Complementary Biomarker Assessment of Components Absorbed from Diet and Creatinine Excretion Rate Reflecting Muscle Mass in Dialysis Patients.

To prevent protein energy malnutrition (PEM) and accumulation of waste products, dialysis patients require diet adjustments. Dietary intake assessed by self-reported intakes often provides biased information and standard 24-h urinary excretion is inapplicable in dialysis patients. We aimed to assess dietary intake via a complementary, less biased biomarker method, and to compare this to dietary diaries. Additionally, we investigated the prospective association of creatinine excretion rate (CER) reflecting muscle mass with mortality. Complete intradialytic dialysate and interdialytic urinary collections were used to calculate 24-h excretion of protein, sodium, potassium, phosphate and creatinine in 42 chronic dialysis patients and compared with protein, sodium, potassium, and phosphate intake assessed by 5-day dietary diaries. Cox regression analyses were employed to investigate associations of CER with mortality. Mean age was 64 ± 13 years and 52% were male. Complementary biomarker assessed (CBA) and dietary assessed (DA) protein intake were significantly correlated (r = 0.610; p < 0.001), but there was a constant bias, as dietary diaries overestimated protein intake in most patients. Correlations were found between CBA and DA sodium intake (r = 0.297; p = 0.056), potassium intake (r = 0.312; p = 0.047) and phosphate uptake/intake (r = 0.409; p = 0.008). However, Bland-Altman analysis showed significant proportional bias. During a median follow-up of 26.6 (25.3⁻31.5) months, nine dialysis patients (23%) died. CER was independently and inversely associated with survival (HR: 0.59 (0.42⁻0.84); p = 0.003). Excretion measurements may be a more reliable assessment of dietary intake in dialysis patients, as this method is relatively free from biases known to exist for self-reported intakes. CER seems to be a promising tool for monitoring PEM.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: desnutrición aguda. No. 09 / Protocol of the National Epidemiological Surveillance System: acute malnutrition. No. 09

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país.

STATE-LEVEL DIETARY DIVERSITY AS A CONTEXTUAL DETERMINANT OF NUTRITIONAL STATUS OF CHILDREN IN INDIA: A MULTILEVEL APPROACH.

This study aimed to identify the determinants of nutritional status of children in India with a special focus on dietary diversity at the state level. Household-level consumption data from three rounds of the Consumer Expenditure Survey of the National Sample Survey Organization (1993-2012) were used. Information on the nutritional status of children was taken from the National Family Health Survey (2005-06). Dietary diversity indices were constructed at the state level to examine diversity in quantity of food consumed and food expenditure. Multilevel regression analysis was applied to examine the association of state-level dietary diversity and other socioeconomic factors with the nutritional status of children. It was observed that significant variation in childhood stunting, wasting and underweight could be explained by community- and state-level factors. The results indicate that dietary diversity has increased in India over time, and that dietary diversity at the state level is significantly associated with the nutritional status of children. Moreover, percentage of households with a regular salaried income in a state, percentage of educated mothers and mothers receiving antenatal care in a community are important factors for improving the nutritional status of children. Diversity in complementary child feeding is another significant determinant of nutritional status of children. The study thus concludes that increasing dietary diversity at the state level is an effective measure to reduce childhood malnutrition in India.

A rapid assessment and response approach for socially marketed nutrition commodities in Viet Nam.

BACKGROUND: The leading cause of death in children in developing countries is protein-energy malnutrition. In Viet Nam, 25.9% of children under 5 experience stunted growth and 6.6% are moderately wasted. Iron deficiency anaemia and vitamin A deficiency contribute to these and other malnutrition conditions. OBJECTIVES: Given these factors, more evidence based approaches are required to improve understanding of current attitudes, opinions and behaviours of mothers with young children, in order to operationalise social marketing of nutrition commodities in Viet Nam. METHODS AND STUDY DESIGN: A literature review supported a rapid assessment and response method involving semi-structured interviews with 77 stakeholders and focus group discussions with 80 program beneficiaries from four geographic locations in the north and south of Viet Nam. Discussion agendas were developed to address key program issues with grounded theory utilized for data analysis. RESULTS: Data analysis highlighted challenges and opportunities within the six Ps of social marketing: Supply and demand side issues included: cost and the quality of products, the limited scale of interventions and promotional activities. Policy issues identified related to current policies that inhibited the broader promotion and distribution of micronutrient products, and opportunities for improved dialogue with policy partners. Partnerships further emphasized the need for public private partnerships to support the social change process. CONCLUSION: Implications for theory, policy, and practice indicates that rapid assessment and response is a cost-effective, pragmatic method of public health research, in resource constrained settings, to explore policies and behaviours amenable to change and build stakeholder engagement in the program.

