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Objectives
n Malnutrition in hospitals
n Definition
n Assignment
Mira Mutiyani
6 March 2017
Nutrition Screening/2017/MM
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Nutrition Screening/2017/MM Mahan L.K, 2016 Nutrition Screening/2017/MM Mahan L.K, 2016
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+ Kesimpulan dari forum diskusi tentang Malnutrisi di RS
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n Malnutrition affects
morbidity by impaired
wound healing and immune Semua pasien pada awal masuk RS perlu dilakukan skrinning gizi untuk
system with increased rate mendeteksi pasien yang berisiko mempunyai masalah gizi
of infectious and non-
infectious complication rate
and a general impairment
of convalescence. Alat skrinning harus mudah dan dapat diterima serta teruji validitasnya
n These consequences of
malnutrition result in Skrinning harus diulang secara periodik
increased treatment costs.
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Nutrition screening
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The nutritional care process including screening, planning, and monitoring according to ESPEN guidelines.
Notes: REQ(requirements of energy and protein), feeding (i.e, food, supplements, tube feeding, and parenteral nutrition), monitoring (weight and food
registration).
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n Screening and
Actual condition? : BB, TB, IMT. Pengukuran LILA (jika assessment are integral
tidak dapat dilakukan pengukuran BB dan TB) parts of the nutrition care
process (NCP)
Is the condition stable? : kehilangan BB, jika kehilangan
BB 5% atau lebih selama 3 bulan maka dianggap n Nutrition risk is
signifikan determined through a
nutrition screening
Will the condition worsen? : pertanyaan tentang asupan process.
makan yang menurun (bisa saat di RS atau riwayat gizi).
Apabila asupan makan < kebutuhan penurunan BB
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+ Nutritional screening tools for hospitalized children
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their aim
The goals of each screening tool Comparison of screening tools according to 4 main
principles of a screening tool (ESPEN)
Joosten K F.M and Hust J.M, 2013 Joosten K F.M and Hust J.M, 2013
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Paediatrics (STAMP)
Kesimpulan: Skor NRS: 0-3 tidak beresiko malnutrisi; skor 4-5 beresiko
sedang, skor > 7 resiko tinggi
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Nutrition Screening/2017/MM Donna J. Secker, 2011 Nutrition Screening/2017/MM Donna J. Secker, 2011
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n The parameters include recent weight loss and recent poor dietary intake. The tool is useful
for the acute hospitalized adult population and was the only one of the 11 evaluated by the
EAL shown to be valid and reliable for identifying problems in acute care and hospital-based
ambulatory care settings (AND, 2013b; Box 4-1).
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Dikembangkan oleh: Dr. Susetyowati, DCN., M.Kes (Staf pengajar di PS Gizi Kesehatan FK UGM Yogyakarta)
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Nutritional screening tools for Elderly Nutritional Risk Index (NRI)
Protein-energy malnutrition (PEM) is a common disorder in the elderly.
Estimations of the prevalence of PEM vary (20 78% in elderly medical patients) n NRI = (1.159 x Albumin) + (41.7 x berat sekarang/berat biasa)
Untuk mengidentifikasi
Nutritional
masalah gizi pada usia lanjut
Berhubungan dengan
n Ket:
Risk Index indikator klinis dan biokimia n Albumin: albumin serum (g/L)
(NRI) Dikembangkan oleh Veteran
Affairs Total Parenteral n Berat biasa: didefinisikan sebagai berat stabil lebih dari 6 bulan sebelum masuk
Cooperative
RS (Gibson, 2005)
Untuk populasi usia lanjut
Menggunakan indikator
biologis: serum albumin dan
berat badan n Kategori ambang batas pengukuran NRI menurut Gibson, 2005 adalah sbb:
Ada modifikasi metode NRI:
Geriatric indikator BB dan
Nutrition pengukuran TB melalui
Risk Index pengukuran tinggi lutut Status Gizi Ambang Batas
Konversi TB dan TL :
persamaan Chumlea
BB dengan formula Lorents
Tidak ada malnutrisi > 100
(Wlo)
Pasien di bangsal bedah Malnutrisi ringan 97.5 - 100
Malnutrisi sedang 83.5 94.7
Mini Banya digunakan di RS untuk
Nutritional pasien lansia
Malnutrisi berat < 83.5
Assessment Cukup sederhana, lengkap
(MNA) untuk menilai status gizi
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Kategori GNRI
Berisiko tinggi < 82
Berisiko sedang 82 - < 92
Berisiko rendah 92 - 98
Tidak berisiko > 98
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References
n Hammond K.A, Mahan L.K, 2016. Intake: Analysis of the Diet. Krauses.
Food and the Nutrition Care Process, 14th ed. Elsevier.
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