"nutritionDay worldwide" is a large scale, worldwide action

project A project is any undertaking, carried out individually or collaboratively and possibly involving research or design, that is carefully planned to achieve a particular goal. An alternative view sees a project managerially as a sequence of even ...

designed to reduce disease-related

malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...

among hospitalised patients and

nursing home A nursing home is a facility for the residential care of elderly or disabled people. Nursing homes may also be referred to as skilled nursing facility (SNF) or long-term care facilities. Often, these terms have slightly different meanings to in ...

residents. The aim of this project is to increase awareness and knowledge regarding disease-related malnutrition in hospitalised

patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health c ...

s and the

elderly Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...

Background

In 1977 poor nutritional status and malnutrition was already detected in surgical patients. Still, disease-related malnutrition is a much underrated

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

issue Issue or issues may refer to: Publishing * ''Issue'' (company), a mobile publishing company * ''Issue'' (magazine), a monthly Korean comics anthology magazine * Issue (postal service), a stamp or a series of stamps released to the public * '' ...

and has also become an enormous economical concern.Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27:5-15. It is estimated that over 50 million

Europe Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...

ans are at risk. A

study Study or studies may refer to: General * Education **Higher education * Clinical trial * Experiment * Observational study * Research * Study skills, abilities and approaches applied to learning Other * Study (art), a drawing or series of drawi ...

performed in the UK in 2005 estimated the cost of malnutrition to the UK to be €10.6 b per year, double the projected €5.1 b cost of

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

. Two

population Population typically refers to the number of people in a single area, whether it be a city or town, region, country, continent, or the world. Governments typically quantify the size of the resident population within their jurisdiction using a ...

groups A group is a number of persons or things that are located, gathered, or classed together. Groups of people * Cultural group, a group whose members share the same cultural identity * Ethnic group, a group whose members share the same ethnic iden ...

are at particularly high risk: hospitalized patients and residents of

nursing homes A nursing home is a facility for the residential care of elderly or disabled people. Nursing homes may also be referred to as skilled nursing facility (SNF) or long-term care facilities. Often, these terms have slightly different meanings to in ...

. Disease-related malnutrition can be responsible for a prolonged hospital stay,

morbidity A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

and premature

mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...

in hospitalized patients.

Research Research is "creativity, creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, characterized by a particular att ...

has shown that approximately 31% of all hospitalized patients can be considered malnourished or at nutritional risk. Previous nutritionDay studies have shown that malnutrition is a major health concern that still gets too little attention in hospitals and nursing homes. Malnutrition, as it has been shown in many studies, increases infection rates, affects the patient’s wound healing, leads to cardiac complications, and also prolongs hospital stay.Valentini L, Schindler K, Schlaffer R, et al., The first nutritionDay in nursing homes: Participation may improve malnutrition awareness. Clin. Nutr. 2009; 28(2):109-116.Schindler K, Pernicka E, Laviano A, et al., How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patients findings from the 2007-2008 cross-sectional nutritionDay survey. Clin. Nutr. 2010; 29(5):552-559.

Obesity and Disease related Malnutrition

Generally

health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...

focuses mainly on the increasing incidence of obesity. Initially health providers believed only patients with low

body weight Human body weight is a person's mass or weight. Strictly speaking, body weight is the measurement of weight without items located on the person. Practically though, body weight may be measured with clothes on, but without shoes or heavy accessor ...

or low

body mass index Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...

(BMI < 18.5 kg/m2) could be

malnourished Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...

. However, studies show that BMI is not always a good parameter to detect malnutrition, and other screening tools should be used. Analysis shows that a high percentage of body fat reduces the sensitivity of BMI to detect nutritional depletion.

Disease related Malnutrition in Hospitals

Internationally, the issue of disease-related malnutrition was raised in various forums, most clearly in the adoption of a resolution by the

Council of Europe The Council of Europe (CoE; french: Conseil de l'Europe, ) is an international organisation founded in the wake of World War II to uphold European Convention on Human Rights, human rights, democracy and the Law in Europe, rule of law in Europe. ...

Resolution ResAP (2003)3
on Food and Nutritional Care in Hospitals of the

Committee of Ministers of the Council of Europe The Committee of Ministers of the Council of Europe ( French: ''Comité des ministres du Conseil de l'Europe'') or Committee of Ministers ( French: ''Comité des ministres'') is the Council of Europe's decision-making body. It comprises the Forei ...

emphasizes inter alia the unacceptable number of undernourished people in hospitals and the beneficial effects of adequate food service and nutritional care in hospitals on patients’

recovery Recovery or Recover may refer to: Arts and entertainment Books * ''Recovery'' (novel), a Star Wars e-book * Recovery Version, a translation of the Bible with footnotes published by Living Stream Ministry Film and television * ''Recovery'' (fil ...

