Issue 33.2 examines some screening tools and comparative approaches for addressing malnutrition in various populations. Other articles in this issue are case, narrative and practice reviews that offer new perspectives for the nutritional care of patients. Our Thanks to Reviewers is a special annual section to acknowledge the dedication and expertise of our many reviewers and editorial board members.
Nutrition-focused physical examination (NFPE) began in the 1980s and by the mid-1990s had been adopted into the clinical practice roles of registered dietitian nutritionists (RDNs). An academic program at the forefront of its promulgation conducted a survey of its RDN graduates who completed an in-person NFPE course from 1996 to 2015 in the Desjardins et al article. Respondents with additional NFPE training after the course compared with those without more NFPE training affected the adoption of its components in daily practice.
Nemec et al determined the validity and consistency parameters of the Child Nutrition and Physical Activity (CNPA) screening tool for obesity risk. More than 2000 children, 2 to 18 years of age, with close to 39% being overweight or obese, comprised the sample. Besides an expert panel for content validity, principal component factor analysis of perception/confidence/importance items yielded 2 factors with acceptable internal consistency. They concluded that the CNPA screener demonstrates moderate reliability and validity.
A pilot study by Kianifar et al of 46 Iranian obese children, aged 7 to 13 years, assessed whether synbiotic supplementation could optimize anthropometric indices. The treatment group had a weight loss diet, increased physical activity, and a synbiotic capsule per day for 12 weeks, whereas the placebo group received a similar diet, activity plan, and placebo capsules. The body fat and body mass index measures decreased significantly in both groups, but only waist circumference decreased in the synbiotic group. They concluded that synbiotic oral supplementation may have potential benefits for weight reduction when combined with lifestyle modifications.
Phase angle (PhA), estimated by bioelectrical impedance analysis, has been used in relation to malnutrition. Two studies are included in this issue, one evaluating the association of PhA with handgrip strength (HGS) in hospitalized patients and one with critically ill patients that contrasts PhA and the Malnutrition Universal Screening Tool (MUST). A cross-sectional study of 139 hospital admissions evaluated weight, height, circumferences, and skinfolds measurements and PhA by bioelectrical impedance and HGS using a dynamometer. Reis et al found that PhA was positively correlated with HGS and could predict 29% of the variance in HGS. Although no consensus exists on a specific screening tool to assess malnutrition, Al-Kalaldeh et al examined nutritional status of 321 patients using MUST, PhA, and anthropometric measurements. The MUST and PhA results showed consistency in identifying malnutrition levels in this sample of critically ill patients.
Patients with Crohn disease (CD) are at risk for malnutrition, and its clinical presentation and complexity affect medical and nutritional management. Both enteral and parenteral nutrition and a number of other factors should be considered in treating CD. The Feasel-Aklilu et al article also reports a case of the nutritional care required for a patient who is dependent on parenteral nutrition (PN) in the home with a peripherally inserted central catheter. The patient with CD managed quite well for 34 years but developed an enderocutaneous fistula and required the careful oversight of a skilled RDN.
Balazh and Franck adopted institutional strategies to reduce the occurrence of central line-associated bloodstream infections (CLABSIs) in patients on PN. A retrospective evaluation assessed the implementation of these strategies in their institution. Application of the CLABSI risk reduction strategies was high and, in fact, no patients receiving PN experienced CLABSI during the duration of the study.
Gomes et al reviewed weight status and its effect on adults with cystic fibrosis (CF) in a literature review. They focused on nutrition interventions that improve weight status and quality of life. By exploring health-related quality of life in adults with CF, they found that the practitioners caring for CF patients should consider body image screening in clinical practice to optimize weight status and improve quality of life.
The Thanks to Reviewers recognizes the hard work and critical appraisal by our many contributors of manuscripts submitted or published in 2017. The editorial board is grateful for another year of practice-based articles by our many authors to meet the educational needs of Topics in Clinical Nutrition readers.
-Judith A. Gilbride, PhD, RDN, FAND
Editor