Effect of nutrition care process-based nutrition intervention on improvement of intake in the elderly in-patients with malnutrition

Ji-Hyun Park; Min-Ji Kang; Jung-Sook Seo

doi:10.4163/jnh.2018.51.4.307

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Park, Kang, and Seo: Effect of nutrition care process-based nutrition intervention on improvement of intake in the elderly in-patients with malnutrition

Research Article

J Nutr Health 2018;51(4):307-315.

Published online: 20 January 2018

DOI: https://doi.org/10.4163/jnh.2018.51.4.307

Effect of nutrition care process-based nutrition intervention on improvement of intake in the elderly in-patients with malnutrition

Ji-Hyun Park¹, Min-Ji Kang², Jung-Sook Seo^†

¹Dietary Team, Daegu Fatima Hospital, Daegu 41199, Korea

²Department of Food and Nutrition, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea

^† To whom correspondence should be addressed. tel: +82-53-810-2875, E-mail: jsseo@ynu.ac.kr

Received 5 June 2018 Revised 26 June 2018 Accepted 23 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated the effects of personalized nutrition intervention for increasing hospital meal intake by elderly patients with malnutrition. Methods: The subjects were 30 elderly patients with malnutrition who visited a general hospital located in Daegu. An individual nutrition intervention such as change of meal types or special meal service was given to the patients according to nutrition diagnosis related to inadequate intake of hospital meals. Nutritional intake status of the subjects was assessed by analyzing energy intake, protein intake, index of nutritional quality (INQ), nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR). Results: The causes of inadequate intake in the subjects were poor appetite or preference problems (46.7%), symptom-related problems (30.0%) and mastication problems (23.3%). The INQ of protein in the subjects was significantly increased from 0.81 ± 0.17 to 1.41 ± 0.25 after the nutrition intervention (p<0.05). The NAR of protein (before 0.50 ± 0.21, after 0.58 ± 0.17), iron (before 0.72 ± 0.30, after 0.84 ± 0.29) and vitamin B₂ (before 0.31 ± 0.16, after 0.37 ± 0.14) was also increased after the nutrition intervention (p<0.05). The MAR of five nutrients, protein, calcium, iron, vitamin A and vitamin B_2, was significantly increased by the nutrition intervention (p<0.05). Conclusion: Personalized nutrition intervention according to nutrition diagnosis related to inadequate intake of hospital meals may improve the intake amount of elderly patients with malnutrition.

Keywords: malnutrition, elderly patient, nutrition intervention, hospital foodservice

References

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Table 1.

Nutrition intervention method according to nutrition diagnosis

Problem (P)	Etiology (E)	Signs/Symptoms (S)	Nutrition intervention	n (%)
Functional changes of	Mastication problem	Low intake amount	Type change of diet	7 (23.3)
digestive system			(chop, grind)
Insufficient oral food/	Poor appetite	Low intake amount	Special porridge/special meal	11 (36.7)
drink intake	Personal preference	Low intake amount	Preference reflection	3 (10.0)
Insufficient energy intake	Oral soreness	Digestive organ symptoms	Limitation of spicy food	3 (10.0)
	Dysphagia, indigestion	Meal time delay, low intake	Change of diet	1 (3.3)
	Adverse effects	Gastrointestinal symptoms	Nutrition education	5 (16.7)
	(diarrhea, nausea)		(diarrhea, nausea)

Table 2.

General characteristics of the subjects

Variable	Classification
Sex	Male	18 (60.0)¹⁾
Age (years)	Female	12 (40.0)
Age (years)	65 ∼ 69	3 (10.0)
Length of stay (days)	70 ∼ 79	15 (50.0)
	≥ 80	12 (40.0)
	< 10	5 (16.7)
	10 ∼ 19	17 (56.7)
	20 ∼ 29	3 (10.0)
	≥ 30	5 (16.7)
Physical activity	Normal	15 (50.0)
	Moderate	5 (16.7)
	Rare	10 (33.3)
Height (cm)	Male	165.3 ± 6.7²⁾
Height (cm)	Female	152.0 ± 5.9
Weight (kg)	Male	51.2 ± 11.5
Weight (kg)	Female	53.9 ± 11.2
BMI (kg/m²)	Underweight	13 (43.3)
	Normal	10 (33.3)
	Overweight/Obese	7 (23.3)

¹⁾ n (%) 2) mean ± SD

Table 3.

Clinical characteristics of the subjects

Variable	Classification	n (%)
Malnutrition diagnosis	Kwasioker	15 (50.0)
Diagnosis	Marasmus	9 (30.0)
	Mild malnutrition	6 (20.0)
	Lung disease	8 (26.7)
	Cancer disease	5 (16.7)
	Infectious disease	5 (16.7)
	Bone disease	5 (16.7)
	Others¹⁾	7 (23.3)
Chronic complications (n)	0	13 (43.3)
	1	4 (13.3)
	2	6 (20.0)
	≥ 3	7 (23.3)
Digestive symptoms	Yes	15 (50.0)
Digestive symptoms	No	15 (50.0)

¹⁾ Others include liver, stomach and brain diseases.

