NutritionDay
Encyclopedia
"nutritionDay worldwide" is a large scale, worldwide action project
designed to reduce disease related malnutrition
. The aim of this project is to increase awareness and knowledge regarding disease related malnutrition in hospitalised patients
and the elderly.
issue
. It is estimated that over 50 million Europeans
are at risk. A recent study
estimated the cost of malnutrition to the UK to be € 10.6 b per year, double the projected € 5.1 b cost of obesity
. Two population
Group|groups are at particularly high risk: hospitalised patients and residents of nursing homes.
It is estimated that disease related malnutrition is responsible for prolonged length of hospital stay, morbidity and premature
mortality
in hospitalised patients. Research
has shown that up to 40% of hospitalised patients suffer from malnutrition.
focuses mainly on the increasing incidence
of obesity.
It used to be the accepted opinion that only patients with low body weight
or low body mass index
(BMI, BMI<18.5) are malnourished. Today it is known that patients who unintentionally lose weight, who can not eat enough or who do not have sufficient appetite
are also at risk of disease related malnutrition. Hence patients with normal body weight or obesity can also be affected.
Illness is frequently accompanied by inadequate food intake. It is generally known that decreased oral intake of hospitalised individuals
and the associated decline in their nutritional status is often not detected or is attributed to the illness itself.
. Resolution ResAP (2003)3 on Food and Nutritional Care in Hospitals of the Committee of Ministers of the Council of Europe emphasises inter alia the unacceptable number of undernourished people in hospitals and the beneficial effects of adequate food service and nutritional care in hospitals on patients’ recovery
and quality of life
. The resolution identifies a long list of actions to be undertaken to remedy the situation.
To date unfortunately, little follow up action has taken place on this resolution neither at the level of the CoE, nor at the individual country level. To respond to this problem it is essential that all parties (medical attendants, patients, relatives, hospital management and political stakeholders) are aware of the importance of nutrition on recovery
This has proven challenging as the interaction
between nutrition and recovery is not always as visibly obvious as the effects of medication on recovery.
and quality of care by raising awareness and increasing knowledge about disease related malnutrition.
In January 2006 the project was conducted for the first time under direction of Univ. Prof. Dr. Michael Hiesmayer (Medical University of Vienna
) with support of the Austrian Society of Clinical Nutrition (AKE) and the European Society for Clinical Nutrition and Metabolism
(ESPEN
). A subsequent audit took place in January 2007 when the project was extended to intensive care units and nursing homes.
The audit is unit and patient centred. Information about the actual nutrition care and nutrition monitoring on participating wards is gathered using four questionnaires
. This happens on one single day throughout Europe
.
The hospital ward as an organisational unit is of particular interest. The ward, with all its´ specific characteristics and local culture, is the direct centre of care for a group of patients within the hospital.
The direct interview
of patients is a characteristic specific to “nutritionDay project”. Patients are surveyed about their eating habits on the day (“how much of your meal did you eat?”) and about the reasons for not eating.
of patients (e.g. immigrants, non native speakers).
Each unit receives feedback about its position compared with all other participating units of the same specialty type. Repeated participation in the audit allows benchmarking
designed to enhance learning within units and to track changes in local practice and international trends.
In the first two years about 1 000 units with more than 30 000 patients participated in 25 European countries.
About 90 wards of German
-speaking nursing homes joined the pilot project “nutritionDay in nursing homes” in 2007. Implementation of this sub-project in other European countries is planned.
Project
A project in business and science is typically defined as a collaborative enterprise, frequently involving research or design, that is carefully planned to achieve a particular aim. Projects can be further defined as temporary rather than permanent social systems that are constituted by teams...
designed to reduce disease related malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
. The aim of this project is to increase awareness and knowledge regarding disease related malnutrition in hospitalised patients
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
and the elderly.
Background
Disease related malnutrition is a much underrated public healthPublic health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
issue
Issue
Issue may refer to:* Issue , a monthly Korean comics anthology magazine* Issues, a Jewish magazine published by the American Council for Judaism* Issue , a unit of work to accomplish an improvement in a data system...
. It is estimated that over 50 million Europeans
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
are at risk. A recent study
Study
Study or studies may refer to:* Research* Study , a drawing or series of drawings done in preparation for a finished piece* Study , a room in a home used as an office or library* Observational study* Education...
estimated the cost of malnutrition to the UK to be € 10.6 b per year, double the projected € 5.1 b cost of obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
. Two population
Population
A population is all the organisms that both belong to the same group or species and live in the same geographical area. The area that is used to define a sexual population is such that inter-breeding is possible between any pair within the area and more probable than cross-breeding with individuals...
