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CLINICAL EXPERIENCE ON NUTRITION SUPPORT FOR PATIENTS WITH UNDERWEIGHT AND MALNUTRITION

Dr. Terry Ho Yan Ting

Registered Dietitian

EVENTS
CME
SYMPOSIUM

KEY MESSAGES

 

1. Clinical impacts of malnutrition:30

2. Local real-world evidence:31

  • In a local cross-sectional study of hospitalized patients, the prevalence of malnutrition risk was 9.2% (4.5% at medium risk and 4.7% at high risk).
  • A higher risk of malnutrition was associated with longer hospital stays, higher readmission rates within 28 days, and higher mortality rates.

Study design: Records of 40,105 adult patients admitted to the Hong Kong North District hospital between January and December 2016 were retrieved. Patient Malnutrition Screening Tool (MST) scores (range, 0–5) and outcomes after discharge from the hospital, such as length of hospital stay (LOS), 28-day emergency readmission rate, and death, were recorded. The malnutrition risk was categorised into three levels according to MST score: low risk (0-1), medium risk (2), and high risk (≥3). Comparisons among the three groups and between the low-risk group and the medium and high-risk (at-risk) group were conducted in the study.31

3. Calorie delivery alone won’t stop lean body mass loss32

 

 

4. British Diabetic Association: Oral nutritional support principles33

  • The role of the dietitian is to provide evidence‐based advice on the most appropriate oral nutritional support for patients and tailor dietary advice to their needs. 
  • Oral nutritional support aims to improve the nutritional intake of macronutrients and micronutrients; approaches include fortified foods, snacks, nourishing drinks and oral nutritional supplements (ONS). 
  • Dietary strategies improve intake, weight and body composition, and can have some benefits on functional outcomes, but clinical efficacy has not been fully assessed. 
  • ONS has been shown to improve intake, weight, and body composition, with other clinical and economic benefits. 
  • All patients receiving oral nutritional support should be monitored regularly against the goals of the intervention.

 

5. Nutrition intervention plan:34

A case report of a 53 years old female with unintentional weight loss and depression: 

  • Estimated requirement: 
    • Energy: BMR x Activity factor + extra 500-700kcal/day for weight gain (~1600kcal/d) 
    • Protein: 1.6g/kg daily for muscle building and weight gain (~66g protein/d) (Protein and calorie intake shall be assessed on a case-by-case basis according to the patient's status.) 
  • First consultation + 2 follow-up consultations on day 30 and day 60 
  • Diet advice 
    • Small portions and frequent meals 
    • Include protein in breakfast 
  • Oral Nutrition Supplement 
    • Suggested having 1 to 2 bottles of energy-dense HMB-fortified ONS daily (with 1.5g CaHMB per serving) 
    • Providing 330kcal and 20g protein per bottle

 

6. Clinical outcomes of nutritional intervention:34

Conclusion

Oral nutritional supplements (ONS) with β-hydroxy-β-methyl butyrate (HMB) can be a promising management option for older polymorbid patients who are at risk of sarcopenia to improve their nutritional status, muscle mass and physical functions. 

PAST EVENTS

Footnotes:

ADRM: acute disease- or injury-related malnutrition

ADRM+NS: ADRM with nutrition support

BMR: basal metabolic rate

CDRM: chronic disease-related malnutrition

CDRM+NS: CDRM with nutrition support.

H2O: water

HMB: ß-hydroxy-ß-methyl butyrate

MST: malnutrition screening tool

Na: sodium

ONS: oral nutritional supplement.

References:

  1. Saunders J, et al. Clin Med (Lond). 2010;10(6):624-627.
  2. Ting, TH, et al, Asian J Gerontol Geriatr. 2019;14(1):10–4.
  3. Jensen GL, et al. JPEN J Parenter Enteral Nutr. 2010;34(2):156-159.
  4. British Diabetic Association. Oral nutritional support. Available at: https://www.bda.uk.com/static/8c523ad7-4a98-408e-8554c3c63519f660/Manual-of-Dietetic-Practice-Chapter-63-Oral-nutritional-support.pdf. Accessed on 25/03/2024.
  5. Local patient study on usage of HMB-ONS by Dr. Terry Ting.

 

HKG.2025.58178.ENS

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