[Screening and management of malnutrition in internal medicine]. / Dépistage et prise en charge de la dénutrition en médecine interne hospitalière.

Malnutrition is a common but underestimated condition in the hospital setting. Malnutrition increases in-hospital mortality and complications, and treatment costs. Simple screening tools such as the mini-nutritional assessment and the nutritional risk score allow identifying patients at risk of malnutrition and starting management. Malnutrition management is a multidisciplinary issue including dieticians, physiatrists, nurses, caregivers and doctors. Meal fractioning and oral nutritional supplements (ONS) should be provided. Frequently, micronutrient supplements are also needed. Particular care should be taken to ensure that the patient consumes the meals and ONS prescribed. Follow-up is based on weight and assessment of prealbumin. Malnutrition status should be systematically reported in the discharge letter.

La dénutrition est fréquente à l'hôpital mais sous-estimée. Elle augmente la mortalité, les complications intrahospitalières, ainsi que les coûts du traitement. Des outils de dépistage tels que le mini-nutritional assessment et le nutritional risk score permettent d'identifier les patients à risque de dénutrition. La prise en charge implique une équipe interprofessionnelle (diététiciennes, physiothérapeutes, infirmières, aides-soignantes et médecins) et se base sur le fractionnement des repas, associé à des suppléments nutritionnels oraux (SNO) adaptés et à des suppléments en micronutriments. Une attention particulière portera sur la consommation effective des repas et des SNO. Le suivi nutritionnel sera complété par la mesure du poids et le dosage de la préalbumine. La documentation dans la lettre de sortie devrait être systématique.

Guidelines on Standard and Therapeutic Diets for Adults in Hospitals by the French Association of Nutritionist Dieticians (AFDN) and the French Speaking Society of Clinical Nutrition and Metabolism (SFNCM).

AIM: Hospital food provision is subject to multiple constraints (meal production, organization, health safety, environmental respect) which influence the meal tray offered to the patient. Multiple diets can add complexity and contribute to non-consumption of the meal. To avoid undernutrition, it appeared necessary to propose guidelines for foods and diets in hospitals. METHODS: These guidelines were developed using the Delphi method, as recommended by the HAS (French Health Authority), based on a formal consensus of experts and led by a group of practitioners and dieticians from the AFDN (French Association of Nutritionist Dieticians) and SFNCM (French Society of Clinical Nutrition and Metabolism). RESULTS: Twenty-three recommendations were deemed appropriate and validated by a panel of 50 national experts, following three rounds of consultations, modifications and final strong agreement. These recommendations aim to define in adults: 1-harmonized vocabulary related to food and diets in hospitals; 2-quantitative and qualitative food propositions; 3-nutritional prescriptions; 4-diet patterns and patient adaptations; 5-streamlining of restrictions to reduce unnecessary diets and without scientific evidence; 6-emphasizing the place of an enriched and adapted diet for at-risk and malnourished patients. CONCLUSION: These guidelines will enable catering services and health-care teams to rationalize hospital food and therapeutic food prescriptions in order to focus on individual needs and tasty foods. All efforts should be made to create meals that follow these recommendations while promoting the taste quality of the dishes and their presentation such that the patient rediscovers the pleasure of eating in the hospital.

Improving nutritional care quality in the orthopedic ward of a Septic Surgery Center by implementing a preventive nutritional policy using the Nutritional Risk Score: a pilot study.

BACKGROUND/OBJECTIVES: Septic Surgery Center (SSC) patients are at a particularly high risk of protein-energy malnutrition (PEM), with a prevalence of 35-85% found in various studies. Previous collaboration between our hospital's SSC and its Clinical Nutrition Team (CNT) only focussed on patients with severe PEM. This study aimed to determine whether it was possible to improve the quality of nutritional care in septic surgery patients with help of a nutritional policy using the Nutritional Risk Score (NRS). SUBJECTS/METHODS: Nutritional practices in the SSC were observed over three separate periods: in the 3 months leading up to the implementation baseline, 6 months after implementation of preventive nutritional practices, and at 3 years. The nutritional care quality indicator was the percentage of patients whose nutritional care, as prescribed by the SSC, was adapted to their specific requirements. We determined the septic surgery team's NRS completion rate and calculated the nutritional policy's impact on SSC length of stay. Data before (T0) and after (T1 + T2) implementation of the nutritional policy were compared. RESULTS: Ninety-eight patients were included. The nutritional care-quality indicator improved from 26 to 81% between T0 and T2. During the T1 and T2 audits, septic surgery nurses calculated NRS for 100% and 97% of patients, respectively. Excluding patients with severe PEM, SSC length of stay was significantly reduced by 23 days (p = 0.005). CONCLUSIONS: These findings showed that implementing a nutritional policy in an SSC is possible with the help of an algorithm including an easy-to-use tool like the NRS.