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Nutrition Screening and Assessment in Hip Fracture

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Handbook of Famine, Starvation, and Nutrient Deprivation

Abstract

Protein-energy malnutrition is prevalent in one in two patients admitted with a hip fracture; commonly observed inadequate postoperative protein/energy intake leads to further incident inpatient malnutrition. This condition is reported as the most costly comorbidity in hip fracture. The complex, multimorbid population limits the usefulness of routinely applied malnutrition screening tools. Given the high cost, prevalence, and incidence of malnutrition, and poor sensitivity of most screening tools, routine comprehensive nutrition assessment of all acute hip fracture inpatients is recommended. There is no gold standard for malnutrition diagnosis in the clinical setting in hip fracture. Malnutrition diagnosis is complex in this patient population, and often requires triangulation of multiple nutrition assessment measures from a variety of sources over multiple time periods. Single variable measures should not be relied upon to diagnose malnutrition, and commonly applied index measures may still require a subjective clinical judgment to inform a final diagnosis.

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References

  • Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering Group (Producer) (2014), Australian and New Zealand guideline for hip fracture care (20 November, 2014). Retrieved from http://www.anzhfr.org/images/resources/Guidelines/ANZ%20Guideline%20for%20Hip%20Fracture%20Care.pdf

  • Auyeung TW, Lee JS, Kwok T, Leung J, Leung PC, Woo J (2009) Estimation of stature by measuring fibula and ulna bone length in 2443 older adults. J Nutr Health Aging 13(10):931–936

    Article  CAS  Google Scholar 

  • Avenell A, Smith TO, Curtain JP, Mak JC, Myint PK (2016) Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev, 11, CD001880. https://doi.org/10.1002/14651858.CD001880.pub6

  • Bell JJ (2014) Identifying and overcoming barriers to nutrition care in acute hip fracture inpatients. PhD thesis, The University of Queensland

    Google Scholar 

  • Bell JJ, Bauer JD, Capra S (2013a) The Malnutrition Screening Tool versus objective measures to detect malnutrition in hip fracture. J Hum Nutr Diet 26(6):519–526

    Article  CAS  Google Scholar 

  • Bell JJ, Bauer JD, Capra S, Pulle CR (2013b) Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine? Can J Physiol Pharmacol 91(6):489–495

    Article  CAS  Google Scholar 

  • Bell JJ, Bauer JD, Capra S, Pulle RC (2014a) Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: a diagnostic accuracy study. Eur J Clin Nutr 68(3):358–362

    Article  CAS  Google Scholar 

  • Bell JJ, Bauer JD, Capra S, Pulle RC (2014b) Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients – results of a pragmatic intervention. Clin Nutr 33(6):1101–1107

    Article  Google Scholar 

  • Bell JJ, Bauer JD, Capra S, Pulle RC (2014c) Quick and easy is not without cost: implications of poorly performing nutrition screening tools in hip fracture. J Am Geriatr Soc 62(2):237–243

    Article  Google Scholar 

  • Bell JJ, Pulle RC, Crouch AM, Kuys SS, Ferrier RL, Whitehouse SL (2016) Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg 86(3):157–161

    Article  Google Scholar 

  • Bishop CW, Bowen PE, Ritchey SJ (1981) Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr 34(11):2530–2539

    Article  CAS  Google Scholar 

  • Blackburn GL, Bistrian BR, Maini BS, Schlamm HT, Smith MF (1977) Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral Nutr 1(1):11–22

    Article  CAS  Google Scholar 

  • Bouillanne O, Hay P, Liabaud B, Duche C, Cynober L, Aussel C (2011) Evidence that albumin is not a suitable marker of body composition-related nutritional status in elderly patients. Nutrition 27(2):165–169

    Article  CAS  Google Scholar 

  • Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF (1980) Prognostic nutritional index in gastrointestinal surgery. Am J Surg 139(1):160–167

    Article  CAS  Google Scholar 

  • Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, Compher C, Correia I, Higashiguchi T, Holst M, Jensen GL, Malone A, Muscaritoli M, Nyulasi I, Pirlich M, Rothenberg E, Schindler K, Schneider SM, de van der Schueren MA, Sieber C, Valentini L, Yu JC, Van Gossum A, Singer P (2017) ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 36(1):49–64

    Article  CAS  Google Scholar 

  • Chevalley T, Hoffmeyer P, Bonjour J-P, Rizzoli R (2010) Early serum IGF-I response to oral protein supplements in elderly women with a recent hip fracture. Clin Nutr 29(1):78–83

    Article  CAS  Google Scholar 

  • Choi BC, Pak AW (2007) Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education and policy: 2. Promotors, barriers, and strategies of enhancement. Clin Invest Med 30(6):E224–E232

    Article  Google Scholar 

  • Correia MI, Waitzberg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22(3):235–239

    Article  Google Scholar 

  • Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA et al (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11(1):8–13

    Article  CAS  Google Scholar 

  • Dietitian/Nutritionists from the Nutrition Education Materials Online team (2014) Estimating energy, protein & fluid requirements for adult clinical conditions. Retrieved 1 June 2015, from http://www.health.qld.gov.au/nutrition/resources/est_rqts.pdf