Intradialytic parenteral nutrition in end-stage renal disease: practical aspects, indications and limits.

Protein-energy malnutrition (PEW) is highly prevalent in patients with end-stage renal disease (ESRD) and is associated with a significant increase of the already high mortality and morbidity risk typical of this clinical setting. Since a key mechanism of PEW in ESRD is inadequate nutrient intake, oral nutritional supplements are extensively employed, and have been demonstrated to be highly effective in PEW prevention and treatment. Intradialytic parenteral nutrition (IDPN), i.e. the administration of nutrients through the extracorporeal circuit during hemodialysis, has also been proposed as a modality of nutritional support for patients with ESRD. However, even though metabolic/nutritional status is improved by this nutritional approach, the evidence linking IDPN to decreased hospitalization rate and lower mortality risk is still scant. The aim of the present paper is to review the role of IDPN as a modality of nutritional supplementation for ESRD patients on hemodialysis. To this end, quantitative and qualitative aspects, practical management, the indications, and limits of IDPN are discussed. On the basis of the available evidence, it is suggested that IDPN is a safe and efficacious modality of nutritional support in ESRD, and could represent an adjunctive strategy for patients with reduced spontaneous dietary intake when intensive dietetic counseling and oral supplementation have failed.

[Protocol for peripheral parenteral nutrition management ready to use in surgical patients]. / Protocolo para el manejo de nutrición parenteral periférica lista para usar en paciente quirúrgico.

INTRODUCTION: Patients undergoing elective surgery, require a comprehensive clinical treatment that tends to maintain or prevent deterioration of nutritional status and promote clinical outcomes, and in turn improve the safety of parenteral nutrition therapy through optimization of technology, as a option aimed at minimizing risk and lower operating costs in institutions providing health services. AIM: To review the literature in order to study the requirements and recommendations of peripheral parenteral nutritional support and / or complementary ready to use in people undergoing surgery. METHODS: Data synthesis after reviewing the relevant literature, to allow the protocol design. The search was conducted in the following databases: PubMed, Medline, Embase and ScienceDirect. CONCLUSIONS: Peripheral parenteral nutrition is a ready to use alternative nutritional support that improves the contribution Protein-Energy and demonstrate improvements in patient safety, decrease costs and increase patient satisfaction.

Introducción: Los pacientes sometidos a cirugía electiva, requieren de un tratamiento clínico integral que propenda por mantener o evitar el deterioro del estado nutricional y favorecer los resultados clínicos, y a su vez mejorar la seguridad de la terapia nutricional parenteral mediante la optimización de la tecnología, como una opción enfocada a la minimización de riesgo y la disminución de los costos operativos en las instituciones de prestación de servicios de salud. Objetivo: Realizar una revisión de la literatura con el fin de estudiar las indicaciones y recomendaciones del soporte nutricional parenteral periférico y/o complementario listo para usar en personas sometidas a una intervención quirúrgica. Métodos: Síntesis de datos tras la revisión de la bibliografía pertinente, que permitiera el diseño del protocolo. Se realizó la búsqueda en las siguientes bases de datos: PubMed, Medline, ScienceDirect y Embase. Conclusiones: La nutrición parenteral periférica lista para usar es una alternativa de soporte nutricional, que permite mejorar el aporte Proteico-Energético así como demostrar mejoras en la seguridad del paciente, disminución de los costos y aumentar la satisfacción del paciente.

