The Norwegian Directorate of Health recommends malnutrition screening tool (MST) for all adults.

BACKGROUND & AIMS: Malnutrition is underdiagnosed and undertreated in Norway. In a revision of a national guideline on malnutrition, the Norwegian Directorate of Health aimed for a harmonization and standardization of the malnutrition screening practice, including a recommendation of one malnutrition screening tool to be used among all adults in Norwegian health and care services. METHODS: A working group was appointed by the Norwegian Directorate of Health. Evidence-based practice, a pragmatic decision-making process based on a literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the DECIDE decision-making model was used as a guidance in order to convert evidence into recommendations. RESULTS: The criteria and properties of the four most frequently validated malnutrition screening tools were identified and ranked by the working group. The tools were prioritized in the following order: 1: Malnutrition Screening Tool (MST), 2: Malnutrition Universal Screening Tool (MUST), 3: Nutritional Risk Screening 2002 (NRS-2002), and 4: Mini-Nutritional Assessment short form (MNA). CONCLUSIONS: The Norwegian Directorate of Health recommends use of MST for screening for malnutrition among all adults (≥18 years), across all health care settings, and diagnoses or conditions in Norway.

Prevalence of patients "at risk of malnutrition" and nutritional routines among surgical and non-surgical patients at a large university hospital during the years 2008-2018.

BACKGROUND & AIMS: Being "at risk of malnutrition", which includes both malnutrition and the risk to be so, is associated with increased morbidity and mortality in both surgical and non-surgical patients. Several strategies and guidelines have been introduced to prevent and treat this, but the effects are scarcely investigated. This study aims to evaluate the long-term effects of these efforts by examining trends concerning: 1) the prevalence of patients «at risk of malnutrition¼ and 2) the use of nutritional support and diagnostic coding related to malnutrition over an 11-year period in a large university hospital. Moreover, we wanted to investigate if there was a difference in trends between surgical and non-surgical patients. METHODS: From 2008 to 2018, Haukeland University Hospital, Norway, conducted 34 point-prevalence surveys to investigate the prevalence of patients «at risk of malnutrition¼, as defined by Nutritional Risk Screening 2002, and the use of nutritional support at the hospital. Diagnostic coding included ICD-10 codes related to malnutrition (E43, E44 and E46) at hospital discharge, which were extracted from the electronic patient journal. Trend analysis by calendar year was investigated using logistic regression models with and without adjustment for age (continuous), gender (male/female) and Charlson Comorbidity Index (none, mild, moderate or severe). RESULTS: The number of patients included in the study was 18 933, where 52.1% were male and the median (25th, 75th percentile) age was 65 (51, 76) years. Of these, 5121 (27%) patients were identified to be «at risk of malnutrition¼. Fewer surgical patients (21.2%) were «at risk of malnutrition¼, as compared to non-surgical patients (30.9%) (p < 0.001). Adjusted trend analysis did not identify any change in the prevalence of patients «at risk of malnutrition¼ from 2008 to 2018. The percentage of patients «at risk of malnutrition¼ who received nutritional support increased from 61.6% in 2008 to 71.9% in 2018 (p < 0.001), with a range from 55.6 to 74.8%. This trend was seen for both surgical and non-surgical patients (p < 0.001 for both). Similarly, dietitians were more involved in the patients' treatment (range: 3.8-16.7%), and there was increased use of ICD-10 codes related to malnutrition during the study period (range: 13.0-41.8%) (p < 0.001). These trends were seen for both surgical patients and non-surgical patients (p < 0.001), despite use being less common for surgical patients, as compared to non-surgical patients (p < 0.001). CONCLUSIONS: This large hospital study shows no apparent change in the prevalence of patients «at risk of malnutrition¼ from 2008 to 2018. However, more patients «at risk of malnutrition¼, both surgical and non-surgical, received nutritional support, treatment from a dietitian and a related ICD-10 code over the study period, indicating improved nutritional routines as a result of the implementation of nutritional guidelines and strategies.

Nutritional treatment is associated with longer survival in patients with pancreatic disease and concomitant risk of malnutrition.

BACKGROUND: Pancreatic diseases involve complex nutritional challenges. Despite this, conflicting evidence exists regarding the clinical relevance of detecting the risk of malnutrition and implementing systematic nutrition support for these patients. Thus, our aims were to investigate whether screening for malnutrition risk and initiating nutrition support are predictive of mortality for hospitalized patients with pancreatic diseases. DESIGN: From 2008 to 2018, 34 prevalence surveys of nutrition were conducted at Haukeland University Hospital (HUH), Norway. Risk of malnutrition was defined by a score of ≥3 in Nutritional Risk Screening 2002 (NRS 2002). Primary outcomes included overall, one-year, and one-month mortality, and were compared according to malnutrition risk and nutrition support for adult patients with ICD-10 codes of K85: acute pancreatitis, K86: other diseases of pancreas, and C25: malignant neoplasm of pancreas. Length of hospital stay (LOS) was included as a secondary outcome. RESULTS: Of the 283 patients investigated, risk of malnutrition was present in 61.5%. Risk of malnutrition was associated with higher overall mortality (Hazard Ratio (HR) = 1.67, 95% confidence interval (CI): 1.2-2.4, P = 0.003) and one-year mortality (HR = 1.89, 95% CI: 1.2-2.9, P = 0.004) compared to patients not at risk. Not receiving nutrition support for at-risk patients was associated with higher overall mortality (HR = 1.60, 95% CI: 1.1-2.4, P = 0.019) and one-year mortality (HR = 1.64, 95% CI: 1.04-2.6, P = 0.034) compared to patients at risk who received nutrition support. Patients at risk of malnutrition had increased LOS (20.5 nights vs 15.2 nights, P = 0.044) compared to patients not at risk of malnutrition. CONCLUSION: This study of hospitalized patients with pancreatic disease suggests that risk of malnutrition may be associated with higher mortality rates, whereas nutrition support may decrease mortality rates. CLINICAL TRIAL REGISTRY: Not registered.