  • Duncan DG, Beck SJ, Hood K, Johansen A (2006) Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward. Age Ageing 35(2):148–153

    Article  Google Scholar 

  • Elia M (2003) Screening for malnutrition: a multidisciplinary responsibility. development and use of the malnutrition universal screening tool (MUST) for adults. BAPEN, Redditch

    Google Scholar 

  • Elia M, Stratton RJ (2011) Considerations for screening tool selection and role of predictive and concurrent validity. Curr Opin Clin Nutr Metab Care 14(5):425–433

    Article  Google Scholar 

  • Eneroth M, Olsson U-B, Thorngren K-G (2005) Insufficient fluid and energy intake in hospitalised patients with hip fracture. A prospective randomised study of 80 patients. Clin Nutr 24(2):297–303

    Article  Google Scholar 

  • Eneroth M, Olsson U-B, Thorngren K-G (2006) Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res 451:212–217

    Article  Google Scholar 

  • Ferguson M, Capra S, Bauer J, Banks M (1999) Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 15(6):458–464

    Article  CAS  Google Scholar 

  • Formiga F, Chivite D, Mascaro J, Ramon JM, Pujol R (2005) No correlation between mini-nutritional assessment (short form) scale and clinical outcomes in 73 elderly patients admitted for hip fracture. Aging-Clin Exper Res 17(4):343–346

    Article  Google Scholar 

  • Foster MR, Heppenstall RB, Friedenberg ZB, Hozack WJ (1990) A prospective assessment of nutritional status and complications in patients with fractures of the hip. J Orthop Trauma 4(1):49–57

    Article  CAS  Google Scholar 

  • Goisser S, Schrader E, Singler K, Bertsch T, Gefeller O, Biber R, Bail HJ, Sieber CC, Volkert D (2015) Malnutrition according to Mini Nutritional Assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture. J Am Med Dir Assoc 16(8):661–667

    Article  Google Scholar 

  • Guigoz Y, Vellas B, Garry P (1994) Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol 4:14–59

    Google Scholar 

  • Gumieiro DN, Rafacho BPM, Gradella LM, Azevedo PS, Gaspardo D, Zornoff LAM, Pereira GJ, Paiva SA, Minicucci MF (2012) Handgrip strength predicts pressure ulcers in patients with hip fractures. Nutrition 28(9):874–878

    Article  Google Scholar 

  • Gumieiro DN, Rafacho BPM, Gonçalves AF, Tanni SE, Azevedo PS, Sakane DT, Carneiro CA, Gaspardo D, Zornoff LA, Pereira GJ, Paiva SA, Minicucci MF (2013) Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture. Br J Nutr 109(9):1657–1661

    Article  CAS  Google Scholar 

  • Guo JJ, Yang H, Qian H, Huang L, Guo Z, Tang T (2010) The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly. J Surg Res 159(1):503–508

    Article  CAS  Google Scholar 

  • Helminen H, Luukkaala T, Saarnio J, Nuotio MS (2017) Changes in nutritional status and associated factors in a geriatric post-hip fracture assessment. Eur Geriatr Med 8(2):134–139

    Article  Google Scholar 

  • Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, EV MC, Jönsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136

    Article  CAS  Google Scholar 

  • Hoekstra JC, Goosen JHM, de Wolf GS, Verheyen CCPM (2011) Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study. Clin Nutr 30(4):455–461

    Article  Google Scholar 

  • Inoue T, Misu S, Tanaka T, Sakamoto H, Iwata K, Chuman Y, Ono R (2016) Pre-fracture nutritional status is predictive of functional status at discharge during the acute phase with hip fracture patients: A multicenter prospective cohort study. Clin Nutr https://doi.org/10.1016/j.clnu.2016.08.021

    Article  Google Scholar 

  • Jensen GL, Compher C, Sullivan DH, Mullin GE (2013) Recognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach. J Parenter Enter Nutr 37(6):802–807

    Article  Google Scholar 

  • Johansen A, Boulton C, Hertz K, Ellis M, Burgon V, Rai S, Wakeman R (2017) The National Hip Fracture Database (NHFD) – Using a national clinical audit to raise standards of nursing care. Int J Orthop Trauma Nurs 26:3–6. https://doi.org/10.1016/j.ijotn.2017.01.001

    Article  Google Scholar 

  • Juliebo V, Bjoro K, Krogseth M, Skovlund E, Ranhoff AH, Wyller TB (2009) Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc 57(8):1354–1361

    Article  Google Scholar 

  • Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC, MNA-International Group (2009) Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 13(9):782–788

    Article  CAS  Google Scholar 

  • Kondrup J, Rasmussen HH, Hamberg O, Stanga Z (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22(3):321–336

    Article  Google Scholar 

  • Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Grosman B, Frishman S, Salai M, Beloosesky Y (2012) The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clin Nutr 31(6):917–921

    Article  Google Scholar 

  • Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Anbar R, Gross Nevo RF, Schlesinger A, Frishman S, Salai M, Beloosesky Y (2016) Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients. Clin Nutr 35(5):1053–1058

