Human Nutrition

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Browsing Human Nutrition by Subject "Adulthood"

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    Fistuloclysis : an option for the nutritional management of adult intestinal failure patients in South Africa
    (Stellenbosch : Stellenbosch University, 2016-03) Du Toit, Anna-Lena; Blaauw, Renee; Boutall, Adam; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Introduction: The development of intestinal failure is the consequence of diverse aetiologies and pathophysiological causes. Fistuloclysis is an effective means of nutritional support in selected intestinal failure patients. This study aimed to investigate the management of adult intestinal failure patients in hospitals in South Africa, determining how practical and acceptable fistuloclysis is. Methods: The study included three phases. Phase 1 consisted of a retrospective record review of adult patients admitted to Groote Schuur Hospital Intestinal Failure Unit between January 2009 and May 2014. Data collected included demographics, surgical interventions, gastrointestinal anatomy, nutritional management, biochemical markers and intake and output. Phase 2 consisted of a purposefully selected case study report published in a peer-reviewed journal. Phase 3 investigated the current management of type 2 and type 3 intestinal failure patients in South African hospitals, evaluating perceptions and opinions among South African doctors, stoma therapists and dietitians by means of occupation-specific questionnaires. Results: Phase 1: Seventeen intestinal failure patients receiving fistuloclysis were included in the study. During the fistuloclysis period, the median daily output was 1 478ml with a median of 71% of effluent received back via fistuloclysis. Four patients went home for a median period of 32,5 days on fistuloclysis. There was a statistically significant increase in the median albumin level between day 0 and day 28 of fistuloclysis, however body weight did not improve during this period. Postoperative complications occurred in only three patients. Patients were discharged after a median of 12 days post definitive surgery, with three complicating postoperatively and all patients regaining nutritional autonomy. Phase 3: Twenty-seven dietitians participated in the survey, the majority (67%) having been involved with patient management in this field for one – five years. All indicated high fistula outputs would be defined as intestinal failure. Only 47% gave the correct definition, with 28% currently utilising fistuloclysis. All respondents agreed that unsuccessful implementation of fistuloclysis was due to training shortfalls and resistance from clinicians and nursing staff. Ten stoma therapists entered the survey but only two fitted the inclusion criteria. Both worked in the private sector, with >10 years of experiece in the management of intestinal failure patients. Only one of the two proceeded with further questions. Four doctors managing intestinal failure responded. All respondents indicated high fistula outputs as associated with intestinal failure. The aetiology of intestinal failure indicated was postoperative complications by 75% of the respondents. The majority of respondents (75%) indicated that keeping patients nil by mouth was common practice, 50% of respondents indicated routine usage of pharmacological agents to decrease output or transit time. All respondents gave the correct explanation of fistuloclysis with 50% currently using fistuloclysis. Conclusion: Fistuloclysis is not superior, but equivalent to conventional methods of intestinal failure management. From this study and other available literature it is evident that fistuloclysis can replace PN support in selected patients. From the different occupation group surveys it is evident that there is a positive perception and awareness of fistuloclysis; however numerous stumbling blocks hamper the wider use of this novel treatment.
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    Prevalence of risk of malnutrition in hospitalised adult patients in a tertiary hospital setting in South Africa
    (Stellenbosch : Stellenbosch University, 2016-03) Moens, Merel; Blaauw, Renee; Visser, Janicke; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Introduction: Hospital malnutrition was first identified by Charles Butterworth in 1974, referring to malnutrition often being overlooked, underdiagnosed and consequently undertreated. This is still a current problem, with worldwide prevalence of malnutrition ranging from 15–76% among adults. Hospital malnutrition is associated with increased cost of care, complications, increased length of stay, mortality and poor quality of life compared to well-nourished patients. South Africa’s hospitalised population is at an increased risk of malnutrition, due to high poverty levels and the quadruple burden of disease. The aim of this study was to determine the prevalence of risk of malnutrition in hospitalised patients in a South African Hospital setting. Methods: Patients that were admitted (≤48 hours) and (≥18 years old) were eligible for inclusion. The prevalence of risk of malnutrition was assessed using three different screening tools (NRS-2002, SGA and AMDT) on admission and discharge (if hospitalised ≥7days). The prevalence of risk of malnutrition, related outcomes and the number of referrals for nutritional support were documented. The included wards were assessed for availability of nutrition protocols and resources needed to implement nutrition intervention using an observational checklist. Results: On admission, a total of 403 patients were included (males 52.9%). The mean age was 45.5 years ±16.6SD. There was an even distribution between patients from surgical (n=192) and medical wards (n=190), with gynaecology (n=21) contributing a small number of patients. The prevalence of risk of malnutrition on admission ranged depending on the screening tool used: NRS-2002 (59.1%; n=237), AMDT (62.9%; n=252) and SGA (56.6%; n=228). The mean length of stay was 6.9 days ±5.9SD, with a significant difference (p<0.01) in length of stay between malnourished patients (mean 7.4 days ±6.1SD) and well-nourished patients (5.2 days ±4.8SD). On discharge, 92 patients were included (males 52.8%). Most patients (64%; n=59) endured a complication, with significantly more complications (p=0.048) among the malnourished (mean 1.7 ±1.6SD) when compared to the well-nourished (mean 0.8±1.3SD).Patients ‘at risk’ were diagnosed with infectious and gastrointestinal diseases, cancer, or had abdominal surgery, making these high-risk disease categories for malnutrition. The prevalence of risk of malnutrition was higher within the discharge sample, regardless of which tool was used: NRS-2002 (73.8%; n=62), SGA (65.2%; n=60) and AMDT (79.3%;n=73). Despite the high prevalence of malnutrition, the nutrition referrals were poor, with only 1.3% (n=5) being referred on admission, and 9.8% (n=9) on discharge. The AMDT was the only tool that had good validity (sensitivity 83.9%, specificity 80.2%) and interrater agreement (k=0.62) when using the SGA as reference. Similarly, the NRS-2002 had fair validity (sensitivity 73.8% and specificity 51.8%) but poor inter-rater agreement (k=0.24). Lastly, the hospital setting had a poor nutrition-care environment as none of the wards (n=28) had nutrition protocols, nor screening tools available at ward level. Scales were available (96.4%; n=27), but 22.2% (n=6) were not in working condition. Stadiometers were not readily available (42.9%; n=12). The mean number of patients per ward was 43 ±17.7SD, with only an average of 11 ±2.5SD nurses on duty per ward, indicating a shortage of nurses for adequate patient care. Conclusion: The prevalence of nutritional risk and malnutrition is very high in the hospital setting, regardless of screening tool used, and is associated with unfavourable patient outcomes.