A new day has dawned for nutrition assessment, with a renewed interest in methods, techniques, and standards by nutrition practitioners around the globe. An awareness of "assessment of nutritional status" began more than 40 years ago. Since that time, much has been learned and has altered hospital care. But the challenges remain-Why is the prevalence of malnutrition still high? Which tools are the best for identifying malnutrition? How does the process of nutrition assessment impact patient outcomes and recovery from illness? The first issue of 2015 comprises several reviews that examine the state-of-the-art of nutrition assessment. Our deep appreciation goes to Guest Editor and Professor Aoife Ryan, University College Cork, for suggesting, encouraging, and editing these reviews from her colleagues with nutrition assessment expertise in Ireland and the United States.
Ryan et al examined the role of inflammatory biomarkers in the assessment of nutritional health and disease. The biomarkers are objective and quantifiable and help measure clinical signs of malnutrition. Specifically targeted in this review are malnutrition, cancer cachexia, cardiovascular disease, surgery outcomes, and sarcopenia and frailty in older adults.
Body composition is a key component when conducting a comprehensive nutrition assessment. This article by Toomey et al reviews procedures for measuring body components-body fat mass, lean body mass, visceral adipose tissue, and bone mineral content. This review gives a good summary of current technological advances in the measurement of human body composition and an overview of research- and field-based methods relevant to the practice of clinical dietetics.
A review article by Walton explores the purpose and types of diet assessment methods including their strengths and limitations for evaluating dietary data. She details many of the questions posed by practitioners and researchers when they select the best available dietary method and guides us on ways to minimize potential errors of self-reported data.
Patients in intensive care units require adequate nutrition support to deal with disease severity, complications, modulation of immune response, and better health outcomes according to O'Hanlon et al. Determining a patient's nutritional requirements can pose a challenge for the nutrition support dietitian. Evidence-based guidelines and individualized monitoring of care can play an important role in optimizing nutrition. Good monitoring and evaluation procedures can improve patient outcomes and reduce health care costs.
Dunlevy summarizes the unique influences imposed on nutritional status during pregnancy. The effect of nutrition on maternal health should be considered when planning diets that align with Institute of Medicine guidelines for weight gain. Gaps in research require further examination of energy requirements, protein quality, and ways to establish optimal macronutrient profiles. Collection of nutrition assessment data should be augmented by measures of maternal health, fetal growth, physical activity levels, and gestational weight gain.
The BabyGrow project by Brennan and Kiely has implications for nutrition assessment of preterm infants, especially very low-birth-weight and extremely low-birth-weight infants. Infants who are born prematurely face nutritional problems due to limited nutrient stores, illness and infections, rapid growth that depletes nutrient stores, and immature physiologic gastrointestinal tract. Early assessment and intervention may have a positive impact on future growth and development.
Mueller reviews nutrition assessment in older adults and describes the nuances of identifying malnutrition in older versus younger adults. Comparison with normal standards is affected by age-associated inflammation, organ/system senescence, sarcopenia, and frailty in this population. A diagnosis of malnutrition is more difficult to determine in the aged. He emphasizes the importance of individualizing care and finding appropriate interventions for older patients. An array of patient information should be collected from the health history-physical examination, anthropometric, biochemical, and dietary data, functional status, and food insecurity.
According to Cushen et al, the assessment of nutritional status is integral for care of oncology patients and helps establish individual nutritional requirements. Malnutrition is often a complication for patients with acute and chronic cancer and may adversely affect health outcomes and result in cancer cachexia. Tools for malnutrition screening and assessment are discussed. This article is designed to help practitioners identify the appropriate tools for evaluating oncology patients.
We will highlight assessment techniques and articles throughout the year along with a variety of other topical articles. Thank you for a very productive year due to the contributions from all of our authors and reviewers.
-Judith A. Gilbride, PhD, RD, FAND
Editor