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Background:Malnutrition in chronic obstructive pulmonary disease (COPD) is associated with a poor prognosis, yet evidence to support the role of dietary counselling and food fortification is lacking. A study was undertaken to assess the impact of dietary counselling and food fortification on outcome in outpatients with COPD who are at risk of malnutrition.Methods:A randomised controlled unblinded trial was performed in 59 outpatients with COPD (6 months intervention and 6 months follow-up). The intervention group received dietary counselling and advice on food fortification and the controls received a dietary advice leaflet. Outcome measures were nutritional status, respiratory and skeletal muscle strength, respiratory function, perceived dyspnoea, activities of daily living (ADL) and quality of life.Results:The intervention group consumed more energy (difference 194 kcal/day; p = 0.02) and protein (difference 11.8 g/day; p<0.001) than controls. The intervention group gained weight during the intervention period and maintained weight during follow-up; the controls lost weight throughout the study. Significant differences were observed between the groups in St George’s Respiratory Questionnaire total score (difference 10.1; p = 0.02), Short Form-36 health change score (difference 19.2; p = 0.029) and Medical Research Council dyspnoea score (difference 1.0; p = 0.03); the difference in ADL score approached statistical significance (difference 1.5; p = 0.06). No differences were observed between groups in respiratory function or skeletal and respiratory muscle strength. Improvements in some variables persisted for 6 months beyond the intervention period.Conclusion:Dietary counselling and food fortification resulted in weight gain and improvements in outcome in nutritionally at-risk outpatients with COPD, both during and beyond the intervention period.

(ProQuest: ... denotes non-USASCII text omitted.) Protected mealtimes (PM) i.e. periods on a hospital ward when all non-urgent clinical activity stops, have been recommended as a method for improving dietary intake in hospitalised patients.

(ProQuest: ... denotes non-USASCII text omitted.) A validated nutrition screening tool (NST) was launched on the general medical and elderly care wards of an acute hospital Trust in March 2000.

Reasons for referral when the NST was not used (53%) include: (a) subjective assessments such as visual examination of the patient, (b) nothing else was working thus a referral was a last resort and (c) ward staff referred with an expectation that their patient would receive a particular treatment, such as nutritional supplements.

[...] malnutrition is itself a patient safety issue.

To avoid any negative outcomes associated with under- or overfeeding it is essential to estimate nutrient requirements before commencing nutrition support. The energy requirements of an individual vary with current and past nutritional status, clinical condition, physical activity and the goals and likely duration of treatment. The evidence-base for prediction methods in current use, however, is poor and the equations are thus open to misinterpretation. In addition, most methods require an accurate measurement of current weight, which is problematic in some clinical situations. The estimation of energy requirements is so challenging in some conditions, e.g. critical illness, obesity and liver disease, that it is recommended that expenditure be measured on an individual basis by indirect calorimetry. Not only is this technique relatively expensive, but in the clinical setting there are several obstacles that may complicate, and thus affect the accuracy of, any such measurements. A review of relevant disease-specific literature may assist in the determination of energy requirements for some patient groups, but the energy requirements for a number of clinical conditions have yet to be established. Regardless of the method used, estimated energy requirements should be interpreted with care and only used as a starting point. Practitioners should regularly review the patient and reassess requirements to take account of any major changes in clinical condition, nutritional status, activity level and goals of treatment. There is a need for large randomised controlled trials that compare the effects of different levels of feeding on clinical outcomes in different disease states and care settings.

