RESUMO
It is the position of the Academy of Nutrition and Dietetics that, based upon current evidence, the Malnutrition Screening Tool should be used to screen adults for malnutrition (undernutrition) regardless of their age, medical history, or setting. Malnutrition (undernutrition) screening is a simple process intended to quickly recognize individuals who may have a malnutrition diagnosis. While numerous malnutrition screening tools are in use, their levels of validity, agreement, reliability, and generalizability vary. The Academy of Nutrition and Dietetics reviewed the body of evidence supporting malnutrition screening tools and determined a single tool for identifying adults in all settings who may have malnutrition, regardless of their age or medical history. The Nutrition Screening for Adults Workgroup conducted a systematic review of the most robust evidence to promote using the highest-quality malnutrition screening tool available.
Assuntos
Dietética , Desnutrição , Adulto , Humanos , Desnutrição/diagnóstico , Desnutrição/prevenção & controle , Avaliação Nutricional , Estado Nutricional , Reprodutibilidade dos TestesRESUMO
Appropriate diet can prevent, manage, or reverse noncommunicable health conditions such as obesity, cardiovascular disease, and diabetes. Consequently, the public's interest in diet and nutrition has fueled the multi-billion-dollar weight loss industry and elevated its standing on social media and the internet. Although many dietary approaches are popular, their universal effectiveness and risks across overall populations are not clear. The objective of this scoping review was to identify and characterize systematic reviews (SRs) examining diet or fasting (intermittent energy restriction [IER]) interventions among adults who are healthy or may have chronic disease. An in-depth literature search of six databases was conducted for SRs published between January 2010 and February 2020. A total of 22,385 SRs were retrieved, and 1,017 full-text articles were screened for eligibility. Of these, 92 SRs met inclusion criteria. Covered diets were organized into 12 categories: high/restricted carbohydrate (n = 30), Mediterranean, Nordic, and Tibetan (n = 19), restricted or modified fat (n = 17), various vegetarian diets (n = 16), glycemic index (n = 13), high protein (n = 12), IER (n = 11), meal replacements (n = 11), paleolithic (n = 8), Dietary Approaches to Stop Hypretension (DASH; n = 6), Atkins, South Beach, and Zone (n = 5), and eight other brand diets (n = 4). Intermediate outcomes, such as body weight or composition and cardiometabolic, were commonly reported. Abundant evidence was found exploring dietary approaches in the general population. However, heterogeneity of diet definitions, focus on single macronutrients, and infrequent macronutrient subanalyses were observed. Based on this scoping review, the Evidence Analysis Center prioritized the need to collate evidence related to macronutrient modification, specifically restricted carbohydrate diets.
Assuntos
Dieta , Obesidade , Adulto , Carboidratos , Dieta Vegetariana , Humanos , Obesidade/prevenção & controle , Redução de PesoRESUMO
Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which patients are at high risk for both pulmonary and systemic complications of their disease. Medical nutrition therapy by a registered dietitian nutritionist can be an integral component of lifestyle treatment targeted at maintaining and improving outcomes, such as lung function, mortality, and quality of life. The Academy of Nutrition and Dietetics (Academy) convened an expert workgroup to conduct a systematic review to update the COPD Evidence-Based Nutrition Practice Guideline. This publication outlines the Academy's Evidence Analysis Library methods used to complete the systematic review and guideline and examines the recommendations and supporting evidence. A total of 14 recommendations were developed based on evidence from eight conclusions. Using the Nutrition Care Process as a framework for practice, recommendations rated as strong included assessing and monitoring and evaluating body weight and medical nutrition therapy by a registered dietitian nutritionist. Weak recommendations included predicting resting and total energy expenditure. All other recommendations were rated as fair. These included individualizing the calorie prescription and macronutrient composition of the diet; assessing and monitoring and evaluating energy intake, serum 25-hydroxyvitamin D levels, and frequency of exacerbations; and determining need for vitamin D supplementation. Fewer than one-third of the systematic review's conclusions could be used to support the recommendations due to conflicting results or limited or no evidence available. The Evidence Analysis Library 2019 COPD Evidence-Based Nutrition Practice Guideline is a valuable resource for registered dietitian nutritionists and other health care professionals caring for those with COPD.