and

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

. The resolution identifies a long list of actions to be undertaken to remedy the situation.

nutritionDay worldwide – The Project

The project “nutritionDay worldwide” addresses improved

patient safety Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of a ...

and quality of care by raising awareness and increasing knowledge about disease-related malnutrition. NutritionDay establishes a worldwide chart in which nutritional status and prevalence of malnutrition are portrayed. Further, it documents relevant nutritional infrastructures in hospitals and nursing homes. The aim of the project is to emphasize the importance of adequate clinical nutrition in both settings. In January 2006 the project was conducted for the first time under the direction of Univ. Prof. Dr. Michael Hiesmayr (

Medical University of Vienna The Medical University of Vienna (German: ''Medizinische Universität Wien'') is a public university located in Vienna, Austria. It is the direct successor to the faculty of medicine at the University of Vienna, founded in 1365 by Rudolf IV, Duk ...

) with support of the Austrian Society of Clinical Nutrition (AKE) and the European Society for Clinical Nutrition and

Metabolism Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...

(

ESPEN Espen is a Norwegian masculine given name. In Norway it reached the peak of its popularity between 1970 and 1990, during which period approximately 1.1% of children were given that name. Origin and variants It originated as a variant of Asbjørn or ...

). A subsequent audit took place in January 2007 when the project was extended to

intensive care units 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensiv ...

and

. Since then, nutritionDay is performed in all 3 settings. In 2012 “oncology nutritionDay” was performed as the first disease-specific nutritionDay. The audit is unit and patient-centered. Information about the actual nutrition care and nutrition monitoring on participating wards is gathered using four

questionnaire A questionnaire is a research Research is "creativity, creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, ...

s. This happens on one single day worldwide. The hospital ward as an organisational unit is of particular interest. The ward, with all its specific characteristics and local culture, is the direct centre of care for a group of patients within the hospital. The direct

interview An interview is a structured conversation where one participant asks questions, and the other provides answers.Merriam Webster DictionaryInterview Dictionary definition, Retrieved February 16, 2016 In common parlance, the word "interview" ...

of patients is a characteristic specific to “nutritionDay project”. Patients are surveyed about their eating habits on the day (“how much of your meal did you eat?”) and about the reasons for not eating.

Transnational multilingual Approach

Hospital wards and nursing homes from 51 countries have already participated in nutritionDay. In January 2013, the nutritionDay database counts more than 132.000 datasets from patients and nursing home residents. The questionnaires are available in over 30 languages. This enables the project to include

minority group The term 'minority group' has different usages depending on the context. According to its common usage, a minority group can simply be understood in terms of demographic sizes within a population: i.e. a group in society with the least number o ...

s of patients (e.g.

immigrant Immigration is the international movement of people to a destination country of which they are not natives or where they do not possess citizenship in order to settle as permanent residents or naturalized citizens. Commuters, tourists, and ...

s, non-native speakers).

Performance of the nutritionDay audit

On one specific day in November, the “nutritionDay” takes place every year. On this day, participating hospital wards and nursing homes collect data on the nutritional status of their patients and residents and record supply structures relevant for nutritional care. Thus, participants receive an actual snapshot of their hospital unit or nursing home. After a specified period of time, a follow-up

evaluation Evaluation is a systematic determination and assessment of a subject's merit, worth and significance, using criteria governed by a set of standards. It can assist an organization, program, design, project or any other intervention or initiative ...

is performed which gives information on the patients’ outcome. After data collection, the hospital staff transfers the data into a database that is accessible over the website http://www.nutritionday.org. An individual code guarantees

anonymity Anonymity describes situations where the acting person's identity is unknown. Some writers have argued that namelessness, though technically correct, does not capture what is more centrally at stake in contexts of anonymity. The important idea he ...

of participants. Each unit receives feedback about its position compared to all other participating units of the same specialty type. Repeated participation in the audit allows

benchmarking Benchmarking is the practice of comparing business processes and performance metrics to industry bests and best practices from other companies. Dimensions typically measured are quality, time and cost. Benchmarking is used to measure performan ...

designed to enhance learning within units and to track changes in local practice and international trends.

nutritionDay questionnaires

Based on four to five

s, information of the participating hospital units or nursing home and their patients and residents is collected. Of particular interest are the unit organisation and structure, health status and nutritional care of the patients, weight monitoring, and food intake. The unit acts as direct care unit of a group of patients with all its specific characteristics, its occupational group, its patient’s population, and the local culture is from special interest. A characteristic of the project is the direct

interrogation Interrogation (also called questioning) is interviewing as commonly employed by law enforcement officers, military personnel, intelligence agencies, organized crime syndicates, and terrorist organizations with the goal of eliciting useful informa ...