Evaluación nutricional de los pacientes con cirrosis hepática compensada atendidos en el Centro Hospitalario Regional de Mouila, Gabón, 2009-2010 / Nutritional assessment in patients with compensated liver cirrhosis treated at the Mouila Regional Hospital, Gabon, 2009-2010

Introducción: algunos investigadores consideran que la malnutrición proteico energética es la complicación más frecuente en el paciente cirrótico y que constituye un elemento predictor independiente de supervivencia. Objetivos: determinar el estado nutricional y su relación con la causa, el tiempo de evolución y la ingesta calórica en pacientes con cirrosis hepática compensada. Métodos: se realizó un estudio observacional descriptivo de todos los pacientes gaboneses de ambos sexos, entre 15 y 60 años, con este diagnóstico. Se halló predominio de las mujeres y del grupo entre 45 y 54 años, con una edad media de 45 años (± 7,6). Prevalecieron la causa mixta y el grupo A de la clasificación de Child-Pugh-Turcotte. Todos tenían menos de 1 año desde el diagnóstico de la enfermedad y según el índice de masa corporal, la malnutrición proteico-energética se observó en 75 por ciento de los casos, predominó la delgadez moderada. La circunferencia del brazo se afectó con menor frecuencia e intensidad que el índice de masa corporal. En la medida que disminuyó el número de comidas al día aumentó el porcentaje de pacientes con malnutrición proteico-energética. Conclusiones: la frecuencia de malnutrición de la población cirrótica compensada fue elevada, con mayor índice de malnutrición en los casos de causa mixta, además, se comprobó que el estado nutricional del paciente cirrótico no puede ser valorado al margen de factores dietéticos

Introduction: some researchers believe that protein energy malnutrition is the most common complication in cirrhotic patients and it is an independent predictor of survival element. Objectives: to determine the nutritional status and its relationship to the cause, time of evolution and caloric intake in patients with compensated liver cirrhosis. Methods: a descriptive study of all Gabonese patients of both sexes, between the ages 15 and 60 years, with this diagnosis. Women and the group between 45 and 54 years was found predominant (mean age 45 years (± 7.6)). Additionally, mixed cause and group A in Child-Pugh-Turcotte widely existed. All patients had diagnosis of this disease for less than a year and according to their body mass index, protein-energy malnutrition was observed in 75 percent of cases; moderate thinness predominated. The arm circumference was less frequently and intensively affected than the body mass index. To the extent that the number of meals reduced per day, the percentage of patients with protein-energy malnutrition increased. Conclusions: the frequency of malnutrition of compensated cirrhotic population was high, with the highest rate of malnutrition in cases of mixed causes; it also was proved that the nutritional status of cirrhotic patient cannot be valued regardless of dietary factors

The integration of frailty into clinical practice: preliminary results from the Gérontopôle.

BACKGROUND: Disability is commonly considered as an irreversible condition of advanced age. Therefore, preventive actions need to be taken before the disabling cascade is fully established, that is in the pre-disability phase defined "frailty syndrome". The complexity and heterogeneity of frailty requires a clinical approach based on multidimensionality and multidisciplinary. In this paper, we present the main characteristics of the newborn Platform for Evaluation of Frailty and Prevention of Disability (Toulouse, France). INTERVENTION: Persons aged 65 years and older screened for frailty by general practitioners in the Toulouse area are invited to undergo a multidisciplinary evaluation at the Platform. Here, the individual is multidimensionality assessed in order to preventively detect potential risk factors for disability. At the end of the comprehensive evaluation, the team members propose the patient (in agreement with the general practitioner) a preventive intervention program specifically tailored to the his/her needs and resources. RESULTS: Mean age of our population is 82.7 years, with a large majority aged 75 years and older. Most patients are women (61.9%) Approximately two thirds of patients received any kind of regular help. Regarding level of frailty, 65 patients (41.4%) were pre-frail, and 83 (52.9%) frail. For what concerns the functional status, 83.9% of patients presented slow gait speed, 53.8% were sedentary, and 57.7% had poor muscle strength. Only 27.2% of patients had a SPPB score equal to or higher than 10. Autonomy in ADL was quite well preserved (mean ADL score 5.6 ± 0.8) as expected, suggesting that the patients of the platform have not yet developed disability. Consistently, IADL showed a marginal loss of autonomy reporting a mean score of 6.0 ± 2.3. About one third of patients (33.1%) presented a MMSE score lower than 25. Dementia (measured by the CDR scale) was observed in 11.6% of the platform population, whereas subjects with mild cognitive impairment (that is CDR equal to 0.5) were 65.8%. New diagnosed depressive disorders were relatively rare with only 3.2% of patients showing signs of depression but some people were already treated. Numerous patients presented vision problems with 10.4% having abnormal findings at the Amsler grid. Finally, it is noteworthy that 9% of the platform population presented an objective state of protein-energy malnutrition, 34% an early alteration of nutritional status, while almost everyone (94.9%) had a vitamin D deficiency (partially explained by the period of the year, that is winter-spring, of most of the measurements). CONCLUSION: The Platform clinically evaluates and intervenes on frailty for the first time at the general population-level. This model may serve as preliminary step towards a wider identification of early signs of the disabling cascade in order to develop more effective preventive interventions.