A positive association between nutritional risk and the incidence of surgical site infections: A hospital-based register study.

Surgical site infections (SSI) are amongst the most common health care-associated infections and have adverse effects for patient health and for hospital resources. Although surgery guidelines recognize poor nutritional status to be a risk factor for SSI, they do not tell how to identify this condition. The screening tool Nutritional Risk Screening 2002 is commonly used at hospitals to identify patients at nutritional risk. We investigated the association between nutritional risk and the incidence of SSI among 1194 surgical patients at Haukeland University Hospital (Bergen, Norway). This current study combines data from two mandatory hospital-based registers: a) the incidence of SSI within 30 days after surgery, and b) the point-prevalence of patients at nutritional risk. Patients with more than 30 days between surgery and nutritional risk screening were excluded. Associations were assessed using logistic regression, and the adjusted odds ratio included age (continuous), gender (male/female), type of surgery (acute/elective) and score from The American Society of Anesthesiologists Physical Status Classification System. There was a significant higher incidence of SSI among patients at nutritional risk (11.8%), as compared to those who were not (7.0%) (p = 0.047). Moreover, the incidence of SSI was positively associated with the prevalence of nutritional risk in both simple (OR 1.76 (95% CI: 1.04, 2.98)) and adjusted (OR 1.81 (95% CI: 1.04, 3.16)) models. Answering "yes" to the screening questions regarding reduced dietary intake and weight loss was significantly associated with the incidence of SSI (respectively OR 2.66 (95% CI: 1.59, 4.45) and OR 2.15 (95% CI: 1.23, 3.76)). In conclusion, we demonstrate SSI to occur more often among patients at nutritional risk as compared to those who are not at nutritional risk. Future studies should investigate interventions to prevent both SSI and nutritional risk among surgical patients.

[Effects of public initiatives aimed at reducing neural tube defects with folic acid supplementation]. / Effekt av offentlige tiltak for å forebygge nevralrørsdefekter med folat.

BACKGROUND: In order to prevent neural tube defects, a daily supplement of 400 microg (microgram) folic acid has been recommended in Norway since 1998, during the last month before conception and the first two or three months of pregnancy. Compliance with and effects of this recommendation has recently been evaluated in Norway in a report to the Directorate of Health and Social Welfare. MATERIAL AND METHODS: Reports published on periconceptional folic acid intake in Norway and some other countries from 1998 to autumn 2003 have been evaluated. RESULTS: In spite of several information activities, few Norwegian women start folic acid supplementation before verified pregnancy. The supplementation is started too late for the prevention of neural tube defects. A reduction is not observed in Norway. Internationally, information has not proven effective either, whereas compulsory fortification of foods with folic acid has been associated with reduced incidence. Information about periconceptional folic acid intake should be intensified. Compulsory fortification of foods with folic acid will affect the whole population, not only the target group of fertile women. If ongoing large intervention studies show improved clinical prognosis for patients with cardiovascular disease, this will be an additional argument for fortification of foods.

[Does folic acid have effects on other health problems than neural tube defects?]. / Effekt av folat på andre helseproblemer enn nevralrørsdefekter?

BACKGROUND: While it is widely accepted that periconceptional supplement of 400 microg (microgram) folic acid reduces the risk of neural tube defects in pregnancy, it remains to be established whether folic acid has other beneficial effects on larger population groups. Evidence concerning effect of increased intake on cardiovascular disease, cancer and other diseases has recently been evaluated in a report to the Directorate of Health and Social Welfare in Norway. MATERIAL AND METHODS: Research reports published mainly from 1998 to 2003 on folic acid intake and disease have been evaluated. RESULTS: Sufficient evidence that increased folic acid intake may prevent cancer or cardiovascular diseases is not yet available, hence at present there is no indication for recommending augmented intake for other groups than fertile women. However, several intervention studies with folic acid supplementation are in progress to establish its effect on cardiovascular mortality and morbidity. INTERPRETATION: If the ongoing intervention studies show a beneficial clinical effect on cardiovascular disease, it would be a further argument for fortification of foods, in addition to reducing the risk of neural tube defects in pregnancy.