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Malnutrition and Chronic Diseases in a Community Hospital in Singapore
SUNDAY, OCTOBER 22
Poster Session: Professional Skills; Nutrition Assessment & Diagnosis; Medical Nutrition Therapy Learning Outside the Classroom: Evaluation of Strategies to Influence Student Cultural Competence and Social Justice Attitudes Author(s): M. Wolff, R. Litchfield; Iowa State University Learning Outcome: Explore the role of service-learning in developing cultural competence among dietetics students. Background: ACEND Accreditation Standards require that DPD graduates are able to “demonstrate an understanding of cultural competence/sensitivity.” Students gain valuable knowledge from Community Nutrition coursework; however, they often do not have the opportunity to engage with the community, particularly those experiencing food insecurity and poverty. The purpose of this study was to determine if a service-learning experience was more effective at influencing student attitudes towards social justice and diversity than traditional lecture. Methods: Students chose one extra-credit experience (six hours each): 1. lecture-based conference on hunger; 2. service-learning experience at a local free meal/food pantry program. Students completed a pre-post survey, the Civic Attitudes and Skills Questionnaire (CASQ), as well as a reflection of their experience. Results: Of 104 students, 36 chose the service-learning experience and 51 chose the conference experience. There was no significant change in any of the six scales of the CASQ for either experience from pre to post. The students attending the conference had significantly higher scores on the leadership skills scale (p<0.05) at pre and post compared to the service-learning group. These students’ reflections tended to be information-based. Conversely, reflections from students participating in service-learning tended to include themes of emotion, empathy, perceptions, and diversity. Conclusion: The results suggest that service-learning in a Community Nutrition course may be effective for influencing students’ social justice attitudes and preparing students for cultural competence as a nutrition professional. Further research should explore the dose of service-learning relative to CASQ scales.
Malnutrition and Chronic Diseases in a Community Hospital in Singapore Author: C. Tong; Sengkang Health, Singapore Learning Outcome: Prevalence of malnutrition in patients at a community hospital and its relationship to chronic diseases. Background: Patients at community hospitals usually suffer multiple chronic diseases and at risk of malnutrition. The objective of this study is to explore the nutritional status of patients admitted to a community hospital in Singapore and its relationship with chronic diseases. Method: Patients referred to dietitians from June to December 2016 were assessed using 7-points Subjective Global Assessment (SGA) and their clinical data were collected. Results: 468 patients (54% male, 46% female) were assessed. 74% of patients were elderly (age65) with a mean age of 73 (19-103) and a mean Body Mass Index (BMI) of 22.2 kg/m2 (9.9-54 kg/m2). 181 patients (39%) were identified as malnourished with SGA <6 and 4.5% of patients were severely malnourished with SGA<3. The malnutrition risk was found to be increased with age (r¼-0.43) but decreased wit BMI (r¼0.57). 85% of patients suffered one or more chronic diseases (1¼15.6%, 2¼28.4%, 3¼26.3%, 4¼12.6%, 5¼2.1%). Common chronic diseases suffered were hypertension (63.5%), hyperlipidemia (56.6%), diabetes (49.4%), renal diseases (16.5%) and dementia (8.5%). No significant difference in SGA was found in patients with or without a specific chronic disease. No significant relationship was found between SGA and the number of chronic diseases (r¼0.11). Conclusion: Elderly patients at community hospital have a high prevalence of malnutrition, especially those with low BMI, but not related to the type or number of chronic diseases. Funding Disclosure: None
Funding Disclosure: None
Low Physical Activity and Muscle Strength in Children and Adolescents with Classical Galactosemia Author(s): A. Kruger, M. Gillingham, E. Moe, S. Van Calcar; Oregon Health and Science University Learning Outcome: Describe the long-term complications associated with classical galactosemia. Background: Classical galactosemia (CG) is an inherited disorder of galactose metabolism treated with a low galactose/lactose diet. Unfortunately, even with pre-symptomatic diagnosis and life-long dietary intervention, patients with CG experience long-term complications including low bone mineral density, poor growth and abnormal body composition. However, muscle strength and the level of physical activity (PA) have not been reported. Methods: We compared PA level, muscle strength, and body composition of patients with CG (8-18 years, n¼12) to an age-, sex-, Tanner stage- and ethnicity-matched population in overall good health (n¼12). Body composition (LBM% and FM%) was determined by Bioimpedance Analysis. Anthropometric measures were plotted on CDC growth charts. Growth was assessed from a corrected height z-score. Muscle strength was