The final issue of 2015 caps off a year partially devoted to the state of the art of nutrition assessment and screening. The declaration of guidelines from ASPEN (American Society for Parenteral and Enteral Nutrition) and the Academy (Academy of Nutrition and Dietetics) prompted all dietitians in 2012 to reexamine their own practices. Initiated and organized by editorial board member, Professor Aoife Ryan, the fall issue highlighted an international perspective. Several authors shared their expertise to give our readers a range of articles that helped us interpret today's effective screening tools and assessment approaches.
Two articles in this issue (30:4) address nutrition assessment. Platek and her colleagues examine the sensitivity and specificity of screening tools to assess malnutrition in hospital patients. They find better agreement in the specificity of 3 tools and caution about the variability in measuring sensitivity. They recommend the Malnutrition Universal Screening Tool, Nutrition Risk Screening-2002, and Malnutrition Screening Tool as good tools for particular settings and subsets of patients. They also advise registered dietitian nutritionists (RDNs) to make decisions based on the needs of their patients, whether the cut points for risk are appropriate, and the ease of application in their environment.
Johnson et al examine knowledge and performance of screening for dysphagia risk. Using an Internet-based survey, they identified knowledge and performance of dysphagia risk screening among RDNs in clinical practice. A sample of US RDNs, who performed or used information about selected components of dysphagia risk screening in clinical practice, had significantly higher mean knowledge scores than those who did not perform/use the components. Respondents with prior training/education performed or used more screening components than those without training.
Gottesman et al study the risk for body dissatisfaction and excessive concern over weight as children enter adolescence when growth, development, and life changes take place. Adolescents with type 1 diabetes mellitus (T1DM) who need to closely monitor and manage medication, diet, and exercise routines are at risk of engaging in unhealthy eating and weight control modalities. Management of T1DM may contribute to the development of an eating disorder and cause some adolescents to turn to insulin omission or insulin purging as a means to control body weight.
Williams-Hooker and her colleagues investigated the relationship between food/vegetable intake and changes in weight of 35 kidney transplant recipients. Measured at 4 time points, diet intake and physical activity records indicated their fruit/vegetable intakes were below recommended federal guidelines. By dividing the group into weight gainers and weight losers, they found a positive correlation between fruit/vegetable consumption among weight losers and women. This small project encourages guidance for transplant recipients to increase fruit and vegetables in their diets to lower posttransplant obesity comorbidities.
Sabour and colleagues add more data on omega-3 polyunsaturated fatty acids ([omega]-3 PUFA) that have been shown to influence serum lipids. These effects were evaluated among 104 patients with spinal cord injury (SCI) in a double-blinded randomized clinical trial. The treatment group received 2 capsules (435 mg of docosahexaenoic acid and 65 mg of eicosapentaenoic acid, daily) and the control group received a placebo. There were no significant changes in lipid profiles, blood glucose, and weight. Thus, it seems that the lipid profile modulation as a response to [omega]-3 PUFA therapy is not a factor in patients with SCI.
Riggs reviewed Piechota's Real Solutions Weight Loss Workbook 2nd ed., an interactive guidebook that provides entry-level education on the basics of weight loss and weight maintenance. It can provide comprehensive current and fact-based information for patients and could be a valuable tool for practitioners.
Our focus on nutrition assessment has proven to be interesting and rewarding this past year. After several decades using nutrition assessment tools and strategies in different settings, we must still work to find the most valid and accurate measures. The application of clinical judgment is still so important for providing care to each patient who requires a comprehensive assessment.
-Judith A. Gilbride, PhD, RDN, FAND
Editor