Housing quality and access to material and learning resources within the home environment in developing countries.

This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were consistently tied to HDI; the availability of formal and informal learning materials a little less so. Gross domestic product (GDP) tended to show a stronger independent relation with housing quality and material resources than life expectancy and education. Formal learning resources were independently related to the GDP and education indices, and informal learning resources were not independently related to any constituent indices of the overall HDI.

Prehemodialysis care by dietitians and first-year mortality after initiation of hemodialysis.

BACKGROUND: Since January 2002, Medicare has provided payment for medical nutrition therapy for patients with chronic kidney disease. Few patients receive dietary counseling before end-stage renal disease onset; whether such counseling is associated with improved outcomes is unknown. STUDY DESIGN: Retrospective cohort analysis. SETTING & PARTICIPANTS: Patients who initiated hemodialysis therapy on June 1, 2005, to May 31, 2007, in the United States for whom predialysis dietitian care was reported on the Centers for Medicare & Medicaid Services Medical Evidence Report. PREDICTOR: Dietitian care before end-stage renal disease onset. OUTCOME: Time to death. MEASUREMENTS: Propensity score for dietitian care calculated using logistic regression; Cox regression analysis used to compare time to death by predialysis dietitian care overall and stratified by tertiles of propensity score, adjusting for baseline characteristics. RESULTS: Most patients (88%) received no dietitian care; 9% received dietitian care for 12 months or less, and 3% received dietitian care for more than 12 months before dialysis therapy initiation (total N = 156,440). Predialysis dietitian care was associated independently with higher albumin and lower total cholesterol levels at dialysis therapy initiation. There was evidence of an independent association between predialysis dietitian care for longer than 12 months and decreased mortality during the first year on dialysis therapy for the second tertile of propensity score. Adjusted mortality HRs were 1.16 (95% CI, 0.44-3.09; P = 0.8), 0.81 (95% CI, 0.71-0.93; P = 0.002), and 0.93 (95% CI, 0.86-1.01; P = 0.1) in the first, second, and third tertiles of propensity score, respectively. LIMITATIONS: Information for dietitian care was missing for 18.6% of Medical Evidence Reports and has low sensitivity; including only incident dialysis patients precluded evaluation of an association between dietitian care and chronic kidney disease progression; the observational design allowed the possibility of residual confounding. CONCLUSIONS: Our study suggests an independent association between predialysis dietitian care for more than 12 months and lower mortality during the first year on dialysis therapy.

Quality protein maize for Africa: closing the protein inadequacy gap in vulnerable populations.

Africa shares a unique relationship with maize (Zea mays). After its introduction from New World explorers, maize was quickly adopted as the cornerstone of local cuisine, especially in sub-Saharan countries. Although maize provides macro- and micronutrients required for humans, it lacks adequate amounts of the essential amino acids lysine and tryptophan. For those consuming >50% of their daily energy from maize, pandemic protein malnutrition may exist. Severe protein and energy malnutrition increases susceptibility to life-threatening diseases such as tuberculosis and gastroenteritis. A nutritionally superior maize cultivar named quality protein maize (QPM) represents nearly one-half century of research dedicated to malnutrition eradication. Compared with traditional maize types, QPM has twice the amount of lysine and tryptophan, as well as protein bioavailability that rivals milk casein. Animal and human studies suggest that substituting QPM for common maize results in improved health. However, QPM's practical contribution to maize-subsisting populations remains unresolved. Herein, total protein and essential amino acid requirements recommended by the WHO and the Institute of Medicine were applied to estimate QPM target intake levels for young children and adults, and these were compared with mean daily maize intakes by African country. The comparisons revealed that ~100 g QPM is required for children to maintain adequacy of lysine, the most limiting amino acid, and nearly 500 g is required for adults. This represents a 40% reduction in maize intake relative to common maize to meet protein requirements. The importance of maize in Africa underlines the potential for QPM to assist in closing the protein inadequacy gap.

