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2/17/2015
Malnourished Patients:
New & Revised
Recommendations
Mary D. Litchford PHD, RDN, LDN
mdlphd@casesoftware.com
©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
Points to Ponder
1. Discuss the characteristics of
malnutrition as potential precursors of
pressure ulcer development.
2. Explore tactics to implement new and
revised nutrition recommendations for
individuals at risk for pressure ulcers
and as part of pressure ulcer treatment.
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
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2/17/2015
Undernutrition-Malnourished Continuum
• Too tired to shop
or cook
• Too tired to eat
• Limited food
budget
•
•
•
•
•
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 Food intake
Wt loss
 Fat stores
 Muscle mass
 Physical strength
• Illness
• Injury or surgery
• Loss of reserves
Poor
dietary
intake
Increased
nutrient
needs
Under
nutrition &
malnutrition
Impaired
nutrient
transport
•  Organ function
• Food-Meds Issues
• Adapted from:
Litchford, M. Nutr Clin
Prac. Aug 2014 29:428.
©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
5 Tactics to Implement Nutrition
Recommendations
1. Use a validated nutrition screening tool
Mini Nutrition Assessment (MNA)
http://mna-elderly.com/default.html
Malnutrition Universal Screening Tool (MUST)
http://www.bapen.org.uk/pdfs/must/must_full.pdf
Nutrition Risk Screening (NRS-2002)
http://www.nutritotal.com.br/icnso/aspen/?acao=bu&categoria=2&i
d=76
Short Nutrition Assessment Questionnaire (SNAQ)
http://www.fightmalnutrition.eu/fileadmin/content/malnutrition/Scre
ening_tools/SNAQ_Engels.pdf
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
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2/17/2015
5 Tactics to Implement Nutrition
Recommendations
2. Incorporate malnutrition guidelines into
practice
Academy/ASPEN: Characteristics of Adult
Malnutrition
http://malnutrition.andjrnl.org/Content/articles/1Consensus_Statement.pdf
ASPEN: Defining Pediatric Malnutrition
http://pen.sagepub.com/content/37/4/460.full
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
5 Tactics to Implement Nutrition
Recommendations
3. Take a look at quantity & quality of
protein served at meals
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
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2/17/2015
Which Menu Promotes the Best
Tissue Synthesis?
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Which Menu Promotes the Best
Tissue Synthesis?
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
Mamerow,M. J. Nutr. 144: 876–880, 2014.
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2/17/2015
5 Tactics to Implement Nutrition
Recommendations
3. Take a look at quality of protein served at
meals
http://www.ift.org/Food-Technology/Daily-News/2013/March/07/FAO-proposes-newprotein-quality-measurement.aspx
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
5 Tactics to Implement Nutrition
Recommendations
3. Take a look at quality of protein
served at meals
 Complete protein sources
 High levels of leucine needed to activate
protein synthesis & tissue accretion
 Best sources leucine in food: beef, pork,
chicken, egg
 Best PRO supplements: whey
 Symons T, JADA. 2009;109:1582–6.
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
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2/17/2015
5 Tactics to Implement Nutrition
Recommendations
4. Add Amino Acids (AA)
 Arginine
 High energy, high protein product with
added AA
 Add separate AA product
 Key to success= adequate protein &
energy intake
 Arginine supplements do NOT count
toward total protein requirement
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
5 Tactics to Implement Nutrition
Recommendations
5. Look at nutrient needs of special populations
Bariatric (Obese) Individual
Nutrition Recommendations following WLS
ASMBS Allied Health Nutritional Guidelines for Surgical Weight
Loss Patient
http://asmbs.org/resources/integrated-health-nutritionalguidelines
Critically Ill Individual
SCCM/ASPEN Guidelines for the Provision and Assessment of
Nutrition Support Therapy in the Adult Critically Ill.
http://pen.sagepub.com/content/33/3/277.short?rss=1&ssource=
mfr
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
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2/17/2015
5 Tactics to Implement Nutrition
Recommendations
5. Look at nutrient needs of special populations
 Individuals in Palliative Care
 Pediatric Individuals
ASPEN Clinical Guidelines
Nutrition Support of the Critically Ill Child.
http://pen.sagepub.com/content/33/3/260.full
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
VITAL Tactics to Implement Nutrition
Recommendations
Validated nutrition screening tool
Incorporate malnutrition guidelines
Take a look at quality & quantity of protein
served
Add amino acids- arginine
Look at nutrient needs of special populations
Nutrition is VITAL to wound healing.
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©2015 National Pressure Ulcer Advisory Panel | www.npuap.org
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2/17/2015
VITAL Tactics to Implement Nutrition
Recommendations
Validated nutrition screening tool
Incorporate malnutrition guidelines
Take a look at quality of protein & amounts served
Add amino acids- arginine
Look at nutrient needs of special populations
©CSB 2015
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