributing to nutritional risk [2] - body weight trends more useful than calorie counts in screening for undernutrition in elderly (calorie counts allegedly not cost effective) Laboratory: 1) serum albumin & serum prealbumin a) serum prealbumin may be more responsive to nutrient intake than serum albumin b) lack sensitivity & specificity as markers of nutritional status in older adults [2] c) does not substitute for calorie count in assessing nutrient intake in elderly patient recovering from an acute illness - Mini Nutritional Assessment better than calorie count 2) hemoglobin A1c 3) Chem 7 4) lipid panel Management: - risk criteria that should trigger a nutrition consult: - unplanned body weight change of > 10% in last 6 months - suboptimal PO intake - problems chewing or swallowing - nausea, vomiting or diarrhea - visibly malnourished - morbidly obese - 70 years of older scheduled for surgery - diagnosis which may alter nutritional needs - severe tolerance problems during external feeding - religious, cultural or ethnic practices affecting diet - pregnant or nursing - patient needs nutritional information to guide eating at home

Specific

mini nutritional assessment short-form (MNA-SF)

References

  1. Veterans Administration
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  3. Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc. 2004 Aug;104(8):1258-64. Review. PMID: 15281044
  4. Anello J, Feinberg B, Heinegg J et al Nutritional Support in Critically Ill Pediatric Patients. Guidelines on nutritional support for pediatric critically ill patients by the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition. Medscape: New Guidelines and Recommendations, August 2017. http://reference.medscape.com/viewarticle/884517