    Article  Google Scholar 

  • Leal J, Gray AM, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, Judge A, REFReSH study group (2016) Impact of hip fracture on hospital care costs: a population-based study. Osteoporos Int 27:549–558

    Article  CAS  Google Scholar 

  • Lindholm C, Sterner E, Romanelli M, Pina E, TorrayBou J, Hietanen H, Iivanainen A, Gunningberg L, Hommel A, Klang B, Dealey C (2008) Hip fracture and pressure ulcers – the Pan-European Pressure Ulcer Study – intrinsic and extrinsic risk factors. Int Wound J 5(2):315–328

    Article  Google Scholar 

  • Marshall WJ (2008) Nutritional assessment: its role in the provision of nutritional support. J Clin Pathol 61(10):1083–1088

    Article  CAS  Google Scholar 

  • Mueller C, Compher C, Ellen DM (2011) A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr 35(1):16–24

    Article  Google Scholar 

  • Myint MWW, Wu J, Wong E, Chan SP, To TSJ, Chau MWR, Ting KH, Fung PM, Au KSD (2013) Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing 42(1):39–45

    Article  Google Scholar 

  • National Centre for Classification in Health (2006) The international statistical classification of diseases and related health problems, tenth revision, Australian modification (ICD-10-AM): tabular list of diseases, 5th edn. Shannon Books, Sydney

    Google Scholar 

  • National Institute for Health and Clinical Excellence (2011) NICE guidelines – National Clinical Guideline Centre. NICE Clinical guideline 124, The management of hip fracture in adults

    Google Scholar 

  • Nematy M, Hickson M, Brynes AE, Ruxton CHS, Frost GS (2006) Vulnerable patients with a fractured neck of femur: nutritional status and support in hospital. J Hum Nutr Diet 19(3):209–218

    Article  CAS  Google Scholar 

  • Nikkel LE, Fox EJ, Black KP, Davis C, Andersen L, Hollenbeak CS (2012) Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am 94(1):9–17

    Article  Google Scholar 

  • Nuotio M, Tuominen P, Luukkaala T (2016) Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fracture. Eur J Clin Nutr 70(3):393

    Article  CAS  Google Scholar 

  • Peak H (2000) Determining the incidence of hospital trust malnutrition to plan and target nutritional support strategies. Proc Nutr Soc 59:139A

    Google Scholar 

  • Rainey-Macdonald CG, Holliday RL, Wells GA, Donner AP (1983) Validity of a two-variable nutritional index for use in selecting candidates for nutritional support. JPEN J Parenter Enteral Nutr 7(1):15–20

    Article  CAS  Google Scholar 

  • Rasmussen HH, Holst M, Kondrup J (2010) Measuring nutritional risk in hospitals. Clin Epidemiol 2:209–216

    Article  Google Scholar 

  • Rutishauser IHE (2005) Dietary intake measurements. Public Health Nutr 8(7A):1100–1107

    Article  Google Scholar 

  • Scottish Intercollegiate Guidelines Network (2009) Management of hip fracture in older people. A national clinical guideline. Retrieved from www.sign.ac.uk/pdf/sign111.pdf

  • Sivakumar BS, McDermott LM, Bell JJ, Pulle CR, Jayamaha S, Ottley MC (2013) Dedicated hip fracture service: implementing a novel model of care. ANZ J Surg 83(7-8):559–563

    Article  Google Scholar 

  • Villani AM, Miller MD, Cameron ID, Kurrle S, Whitehead C, Crotty M (2013) Development and relative validity of a new field instrument for detection of geriatric cachexia: preliminary analysis in hip fracture patients. J Cachex Sarcopenia Muscle 4(3):209–216

    Article  Google Scholar 

  • Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P (2017) ESPEN guideline: clinical nutrition in surgery. Clin Nutr 36(3):623–650. https://doi.org/10.1016/j.clnu.2017.02.013

    Article  PubMed  Google Scholar 

  • White JV, Guenter P, Jensen G, Malone A, Schofield M (2012) Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr 36(3):275–283

    Article  Google Scholar 

  • Williamson DA, Allen HR, Martin PD, Alfonso AJ, Gerald B, Hunt A (2003) Comparison of digital photography to weighed and visual estimation of portion sizes. J Am Diet Assoc 103(9):1139–1145

    Article  Google Scholar 

  • Wilson MM, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A et al (2005) Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr 82(5):1074–1081

    Article  CAS  Google Scholar 

  • Yuwen P, Chen W, Lv H, Feng C, Li Y, Zhang T, Hu P, Guo J, Tian Y, Liu L, Sun J, Zhang Y (2017) Albumin and surgical site infection risk in orthopaedics: a meta-analysis. BMC Surg 17(1):7

    Article  Google Scholar 

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Bell, J. (2017). Nutrition Screening and Assessment in Hip Fracture. In: Preedy, V., Patel, V. (eds) Handbook of Famine, Starvation, and Nutrient Deprivation. Springer, Cham. https://doi.org/10.1007/978-3-319-40007-5_74-1

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  • DOI: https://doi.org/10.1007/978-3-319-40007-5_74-1

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