[Dysphagia - epidemiology, diagnostics, therapy and nutrition-management]. / Dysphagie - Epidemiologie, Diagnostik, Therapie und Ernährungsmanagement.

BACKGROUND: Swallowing is a complex neuro-muscular process at which around 50 muscle couples need to be coordinated. The swallowing process is controlled by the swallowing centres in cortex and brainstem as well as by five brain nerves. EPIDEMIOLOGY: Severe dysphagia appears most frequently in the context of neurological illnesses. Particularly in patients with acute stroke, swallowing disorders are reported in up to 50% of cases. DIAGNOSTICS: The main emphases must be put on the case history, a swallowing specific physical examination, a "Swallowing Screening Test" and the use of technical examination methods, like the flexible laryngoscopy as well as the video-fluoroscopy. It is of special importance to identify "silente aspiration" which can only be verified by the use of technical examination methods. THERAPY: It should always be carried out interdisciplinarily. Besides a restitutive and a compensatory therapy also an ADAPTATIVE THERAPY have to be applied. The duration of therapy needed depends on severity of dysphagia and can be accounted to 2.5 months on average. nutrition-management: All measures should be targeted at avoiding weight loss and malnutrition. The oral feeding should be started early, however in a controlled fashion and has to be carried out by the use of a diet that is adapted to the swallowing disorders. CONCLUSION: Dysphagia is a clinical relevant problem in known risk patients. To avoid "silent aspiration" disinguished and routinely established diagnostic processes as well straight therapeutic approaches are needed. These approaches need to be done by highly trained and clinically experienced stuff members who cooperate interdisciplinary and multiprofessional.

Nutritional implications of patient-provider interactions in hospital settings: evidence from a within-subject assessment of mealtime exchanges and food intake in elderly patients.

OBJECTIVE: To examine the nutritional implications of the interactions taking place between patients and care providers during mealtimes in hospital settings. Specifically, we tested research propositions that the amount and nature of interpersonal behaviours exchanged between patients and providers impact patients' food intake. These propositions were derived from prior evidence of social influences on eating behaviour and a well-established framework that identifies two fundamental modalities of human interaction: striving for mastery and power (agency) and efforts to promote union with others (communion). DESIGN: In a within-subject naturalistic study, participants were observed on multiple meals (n=1477, 46.2 meals/participant on average), during which participants' and providers' agency- and communion-related behaviours and patients' protein and energy intake were recorded. Meal-level frequency and complementarity of patients' and providers' behaviours were computed to test research propositions. SETTING: Dining room of a geriatric rehabilitation unit. SUBJECTS: Thirty-two elderly patients (21 females, mean age:78.8, 95% CI: 76.4, 81.1). RESULTS: Meal-level frequency of patient-provider exchanges (P=0.016) and patients' agency-related behaviours (P=0.029), as well as mutual reciprocation of patients' and providers' communion-related behaviours (P=0.015) on a given meal were positively linked to protein intake. Higher energy intake was found during meals where patients expressed more agency-related behaviours (P=0.029). CONCLUSION: Results present evidence that the amount and nature of patient-provider interpersonal exchanges on a given meal influence the nutritional quality of food intake in hospitalized elderly. They provide insights into how to improve the design and delivery of routine care to this malnutrition-prone population. SPONSORSHIP: This study was supported by the Canadian Institutes of Health Research (Operating grant to Laurette Dubé, Doctoral Fellowship to Catherine Paquet) the Fonds de la Recherche en santé du Québec and by the Danone Institute (Doctoral fellowship to Danielle St-Arnaud McKenzie).

Promotion of the feeding minds and fighting hunger initiative in selected rural schools in Andhra Pradesh, India.