Table 4.

Nutrition screening characteristics according to body mass index of the subjects

Variable	Total (n = 30)	Underweight (n = 13)	Normal (n = 10)	Overweight/Obese (n = 7)	p-value¹⁾
PIBW³⁾ (%)	92.6± 18.4²⁾	76.3± 8.6^a	95.9± 5.1^b	118.0± 10.4^C	< 0.001^∗∗∗
ALB⁴⁾ (g/dL)	3.0± 0.7	3.5± 0.7^b	2.7± 0.6^a	2.6± 0.3^a	0.001^∗∗
TLC⁵⁾ (cells/mm³)	1,404.7± 833.8	1,387.3± 526.8	1,433.6± 946.5	1,395.7± 1,208.1	0.991
Hb⁶⁾ (g/dL)	10.4± 1.5	11.0± 1.5^b	9.4± 1.2^a	11.0± 1.5^b	0.018^∗
1) By ANOVA-test 2) mean ± SD 3) PIBW; percent of ideal body weight 4) ALB; albumin 5) TLC; total lymphocyte count 6) Hb;

hemoglobin

^a,b,c By Duncan's multiple range test

^∗ p < 0.05,

^∗∗ p < 0.01,

^∗∗∗ p < 0.001

Table 5.

Diet-related characteristics of the subjects

Variable	Classification	n (%)
Dietary prescription	Porridge	12 (40.0)
Dietary prescription	General diet	18 (60.0)
Eating ability	By oneself	26 (86.7)
Eating ability	By helper	4 (13.3)
Cognition degree of hospital meal intake	Ample	3 (10.0)
	Normal	11 (36.7)
	Poor	16 (53.3)
Cause of inadequate hospital meal intake	Mastication problem	7 (23.3)
	Poor appetite	11 (36.7)
	Preference	3 (10.0)
	Digestive symptoms	9 (30.0)
Nutritional supplements intake	Yes	1 (3.3)
No		29 (96.7)

Table 6.

Energy/Protein n intake befo ore and after nut rition intervention according to nutrition d diagnosis

Variable	Energy (kcal)			p-value¹⁾	Protein (g)			p-value
Variable	n (%)	Before	After	p-value¹⁾	n (%)	Before	After	p-value
Mastication problem	7 (23.3)	621.1 ± 27.0²⁾	664.5 ± 200.1	0.560	7 (23.3)	19.6 ± 10.9	25.2 ± 7.4	0.015^∗
Poor appetite/	14 (46.7)	701.9 ± 241.3	780.7 ± 223.7	0.030^∗	14 (46.7)	25.6 ± 9.2	28.9 ± 8.7	0.009^∗∗
Preference
Digestive symptoms³⁾	9 (30.0)	765.9 ± 325.4	819.7 ± 215.6	0.329	9 (30.0)	25.3 ± 11.7	28.9 ± 10.0	0.282
Total	30 (100.0)	702.3 ± 283.3	765.3 ± 216.8	0.023^∗	30 (100.0)	24.1 ± 10.3	28.0 ± 8.7	0.001^∗∗

¹⁾ By paired t-test 2) mean ± SD 3) Digestive symptoms include oral soreness, dysphagia, indigestion, diarrhea and nausea.

^∗ p < 0.05,

^∗∗ p < 0.01

Table 7.

Assessment of nutrients intake before and after nutrition intervention

Variable	Nutrient	Before	After	p-value¹⁾
Intake (%)	Energy	42.26 ± 16.26²⁾	46.28 ± 12.93	0.015^∗
INQ³⁾	Protein	36.29 ± 15.52	42.45 ± 13.59	0.001^∗∗
	Protein	0.81 ± 0.17	1.41 ± 0.25	< 0.001^∗∗∗
	Calcium	0.65 ± 0.32	0.60 ± 0.23	0.356
	Iron	1.89 ± 0.43	2.02 ± 0.47	0.089
	Vitamin A	1.07 ± 0.63	1.20 ± 0.64	0.311
	Vitamin B₂	0.81 ± 0.31	0.89 ± 0.25	0.217
NAR⁴⁾	Protein	0.50 ± 0.21	0.58 ± 0.17	0.001^∗∗
	Calcium	0.24 ± 0.14	0.24 ± 0.11	0.962
	Iron	0.72 ± 0.30	0.84 ± 0.29	0.003^∗∗
	Vitamin A	0.44 ± 0.33	0.50 ± 0.30	0.197
	Vitamin B₂	0.31 ± 0.16	0.37 ± 0.14	0.008^∗∗
MAR⁵⁾		0.45 ± 0.20	0.51 ± 0.17	0.002^∗∗

¹⁾ By paired t-test 2) mean ± SD 3) INQ; index of nutritional quality 4) NAR; nutrient adequacy ratio 5) MAR; mean adequacy ratio

^∗ p < 0.05,

^∗∗ p < 0.01

^∗∗∗ p < 0.001

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