quantified from handgrip dynamometer and a 60-second sit-to-stand test. Participants wore an Actigraph tri-axial accelerometer for 7 days to measure PA level. Results: Corrected height z-score, weight z-score, and BMI z-score were all significantly decreased in subjects with CG. There was no significant difference in LBM% or FM%. All muscle strength measures were significantly decreased in subjects with CG. Control participants spent significantly more time in moderate to vigorous PA per day than participants with CG, but there was no difference in time spent in sedentary to light physical activity. Conclusions: Patients with CG are smaller in height and weight with decreased growth compared to matched controls. Children with CG have decreased muscle strength and PA. Future studies should investigate the effects of strength training and increased PA in patients with CG. Funding Disclosure: None
A-28
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
Malnutrition Coding Practices in a Midwestern Academic Medical Center Author(s): C. Hanson1, C. Becker1, E. Lyden1, B. Robertson2, G. Woscyna1; 1 University of Nebraska Medical Center, 2Nebraska Medicine Learning Outcome: The participant will describe malnutrition codes most commonly used in the inpatient setting based on severity. Background: Malnourished hospitalized patients are assigned a code based on severity in order to gain reimbursement required for care. There is a current gap in the research regarding the characteristics that differ between patients classified with major complications and comorbidities (MCC) versus complications and comorbidities (CC). Objective: Quantify utilization of malnutrition codes and clinical factors associated with reimbursement category. Methods: The ICD-9 malnutrition code used during admission and the reimbursement category the codes belonged to was collected for 923 subjects. In a subset of 200 subjects, admission, discharge, demographic and anthropometric data were collected and analyzed. All data was collected at two time points for each subject: admission and discharge. Results: Out of 923 subjects, 67.4% were classified with malnutrition codes that are within the CC reimbursement category. Percent of ideal body weight, body mass index, and albumin differed significantly between the MCC and CC groups when categorized based on severity criteria. The odds of being classified with a MCC code are 3.5 times higher for subjects who presented with muscle mass loss at admission, and 2.2 times higher for subjects who had muscle mass loss at discharge. Conclusion: Both MCC and CC malnutrition codes were utilized. Muscle mass loss at admission and discharge significantly increased the odds of a subject being classified with a MCC malnutrition code. Malnourished patients were being classified as MCC or CC based on current malnutrition guidelines with the exception of albumin. Further education regarding malnutrition criteria may be beneficial. Funding Disclosure: None
September 2017 Suppl 1—Abstracts Volume 117 Number 9
Poster Session: Professional Skills; Nutrition Assessment & Diagnosis; Medical Nutrition Therapy Learning Outside the Classroom: Evaluation of Strategies to Influence Student Cultural Competence and Social Justice Attitudes Author(s): M. Wolff, R. Litchfield; Iowa State University Learning Outcome: Explore the role of service-learning in developing cultural competence among dietetics students. Background: ACEND Accreditation Standards require that DPD graduates are able to “demonstrate an understanding of cultural competence/sensitivity.” Students gain valuable knowledge from Community Nutrition coursework; however, they often do not have the opportunity to engage with the community, particularly those experiencing food insecurity and poverty. The purpose of this study was to determine if a service-learning experience was more effective at influencing student attitudes towards social justice and diversity than traditional lecture. Methods: Students chose one extra-credit experience (six hours each): 1. lecture-based conference on hunger; 2. service-learning experience at a local free meal/food pantry program. Students completed a pre-post survey, the Civic Attitudes and Skills Questionnaire (CASQ), as well as a reflection of their experience. Results: Of 104 students, 36 chose the service-learning experience and 51 chose the conference experience. There was no significant change in any of the six scales of the CASQ for either experience from pre to post. The students attending the conference had significantly higher scores on the leadership skills scale (p<0.05) at pre and post compared to the service-learning group. These students’ reflections tended to be information-based. Conversely, reflections from students participating in service-learning tended to include themes of emotion, empathy, perceptions, and diversity. Conclusion: The results suggest that service-learning in a Community Nutrition course may be effective for influencing students’ social justice attitudes and preparing students for cultural competence as a nutrition professional. Further research should explore the dose of service-learning relative to CASQ scales.
