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
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
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
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
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
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
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
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
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
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
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
Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF (1980) Prognostic nutritional index in gastrointestinal surgery. Am J Surg 139(1):160–167
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
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
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
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
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
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
Elia M (2003) Screening for malnutrition: a multidisciplinary responsibility. development and use of the malnutrition universal screening tool (MUST) for adults. BAPEN, Redditch
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
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
Eneroth M, Olsson U-B, Thorngren K-G (2006) Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res 451:212–217
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Marshall WJ (2008) Nutritional assessment: its role in the provision of nutritional support. J Clin Pathol 61(10):1083–1088
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
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
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
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
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
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
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
Peak H (2000) Determining the incidence of hospital trust malnutrition to plan and target nutritional support strategies. Proc Nutr Soc 59:139A
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
Rasmussen HH, Holst M, Kondrup J (2010) Measuring nutritional risk in hospitals. Clin Epidemiol 2:209–216
Rutishauser IHE (2005) Dietary intake measurements. Public Health Nutr 8(7A):1100–1107
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
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
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
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
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
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
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
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Bell, J. (2019). 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/10.1007/978-3-319-55387-0_74
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