Assuntos
Prática Clínica Baseada em Evidências/normas , Terapia Nutricional/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Academias e Institutos , HumanosRESUMO
Both food insecurity and malnutrition are associated with adverse health outcomes in the pediatric population. However, the research on the relationship between these factors has been inconsistent, leading to uncertainty regarding whether or how evaluation of food insecurity should be incorporated into nutrition screening or the nutrition care process. The objective of this systematic review was to determine the association between food insecurity and malnutrition related to undernutrition or overnutrition (defined by anthropometrics) in the pediatric population in the United States. A literature search was conducted using Medline, Embase, and CINAHL databases for studies published from January 2002 through November 2017. A total of 23 studies (19 cross-sectional and 4 prospective cohort studies) met inclusion criteria and were included in qualitative analysis. In 6 studies, there was no overall relationship between food insecurity and underweight. All included studies examined the relationship between food insecurity status and overweight/obesity and results were mixed, with large cross-sectional studies demonstrating a positive relationship between food insecurity and overweight/obesity. There were no clear patterns according to subpopulation. Evidence quality was graded as fair due to heterogeneity in how food insecurity was measured and populations included as well as inconsistency in results. Use of a 2-item food insecurity screening tool may allow for efficient, effective screening of food insecurity in order to identify potential contributors overweight and obesity.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Insegurança Alimentar , Avaliação Nutricional , Obesidade Infantil/epidemiologia , Magreza/epidemiologia , Criança , Transtornos da Nutrição Infantil/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Obesidade Infantil/etiologia , Estudos Prospectivos , Pesquisa Qualitativa , Magreza/etiologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Malnutrition screening relies on quick and easy-to-use tools that require minimal training of users. Valid and reliable tools should avoid under-referral of adults with a malnutrition diagnosis or over-referral of those without a malnutrition diagnosis to dietitians. OBJECTIVE: Our aim was to conduct a systematic review of adult malnutrition screening tools for validity, agreement, and reliability, and to determine the costs of the malnutrition screening procedure. METHODS: Following a structured process, a comprehensive search using PubMed, MEDLINE, EMBASE, and CINAHL was conducted for relevant research published between 1997 and 2017 that examined the validity, agreement, reliability, and costs of nutrition screening tools. RESULTS: Sixty-nine studies met the inclusion criteria. The Malnutrition Screening Tool exhibited moderate validity, agreement, and reliability based on Grade I (Good/Strong) evidence. The evidence supporting the conclusions for the remaining tools was Fair (Grade II). The Malnutrition Universal Screening Tool exhibited high validity and moderate agreement and reliability. The Mini Nutritional Assessment-Short Form exhibited moderate validity and reliability and low agreement. The Short Nutritional Assessment Questionnaire and the Nutrition Risk Screening 2002 exhibited moderate validity and reliability and the Mini Nutritional Assessment-Short Form Body Mass Index exhibited high validity and moderate agreement. However, these last three tools were missing reliability or agreement data. Limited data were available to evaluate malnutrition screening costs. CONCLUSIONS: This review provides an analysis of validity, agreement, and reliability of tools to screen adults for malnutrition, regardless of their age, medical history, or location. No tools were found with high validity, reliability, and strong supportive evidence. Tools most often achieved moderate validity, agreement, and reliability, and had large variations in individual results. The minimum validity and reliability of tools to screen adults for malnutrition should be established to shape future research. Cost data for the screening process should be obtained and examined.
Assuntos
Desnutrição/diagnóstico , Programas de Rastreamento/normas , Avaliação Nutricional , Inquéritos e Questionários/normas , Adulto , Feminino , Humanos , Masculino , Reprodutibilidade dos TestesRESUMO
It is the position of the Academy of Nutrition and Dietetics that, based upon current evidence, the Malnutrition Screening Tool should be used to screen adults for malnutrition (undernutrition) regardless of their age, medical history, or setting. Malnutrition (undernutrition) screening is a simple process intended to quickly recognize individuals who may have a malnutrition diagnosis. While numerous malnutrition screening tools are in use, their levels of validity, agreement, reliability, and generalizability vary. The Academy of Nutrition and Dietetics reviewed the body of evidence supporting malnutrition screening tools and determined a single tool for identifying adults in all settings who may have malnutrition, regardless of their age or medical history. The Nutrition Screening for Adults Workgroup conducted a systematic review of the most robust evidence to promote using the highest-quality malnutrition screening tool available.
