Evaluation of malnutrition in patients with nervous system disease

Abstract

Nutritional deficiencies are independent risk factors for adverse outcomes in patients with nervous system disease. Patients with nervous system disease can often become malnourished due to swallowing difficulties or unconsciousness. This malnourishment increases hospitalization duration; average total hospital cost; occurrence of infection, pressure ulcers, and other complications. These problems need to be addressed in the clinic. In this paper, we review the relevant literature, including studies on influencing factors, evaluations, indexes, and methods: Our aim is to understand the current status of malnutrition in patients with nervous system disease and reasons associated with nutritional deficiencies by using malnutrition evaluation methods to assess the risk of nutritional deficiencies in the early stages.

Keywords::

• malnutrition
• nervous system diseases
• nutritional assessment tool
• nutritional deficiencies
• protein-energy malnutrition

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Patients with neurological disease can become malnourished due to swallowing difficulties or unconsciousness. This malnourishment increases hospitalization duration; average total hospital cost; occurrence of infection, pressure ulcers and other complications.

• The occurrence of malnutrition in patients with neurological disease is closely related to the disease type. To detect this problem in the early stages of disease, we must utilize effective assessment methods and tools to facilitate rapid, objective, comprehensive and accurate assessment.

• Nutritional status and the degree of malnutrition are determined using anthropometric measurements, laboratory tests and a number of comprehensive nutritional assessment methods. The purpose is to objectively evaluate whether it is necessary for patients to receive nutritional intervention or treatment.

• The nutritional assessment tools currently employed in the clinical setting fall into two categories: single indicators (including ergonomic measurement and biochemical laboratory indicators) and composite indicators.

• BMI is sensitive and specific, and the associated nutritional assessment is reliable in acute cerebral apoplexy patients.

• Critical illness or injury in patients with neurological disease promotes an acute inflammatory response that has a rapid catabolic effect on lean body mass. However, the arm muscle circumference, arm fat area and arm muscle area can be calculated according to the TSF and MAC and are helpful in assessing fat content and percentage of lean body tissue.

• Patients with confusion or an inability to stand, or those for whom avoiding standing is recommended, who are unable to undergo BMI measurement should be assessed via serum albumin levels instead of BMI to obtain a score on the Nutritional Risk Screening 2002, with a score of 3 corresponding to albumin <30 g/l.

• In neurology, malnutrition universal screening tool is widely used to screen for nutritional risk in patients with stroke or spinal cord injury. Additionally, for patients with spinal cord injury, spinal nutrition screening tool is now available and is widely used by spinal cord injury centers.

• The practicality and effectiveness of the Mini Nutritional Assessment Short-Form are strong, especially for patients who are bedridden for those whose BMI cannot be effectively measured; in these cases, calf circumference or upper arm circumference can be measured instead. Similarly, the Mini Nutritional Assessment Short-Form is a very good tool for screening for malnutrition in patients with Parkinson’s disease.

• To improve their accuracy and reliability and to enhance their ability to predict adverse clinical outcomes in patients, the patient-generated subjective global assessment and Nutritional Risk Screening 2002 should be used in combination. In particular, the patient-generated subjective global assessment can be used to determine the nutritional status of these patients rapidly and can also be used to monitor nutritional support in patients with Parkinson’s disease.