Registered Dietitian II Lehigh Valley Health Network Emmaus, Pennsylvania
Define the importance of the nutrition focused physical examination in malnutrition assessment and the goal to maximize each indicator during assessment.
Background: The Academy of Nutrition and Dietetics (AND) and American Society for Parenteral and Enteral Nutrition (ASPEN) published guidelines are widely utilized for protein-energy malnutrition (PEM) identification but with only needing two indicators for a positive diagnosis, the nutrition focused physical examination (NFPE) may not only be underutilized but cause a discrepancy in PEM identification. Alternatives for muscle functionality testing are worthy of exploration as handgrip strength (HGS) is not always feasible.
Methods: Participants with PEM (n=61) admitted to a Pennsylvania teaching hospital were assessed using AND/ASPEN guidelines by two registered dietitian nutritionists (RDNs) on separate visits to determine assessment agreement. Handgrip strength and respiratory muscle strength (maximum inspiratory pressure (MIP)) were also assessed with each participant. A non-PEM control group (n=30) was assessed using the same measures by the primary investigator (PI).
Results: PEM diagnosis severity increased in 45.9% of participants with the NFPE compared to using only energy intake and weight loss, with 65.5% agreement between the two RDN assessments. Nutrition focused physical examination took 5 minutes or less in 59% of PI assessments. HGS was confirmed to be a significant measure of muscle functionality loss for PEM with positive correlational relationships compared to PEM severity, weight loss, muscle mass loss, age and MIP. MIP was also found significant in relation to PEM severity and severity of muscle loss.
Conclusion: Maximizing the use of each PEM identifier would provide an in-depth clinical picture in order to properly identify PEM and lead to increased revenue generation in facilities.