Group|groups are at particularly high risk: hospitalised patients and residents of nursing homes.
It is estimated that disease related malnutrition is responsible for prolonged length of hospital stay, morbidity and premature
Premature
Premature can refer to:*Premature aging: see Senescence*Premature birth or prematurity: see Preterm birth*Premature ejaculation*Premature menopause*Premature stop codon: see Nonsense mutation*Premature ventricular contraction...
mortality
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
in hospitalised patients. Research
Research
Research can be defined as the scientific search for knowledge, or as any systematic investigation, to establish novel facts, solve new or existing problems, prove new ideas, or develop new theories, usually using a scientific method...
has shown that up to 40% of hospitalised patients suffer from malnutrition.
Obesity and Disease related Malnutrition
Generally health careHealth care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
focuses mainly on the increasing incidence
Incidence
Incidence may refer to:* Incidence , a measure of the risk of developing some new condition within a specified period of time* Incidence , the binary relations describing how subsets meet...
of obesity.
It used to be the accepted opinion that only patients with low body weight
Body weight
The term body weight is used in daily English speech as well as in the contexts of biological and medical sciences to describe the mass of an organism's body. Body weight is measured in kilograms throughout the world, although in some countries it is still measured in pounds or stones and pounds...
or low body mass index
Body mass index
The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...
(BMI, BMI<18.5) are malnourished. Today it is known that patients who unintentionally lose weight, who can not eat enough or who do not have sufficient appetite
Appetite
The appetite is the desire to eat food, felt as hunger. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Decreased desire to eat is...
are also at risk of disease related malnutrition. Hence patients with normal body weight or obesity can also be affected.
Illness is frequently accompanied by inadequate food intake. It is generally known that decreased oral intake of hospitalised individuals
Individual
An individual is a person or any specific object or thing in a collection. Individuality is the state or quality of being an individual; a person separate from other persons and possessing his or her own needs, goals, and desires. Being self expressive...
and the associated decline in their nutritional status is often not detected or is attributed to the illness itself.
Disease related Malnutrition in Hospitals
Internationally, the issue of disease related malnutrition was raised in various forums, most clearly in the adoption of a resolution by the Council of EuropeCouncil of Europe
The Council of Europe is an international organisation promoting co-operation between all countries of Europe in the areas of legal standards, human rights, democratic development, the rule of law and cultural co-operation...
. Resolution ResAP (2003)3 on Food and Nutritional Care in Hospitals of the Committee of Ministers of the Council of Europe emphasises inter alia the unacceptable number of undernourished people in hospitals and the beneficial effects of adequate food service and nutritional care in hospitals on patients’ recovery
Recovery
-Health:* Healing* Cure* The Recovery model of mental distress/disorder* Recovery International, a self-help mental health program based on the work of the late Abraham A...
and quality of life
Quality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...
. The resolution identifies a long list of actions to be undertaken to remedy the situation.
To date unfortunately, little follow up action has taken place on this resolution neither at the level of the CoE, nor at the individual country level. To respond to this problem it is essential that all parties (medical attendants, patients, relatives, hospital management and political stakeholders) are aware of the importance of nutrition on recovery
This has proven challenging as the interaction
Interaction
Interaction is a kind of action that occurs as two or more objects have an effect upon one another. The idea of a two-way effect is essential in the concept of interaction, as opposed to a one-way causal effect...
between nutrition and recovery is not always as visibly obvious as the effects of medication on recovery.
nutritionDay worldwide – The Project
The project “nutritionDay worldwide” addresses improved patient safetyPatient safety
Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
and quality of care by raising awareness and increasing knowledge about disease related malnutrition.
In January 2006 the project was conducted for the first time under direction of Univ. Prof. Dr. Michael Hiesmayer (Medical University of Vienna
Medical University of Vienna
The Medical University of Vienna is a medical university in Vienna, Austria.Formerly the faculty of medicine of the University of Vienna, became an independent university on January 1, 2004...
) with support of the Austrian Society of Clinical Nutrition (AKE) and the European Society for Clinical Nutrition and Metabolism
Metabolism
Metabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...
(ESPEN
ESPEN
The European Society for Clinical Nutrition and Metabolism is an organization in the field of parenteral and enteral nutrition and promotes basic and clinical research, basic and advanced education, organization of consensus statements about clinical care and care quality control...