IntroductionDisease-related malnutrition is common and is often identified during a hospital admission. Hospital stays tend to be short and therefore it is crucial that nutritional interventions begun in hospital are continued on discharge (Elia et al 2010). Research has highlighted failings in nutritional care across this boundary (van Bokhorst-de van der Schueren et al 2005; Bavelaar et al 2008). The aim of this study was to evaluate the continuation of dietetic interventions across the transition from acute to community care.MethodsAll patients admitted to the acute medical wards and referred to a dietitian for nutrition support between 1 July and 30 September 2011 were considered eligible for this study. Patients were excluded if they died within 1-month of discharge, received enteral or parenteral nutrition, were receiving dietetic care for a long-term chronic condition or were still in hospital at 31 October 2011. Eligible patients or their carers were contacted to determine whether recommendations for their post-discharge oral nutritional support had been carried out. Data were analysed using SPSS V.17.0.ResultsOf 108 patients, 27 (25 %) died before contact could be made and 17 (16 %) did not meet the inclusion criteria. 64 patients were included in this study of whom 35 (56%) were recommended one or more post-discharge dietetic interventions, including consumption of oral nutritional supplements and follow-up dietetic appointments. Of the 35 patients, it was not possible to contact 14 (40 %) within the time limits of the study. Contact was made with 21 patients of whom 17 (81%) received all the interventions recommended by the dietitian. Of the four patients who did not receive the recommended interventions, in 3 (75%) this was due to patient perception that treatment was no longer required. Of the 64 patients who met the inclusion criteria no comments were included in the discharge letter from the medical team on either nutritional status or dietetic input.ConclusionIn this study it was possible to contact only a small sample of eligible patients however, of those who were contacted the majority had received the post-discharge interventions recommended by the dietitian. Further studies are required to determine if dietetic recommendations are as likely to be carried out in patients who are more difficult to contact post discharge.Competing interestsNone declared.References1. Bavelaar JW, Otter CD, van Bodegraven AA, et al. Clin Nutr 2008;27:431–8.2. Elia M, Russell CA, Stratton RJ. Proc Nutr Soc 2010;69:470–6.3. van Bokhorst-de van der Schueren MAE, Klinkenberg M, Thijs A. Eur J Clin Nutr 2005;59:1129–35.

IntroductionDisease-related malnutrition is common and is often identified during a hospital admission. Hospital stays tend to be short and therefore it is crucial that nutritional interventions begun in hospital are continued on discharge (Elia et al 2010). Research has highlighted failings in nutritional care across this boundary (van Bokhorst-de van der Schueren et al 2005; Bavelaar et al 2008). The aim of this study was to evaluate the continuation of dietetic interventions across the transition from acute to community care.MethodsAll patients admitted to the acute medical wards and referred to a dietitian for nutrition support between 1 July and 30 September 2011 were considered eligible for this study. Patients were excluded if they died within 1-month of discharge, received enteral or parenteral nutrition, were receiving dietetic care for a long-term chronic condition or were still in hospital at 31 October 2011. Eligible patients or their carers were contacted to determine whether recommendations for their post-discharge oral nutritional support had been carried out. Data were analysed using SPSS V.17.0.ResultsOf 108 patients, 27 (25 %) died before contact could be made and 17 (16 %) did not meet the inclusion criteria. 64 patients were included in this study of whom 35 (56%) were recommended one or more post-discharge dietetic interventions, including consumption of oral nutritional supplements and follow-up dietetic appointments. Of the 35 patients, it was not possible to contact 14 (40 %) within the time limits of the study. Contact was made with 21 patients of whom 17 (81%) received all the interventions recommended by the dietitian. Of the four patients who did not receive the recommended interventions, in 3 (75%) this was due to patient perception that treatment was no longer required. Of the 64 patients who met the inclusion criteria no comments were included in the discharge letter from the medical team on either nutritional status or dietetic input.ConclusionIn this study it was possible to contact only a small sample of eligible patients however, of those who were contacted the majority had received the post-discharge interventions recommended by the dietitian. Further studies are required to determine if dietetic recommendations are as likely to be carried out in patients who are more difficult to contact post discharge.Competing interestsNone declared.References1. Bavelaar JW, Otter CD, van Bodegraven AA, et al. Clin Nutr 2008; 27:431-8.2. Elia M, Russell CA, Stratton RJ. Proc Nutr Soc 2010; 69:470-6.3. van Bokhorst-de van der Schueren MAE, Klinkenberg M, Thijs A. Eur J Clin Nutr 2005; 59:1129-35.