BACKGROUND: Schoolchildren are good agents of change and need to be educated and sensitized to specific issues of hunger and malnutrition through a question-and-answer process. Feeding Minds and Fighting Hunger (FMFH), a global project initiated by the Food and Agriculture Organization and partner organizations, attempts to help schoolchildren learn about these issues by introducing concepts in the prevention of hunger and malnutrition to teachers, and by facilitating transfer of knowledge to the children through a set of model lessons. OBJECTIVE: To test the feasibility of the FMFH approach to improve the nutrition knowledge of rural schoolchildren in three rural schools in Medak District of the South Indian state of Andhra Pradesh. METHODS: Participatory workshops for teachers were conducted to facilitate knowledge transfer to the children through interactive classroom teaching and other activities. The change in knowledge and thinking of children in the seventh and eighth grades was assessed by a ques- tionnaire administered before and after the intervention. The questionnaire also assessed, in part, the status of local food security based on the sources of different food items in the households. RESULTS: The responses to the questionnaire suggested that the children's knowledge of nutrients and their functions was not good initially but improved after the intervention. However, their understanding of the social factors responsible for hunger and malnutrition was fairly good prior to the intervention. Improvement in responses to the question of what should be done to combat malnutrition also occurred after intervention. The community had village-level food security for rice and maize but depended partially or fully on outside sources for pulses, fruits and vegetables, and animal products. CONCLUSIONS: The FMFH approach can be applied in rural schools where "the poorest of the poor" children can improve their understanding of balanced diets, better nutrition, the causes of malnutrition, and approaches to combat malnutrition.

Malnutrition and health in developing countries.

Malnutrition, with its 2 constituents of protein-energy malnutrition and micronutrient deficiencies, continues to be a major health burden in developing countries. It is globally the most important risk factor for illness and death, with hundreds of millions of pregnant women and young children particularly affected. Apart from marasmus and kwashiorkor (the 2 forms of protein- energy malnutrition), deficiencies in iron, iodine, vitamin A and zinc are the main manifestations of malnutrition in developing countries. In these communities, a high prevalence of poor diet and infectious disease regularly unites into a vicious circle. Although treatment protocols for severe malnutrition have in recent years become more efficient, most patients (especially in rural areas) have little or no access to formal health services and are never seen in such settings. Interventions to prevent protein- energy malnutrition range from promoting breast-feeding to food supplementation schemes, whereas micronutrient deficiencies would best be addressed through food-based strategies such as dietary diversification through home gardens and small livestock. The fortification of salt with iodine has been a global success story, but other micronutrient supplementation schemes have yet to reach vulnerable populations sufficiently. To be effective, all such interventions require accompanying nutrition-education campaigns and health interventions. To achieve the hunger- and malnutrition-related Millennium Development Goals, we need to address poverty, which is clearly associated with the insecure supply of food and nutrition.

Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition.

BACKGROUND: In order to reduce protein-energy malnutrition in older people during hospitalisation an early interdisciplinary intervention is needed. We developed a protocol which includes screening for malnutrition, dysphagia and dehydration on admission, followed by immediate interventions. OBJECTIVE: To assess effectiveness of the protocol on nutritional status, hospital-acquired infections and pressure sores, and to evaluate the protocol s economical feasibility. DESIGN: Prospective, controlled study. SETTING: The inpatient geriatric service of a university hospital (UMC Nijmegen) and a geriatric ward of a non-academic teaching hospital (Rijnstate Hospital, Arnhem). SUBJECTS: 298 older patients (>60 years). METHODS: One of the geriatric wards applied the protocol (N=140) while the other provided standard care (N=158). All non-terminally ill patients admitted for more than two days were included. Body mass was measured on admittance and discharge and hospital-acquired infections and pressure sores were scored and costs related to nutrition, infections and length of hospital stay were assessed. RESULTS: There was a 0.8 kg loss (SEM 0.3 kg) in average weight in the standard care group and a 0.9 kg gain (SEM 0.2 kg) in the intervention group (p<0.001). The number of hospital acquired infections was significantly lower in the intervention group (33/140 versus 58/158, p=0.01) but no significant difference in number of patients with pressure sores (23/140 versus 33/158) was found. Costs were not significantly different: 7516 versus 7908 Euro/patient for intervention versus controls, respectively. CONCLUSION: An early interdisciplinary intervention approach can be effective in reducing protein-energy malnutrition and related hospital-acquired infections and appears to be economically feasible.