). A subsequent audit took place in January 2007 when the project was extended to intensive care units and nursing homes.
The audit is unit and patient centred. Information about the actual nutrition care and nutrition monitoring on participating wards is gathered using four questionnaires
Questionnaire
A questionnaire is a research instrument consisting of a series of questions and other prompts for the purpose of gathering information from respondents. Although they are often designed for statistical analysis of the responses, this is not always the case...
. This happens on one single day throughout Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
.
The hospital ward as an organisational unit is of particular interest. The ward, with all its´ specific characteristics and local culture, is the direct centre of care for a group of patients within the hospital.
The direct interview
Interview
An interview is a conversation between two people where questions are asked by the interviewer to obtain information from the interviewee.- Interview as a Method for Qualitative Research:"Definition" -...
of patients is a characteristic specific to “nutritionDay project”. Patients are surveyed about their eating habits on the day (“how much of your meal did you eat?”) and about the reasons for not eating.
Transnational multilingual Approach
The questionnaires are available in almost every European language. This enables the project to include minority groupsMinority group
A minority is a sociological group within a demographic. The demographic could be based on many factors from ethnicity, gender, wealth, power, etc. The term extends to numerous situations, and civilizations within history, despite the misnomer of minorities associated with a numerical statistic...
of patients (e.g. immigrants, non native speakers).
Each unit receives feedback about its position compared with all other participating units of the same specialty type. Repeated participation in the audit allows benchmarking
Benchmarking
Benchmarking is the process of comparing one's business processes and performance metrics to industry bests and/or best practices from other industries. Dimensions typically measured are quality, time and cost...
designed to enhance learning within units and to track changes in local practice and international trends.
In the first two years about 1 000 units with more than 30 000 patients participated in 25 European countries.
About 90 wards of German
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....
-speaking nursing homes joined the pilot project “nutritionDay in nursing homes” in 2007. Implementation of this sub-project in other European countries is planned.
nutritionDay Objectives
- Raising awarenessAwarenessAwareness is the state or ability to perceive, to feel, or to be conscious of events, objects or sensory patterns. In this level of consciousness, sense data can be confirmed by an observer without necessarily implying understanding. More broadly, it is the state or quality of being aware of...
of the interaction between food intake and recovery. Target groupsTarget GroupTarget Group is a provider of software and outsourcing solutions to financial services and insurance companies. It specialises in delivering business solutions to the following markets: loans and mortgages, investments, general insurance, utilities and finance brokers.Target operates...
are health care professionals as well as patients, their relatives and political and economicalstakeholdersStakeholderThe term stakeholder, as traditionally used in the English language in law and notably gambling, is a third party who temporarily holds money or property while its owner is still being determined....
. - Gathering knowledge about inadequate food intake in European hospitals in relation to risk factorsRisk factorIn epidemiology, a risk factor is a variable associated with an increased risk of disease or infection. Sometimes, determinant is also used, being a variable associated with either increased or decreased risk.-Correlation vs causation:...
, medical specialty type, organisational units and countries - Decrease human suffering and reduce community costs.
- Initiate research for “eating despite illness” and the ideal utilisation of clinical nutritionClinical nutritionClinical nutrition is nutrition of patients in health care. Clinical in this sense refers to the manage of patients, not only outpatients at clinics, but also, and actually mainly, inpatients in hospitals. It incorporates mainly the scientific fields of nutrition and dietetics...
List of Literature
- Stratton, IM, et al., The cost of diseaserelated malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults., de. M. Elia. BAPEN. 2005.
- Hill GL, Blackett RL, Pickford I, et al., Malnutrition in surgical patients. An unrecognised problem. LANCET. 1977; 1(8013):689-92.
- Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J., Prevalence of malnutrition in general medical patients. Jama. 1976; 235(15):1567-70.
- Valentini L, Schindler K, Schlaffer R, et al., The first nutritionDay in nursing homes: Participation may improve malnutrition awareness. Clin. Nutr. 2009; 28(2):109-116.
- Hiesmayr M, Schindler K, Pernicka E, et al., Decreased food intake is a risk factor for mortality in hospitalised patients: The NutritionDay survey 2006. Clin. Nutr. 2009; 28(5):484-491.
- Schindler K, Pernicka E, Laviano A, et al., How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patients findings from the 2007-2008 cross-sectional nutritionDay survey. Clin. Nutr. 2010; 29(5):552-559.
External links
- http://www.nutritionday.org
- http://www.ake-nutrition.at
- http://www.espen.org
- http://www.meduniwien.ac.at