Malnutrition and Chronic Diseases in a Community Hospital in Singapore Author: C. Tong; Sengkang Health, Singapore Learning Outcome: Prevalence of malnutrition in patients at a community hospital and its relationship to chronic diseases. Background: Patients at community hospitals usually suffer multiple chronic diseases and at risk of malnutrition. The objective of this study is to explore the nutritional status of patients admitted to a community hospital in Singapore and its relationship with chronic diseases. Method: Patients referred to dietitians from June to December 2016 were assessed using 7-points Subjective Global Assessment (SGA) and their clinical data were collected. Results: 468 patients (54% male, 46% female) were assessed. 74% of patients were elderly (age65) with a mean age of 73 (19-103) and a mean Body Mass Index (BMI) of 22.2 kg/m2 (9.9-54 kg/m2). 181 patients (39%) were identified as malnourished with SGA <6 and 4.5% of patients were severely malnourished with SGA<3. The malnutrition risk was found to be increased with age (r¼-0.43) but decreased wit BMI (r¼0.57). 85% of patients suffered one or more chronic diseases (1¼15.6%, 2¼28.4%, 3¼26.3%, 4¼12.6%, 5¼2.1%). Common chronic diseases suffered were hypertension (63.5%), hyperlipidemia (56.6%), diabetes (49.4%), renal diseases (16.5%) and dementia (8.5%). No significant difference in SGA was found in patients with or without a specific chronic disease. No significant relationship was found between SGA and the number of chronic diseases (r¼0.11). Conclusion: Elderly patients at community hospital have a high prevalence of malnutrition, especially those with low BMI, but not related to the type or number of chronic diseases. Funding Disclosure: None
Funding Disclosure: None
Low Physical Activity and Muscle Strength in Children and Adolescents with Classical Galactosemia Author(s): A. Kruger, M. Gillingham, E. Moe, S. Van Calcar; Oregon Health and Science University Learning Outcome: Describe the long-term complications associated with classical galactosemia. Background: Classical galactosemia (CG) is an inherited disorder of galactose metabolism treated with a low galactose/lactose diet. Unfortunately, even with pre-symptomatic diagnosis and life-long dietary intervention, patients with CG experience long-term complications including low bone mineral density, poor growth and abnormal body composition. However, muscle strength and the level of physical activity (PA) have not been reported. Methods: We compared PA level, muscle strength, and body composition of patients with CG (8-18 years, n¼12) to an age-, sex-, Tanner stage- and ethnicity-matched population in overall good health (n¼12). Body composition (LBM% and FM%) was determined by Bioimpedance Analysis. Anthropometric measures were plotted on CDC growth charts. Growth was assessed from a corrected height z-score. Muscle strength was quantified from handgrip dynamometer and a 60-second sit-to-stand test. Participants wore an Actigraph tri-axial accelerometer for 7 days to measure PA level. Results: Corrected height z-score, weight z-score, and BMI z-score were all significantly decreased in subjects with CG. There was no significant difference in LBM% or FM%. All muscle strength measures were significantly decreased in subjects with CG. Control participants spent significantly more time in moderate to vigorous PA per day than participants with CG, but there was no difference in time spent in sedentary to light physical activity. Conclusions: Patients with CG are smaller in height and weight with decreased growth compared to matched controls. Children with CG have decreased muscle strength and PA. Future studies should investigate the effects of strength training and increased PA in patients with CG. Funding Disclosure: None
A-28
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
Malnutrition Coding Practices in a Midwestern Academic Medical Center Author(s): C. Hanson1, C. Becker1, E. Lyden1, B. Robertson2, G. Woscyna1; 1 University of Nebraska Medical Center, 2Nebraska Medicine Learning Outcome: The participant will describe malnutrition codes most commonly used in the inpatient setting based on severity. Background: Malnourished hospitalized patients are assigned a code based on severity in order to gain reimbursement required for care. There is a current gap in the research regarding the characteristics that differ between patients classified with major complications and comorbidities (MCC) versus complications and comorbidities (CC). Objective: Quantify utilization of malnutrition codes and clinical factors associated with reimbursement category. Methods: The ICD-9 malnutrition code used during admission and the reimbursement category the codes belonged to was collected for 923 subjects. In a subset of 200 subjects, admission, discharge, demographic and anthropometric data were collected and analyzed. All data was collected at two time points for each subject: admission and discharge. Results: Out of 923 subjects, 67.4% were classified with malnutrition codes that are within the CC reimbursement category. Percent of ideal body weight, body mass index, and albumin differed significantly between the MCC and CC groups when categorized based on severity criteria. The odds of being classified with a MCC code are 3.5 times higher for subjects who presented with muscle mass loss at admission, and 2.2 times higher for subjects who had muscle mass loss at discharge. Conclusion: Both MCC and CC malnutrition codes were utilized. Muscle mass loss at admission and discharge significantly increased the odds of a subject being classified with a MCC malnutrition code. Malnourished patients were being classified as MCC or CC based on current malnutrition guidelines with the exception of albumin. Further education regarding malnutrition criteria may be beneficial. Funding Disclosure: None
September 2017 Suppl 1—Abstracts Volume 117 Number 9