Effectiveness of nutritional intervention led by clinical dietitian in patients at risk of malnutrition at the primary healthcare level in Slovenia - evaluation study

Mlakar-Mastnak, Denis (author), Kovač-Blaž, Milena (author), Terčelj, Mila (author), Uhan, Samo (author), Majdič, Neža (author), Rotovnik-Kozjek, Nada (author)

Introduction: Clinical dietitians play a crucial role in the nutritional support of patients at risk of malnutrition in primary care settings. The study aimed to evaluate the effect of an individualized nutritional intervention on clinically relevant outcomes for patients with chronic disease at nutritional risk. Methods: A longitudinal evaluation study was conducted in two Slovenian primary health centres. We used pre-test and post-test design. Patients with chronic disease were screened using the Malnutrition Universal Screening Tool and additional risk factors (≥70 years and BMI <22 kg/m²; lower food intake in the last five days). Patients at nutritional risk were referred to a clinical dietitian for individual nutritional intervention. The effect of the nutritional intervention was assessed six months after the patients’ first visit with a clinical dietitian. Results: The sample included 94 patients. Nutritional risk was reduced significantly in high-risk and moderate- risk patients. In a subgroup of patients with a MUST score ≥1 (77 patients), body weight, BMI, Fat-Free Mass Index (FFMI), energy intake, and protein intake increased significantly (p<0.001). At the same time, the phase angle significantly increased (p<0.001), but there were no statistically significant changes in the improvement of grip strength. In a subgroup of patients with MUST score 0 (17 patients), we observed an increase in their median daily energy intake (p<0.001) and median protein intake (p=0.003). Conclusion: Nutritional intervention delivered by a clinical dietitian improved patients’ nutritional intake and nutritional and functional status.

• Language: English
• Keywords: nutritional screening, nutritional assessment, chronic diseases, nutritional care, primary care, anthropometric measurements, clinical dietitians
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: FDV - Faculty of Social Sciences; MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2024
• Number of pages: Str. 81-88
• Numbering: Letn. 63, št. 2
• PID: 20.500.12556/RUL-165966
• UDC: 614
• ISSN on article: 0351-0026
• DOI: 10.2478/sjph-2024-0012
• COBISS.SI-ID: 190730499
• Publication date in RUL: 16.12.2024

Record is a part of a journal

• Title: Zdravstveno varstvo
• Publisher: Zavod LRS za zdravstveno varstvo, Republiški zdravstveni center, Zavod LRS za zdravstveno varstvo, Republiški zdravstveni center, Univerzitetni zavod za zdravstveno in socialno varstvo, Inštitut za varovanje zdravja Republike Slovenije, Nacionalni inštitut za javno zdravje
• ISSN: 0351-0026
• COBISS.SI-ID: 3287810

Licences

• License: CC BY-NC-ND 3.0, Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported
• Link: http://creativecommons.org/licenses/by-nc-nd/3.0/
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Secondary language

• Language: Slovenian
• Title: Učinkovitost prehranskih ukrepov kliničnega dietetika v obravnavi prehransko ogroženih pacientov na primarni ravni zdravstvenega varstva v Sloveniji – evalvacijska raziskava

Abstract

Namen: Preveriti učinkovitost individualnih prehranskih ukrepov, ki jih v obravnavi prehransko ogroženih pacientov s kronično boleznijo, načrtuje in izvaja klinični dietetik ter se odražajo v spremembah prehranskega in funkcionalnega stanja pacientov. Metode: Longitudinalno evalvacijsko raziskavo smo med majem 2020 in novembrom 2022 izvedli v dveh večjih slovenskih zdravstvenih domovih. Prehransko presejanje smo izvedli z uporabo univerzalnega orodja za prehransko presejanje Malnutrition Universal Screening Toll (MUST) in dodatnimi dejavniki tveganja (≥ 70 let in ITM < 22 kg/m²; manjši vnos hrane v zadnjih petih dneh). Prehransko ogrožene paciente smo napotili h kliničnemu dietetiku na individualno prehransko obravnavo. Skupino pacientov smo spremljali v dveh različnih časovnih točkah, uporabili smo dizajn pred postopkom/po postopku. Rezultate smo analizirali po šestih mesecih. Rezultati: V vzorec smo vključili 94 bolnikov. Prehranska ogroženost se je pri pacientih z visokim in zmernim tveganjem po šestih mesecih znatno zmanjšala. V podskupini pacientov z oceno MUST ≥ 1 (77 pacientov) so se telesna masa, indeks telesne mase, indeks puste mase, količina zaužite energije in količina zaužitih beljakovin znatno povečali (p < 0,001). Medtem ko se je fazni kot pomembno povečal (p < 0,001), je moč prijema ostala relativno stabilna. V podskupini pacientov z oceno MUST = 0 (17 bolnikov), smo po šestih mesecih opazili porast povprečne količine zaužite energije (p < 0,001) in povprečno količino zaužitih beljakovin (p = 0,003). Zaključki: Rezultati raziskave so dokazali, da lahko z individualno naravnavami prehranskimi ukrepi, ki jih izvaja klinični dietetik, pri prehransko ogroženih pacientih s kronično boleznijo pomembno izboljšamo prehransko in funkcionalno stanje ter zmanjšamo njihovo prehransko ogroženost.

• Keywords: prehransko presejanje, prehranski pregled, kronične bolezni, prehranska obravnava, primarno zdravstvo, antropometrične meritve, klinični dietetiki