Assuntos
Dietética/normas , Desnutrição/diagnóstico , Programas de Rastreamento/normas , Avaliação Nutricional , Academias e Institutos , Adulto , Feminino , Humanos , Masculino , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Nutrition screening tools are used to identify risk of malnutrition or change in risk of malnutrition. However, it is unclear which tools have demonstrated high validity, reliability, and agreement. OBJECTIVE: Our aim was to conduct a systematic review of valid and reliable pediatric nutrition screening tools for identifying malnutrition risk (under- or overnutrition), and to determine whether there are differences in validity and reliability according to users of the tools. METHODS: A literature search using Medline, Embase, and CINAHL databases was conducted to identify relevant research published between 1995 and May 2017 examining validity and reliability of nutrition screening tools in the pediatric population. A multidisciplinary workgroup developed eligibility criteria, data were extracted and summarized, risk of bias was assessed, and evidence strength was graded, according to a standard process. RESULTS: Twenty-nine studies met inclusion criteria. Thirteen pediatric nutrition screening tools designed for various settings were included in the review (seven inpatient/hospital, three outpatient or specialty setting, and three community). The most frequently examined tools were the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth (13 studies each), and Paediatric Yorkhill Malnutrition Score (nine studies). No tools demonstrated high validity. Reliability and agreement were reported infrequently. CONCLUSIONS: Nutrition screening tools with good/strong or fair evidence and moderate validity included the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth, and Paediatric Yorkhill Malnutrition Score in the inpatient setting and Nutrition Risk Screening Tool for Children and Adolescents with Cystic Fibrosis in the specialty setting. No tools in the community setting met these criteria. While differences in validity and reliability measures among tool users were found, the significance of these findings is unclear. Limitations included few studies examining each tool, heterogeneity between studies examining a common tool, and lack of tools that included currently recommended indicators to identify pediatric malnutrition.
Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Inquéritos sobre Dietas/normas , Programas de Rastreamento/normas , Avaliação Nutricional , Ciências da Nutrição/normas , Adolescente , Criança , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Ciências da Nutrição/métodos , Reprodutibilidade dos Testes , Estudos de Validação como AssuntoAssuntos
Medicina Baseada em Evidências , Desnutrição/prevenção & controle , Neoplasias/complicações , Terapia Nutricional , Guias de Prática Clínica como Assunto , Adulto , Ensaios Clínicos como Assunto , Tratamento Farmacológico , Humanos , Desnutrição/diagnóstico , Desnutrição/etiologia , National Cancer Institute (U.S.) , Neoplasias/terapia , Estado Nutricional , Radioterapia/efeitos adversos , Estados UnidosRESUMO
When measurement of resting metabolic rate (RMR) by indirect calorimetry is necessary, following evidence-based protocols will ensure the individual has achieved a resting state. The purpose of this project was to update the best practices for measuring RMR by indirect calorimetry in healthy and non-critically ill adults and children found the Evidence Analysis Library of the Academy of Nutrition and Dietetics. The Evidence Analysis process described by the Academy of Nutrition and Dietetics was followed. The Ovid database was searched for papers published between 2003 and 2012 using key words identified by the work group and research consultants, studies used in the previous project were also considered (1980 to 2003), and references were hand searched. The work group worked in pairs to assign papers to specific questions; however, the work group developed evidence summaries, conclusion statements, and recommendations as a group. Only 43 papers were included to answer 21 questions about the best practices to ensure an individual is at rest when measuring RMR in the non-critically ill population. In summary, subjects should be fasted for at least 7 hours and rest for 30 minutes in a thermoneutral, quiet, and dimly lit room in the supine position before the test, without doing any activities, including fidgeting, reading, or listening to music. RMR can be measured at any time of the day as long as resting conditions are met. The duration of the effects of nicotine and caffeine and other stimulants is unknown, but lasts longer than 140 minutes and 240 minutes, respectively. The duration of the effects of various types of exercise on RMR is unknown. Recommendations for achieving steady state, preferred gas-collection devices, and use of respiratory quotient to detect measurement errors are also given. Of the 21 conclusions statements developed in this systemic review, only 5 received a grade I or II. One limitation is the low number of studies available to address the questions and most of the included studies had small sample sizes and were conducted in healthy adults. More research on how to conduct an indirect calorimetry measurement in healthy adults and children and in sick, but not critically ill, individuals is needed.