of the patient about their nutritional behaviour on nutritionDay and if there were reasons for not eating.

nutritionDay Oncology

Nutritional treatment plays an important role for patients who suffer from cancer. In studies it has been shown that weight stable cancer patients have a better prognosis than cancer patients with weight loss: in concrete, a lower number of treatment-related adverse reactions in weight stable patients is reported, the response to cancer treatment is increased, the patient reports a higher activity level and a better subjective quality of life. Moreover, the actual survival rate of weight stable patients is higher compared to patients with weight loss. The importance of nutritional treatment of cancer patients was reason to appoint „nutritionDay oncology“ the first disease-specific focus of the nutritionDay audit for the years 2012 and 2013. The project „nutritionDay oncology“, comprises three additional questionnaires which collect nutritional data of patients who suffer from cancer. Data obtained from „nutritionDay oncology“ will be incorporated into the new

(European Society for Clinical nutrition and Metabolism)

guidelines A guideline is a statement by which to determine a course of action. A guideline aims to streamline particular processes according to a set routine or sound practice. Guidelines may be issued by and used by any organization (governmental or pri ...

and thus increase their practical worth.

nutritionDay Objectives

The overall objective of the nutritionDay project is to promote safe nutritional care worldwide by increasing knowledge, awareness, and nutrition monitoring and to bring attention to the importance of nutritional care for the patient’s recovery. Further nutritionDay shall raise

awareness Awareness is the state of being conscious of something. More specifically, it is the ability to directly know and perceive, to feel, or to be cognizant of events. Another definition describes it as a state wherein a subject is aware of some inform ...

of the interaction between food intake and recovery.

Target group A target audience is the intended audience or readership of a publication, advertisement, or other message catered specifically to said intended audience. In marketing and advertising, it is a particular group of consumer within the predetermined ...

s are

health care professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (su ...

s as well as patients, their

relatives Relatives can refer to: * Kinship * ''Relatives'' (1985 film), a 1985 Australian movie * ''Relatives'' (2006 film), a 2006 Hungarian movie * "Relatives", a song by Irving Berlin Irving Berlin (born Israel Beilin; yi, ישראל ביילין ...

and political and economical stakeholders. *Gathering knowledge about inadequate food intake in the three settings hospitals, nursing homes, and intensive care units in relation to

risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often use ...

s, medical specialty type, organizational units, and countries. *Decrease human suffering and reduce community costs. *Initiate research for “eating despite illness” and the ideal utilization of

clinical nutrition Clinical nutrition centers on the prevention, diagnosis, and management of nutritional changes in patients linked to chronic diseases and conditions primarily in health care. Clinical in this sense refers to the management of patients, including no ...

Benefits for health facilities

*Participating units receive a unit report with an international benchmark which allows a comparison between similar units worldwide. On basis of the received data, actions and consequences can be derived individually. *Repeated participation enables a continuous quality improvement process by pursuing targeted actions. *The participation in the project „nutritionDay“ facilitates a good food supply in your hospital or nursing home and increases the attention for the topic around nutrition and malnutrition. *A repeated participation documents a development of the nutritional situation over years and provides an anonymous international comparison within your specialty.

nutritionDay findings

The nutritionDay study is conducted to determine the effects of nutritional factors on the outcomes of hospitalized patients and nursing homes. 3 papers were published in the years 2009 and 2010 in this concern. An analysis of the data of the nutritionDay audit 2006 performed by Hiesmayr et al. (2009) revealed that less than half of all patients in European hospitals included in the audit eat less than provided as regular meal. Further, an association of reduced food intake with an increased risk of mortality in patients after 30 days was found. Reduced food intake can therefore be seen as a risk factor for hospital mortality.Hiesmayr M, Schindler K, Pernicka E, et al., Decreased food intake is a risk factor for mortality in hospitalised patients: The NutritionDay survey 2006. Clin. Nutr. 2009; 28(5):484-491. In 2009, Valentini et al. analyzed the data of the nutritionDay in nursing homes in 2007 and described the effects of 'nD' of first time participants. Therein outcome results indicated that nutritionDay participation induces behavioural changes such as awareness in malnutrition. Schindler et Al conducted a study based on the data of the nutritionDay audit of the years 2007 and 2008. Core findings of this study on “how nutritional risk is assessed and managed in European hospitals” indicate that still an inconsistent way of assessing nutritional risk in patients in different units and countries exists and that frequently energy goals of patients are not met.

References

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External links

* http://www.nutritionday.org * http://www.ake-nutrition.at * http://www.espen.org * http://www.meduniwien.ac.at * http://www.bapen.org.uk * http://www.dgem.de * http://www.geskes.ch * http://www.grespen.org * http://www.polspen.pl * http://www.sbnpe.com * http://www.senpe.com Malnutrition Health awareness days