How can we journey from malnutrition to well-nutrition? Explore takeaways from DSM’s Satellite Symposium at ESPEN 2021

• Good nutrition is key for optimal health and wellbeing. But malnutrition is frequent in older people – especially in nursing homes and hospitals – and has a significant negative impact on health, independence, and quality of life. So how can we help to raise standards for nutritional care in senior adults?
• During dsm-firmenich’s Satellite Symposium at the ESPEN 2021 Virtual Congress, renowned specialists – Prof. Philip Schütz, Marcel J.G Smets and Markus Biedermann – explored the steps that can be taken to elevate nutritional management in older people. Among other topics, the session discussed findings from a newly published sub-group analysis of the EFFORT trial investigating the impact of nutritional support on inpatients with age-related vulnerability, and latest recommendations for nutrition in care homes developed by the European Aging Network.
• Read on to discover the top four takeaways for medical directors, portfolio managers, R&D and innovation managers, and learn how you can transform malnutrition into well-nutrition in care facilities. 

Disease-related malnutrition is common in clinical settings, thought to affect one in four patients admitted to hospital.¹ While it impacts people of all ages, older people are most vulnerable to malnutrition due to changes in food intake and appetite as we age. Malnutrition can compromise immune function, leading to higher risk of infection and disease, further vulnerability, poorer patient outcomes and reduced quality of life. Therefore, timely nutritional care is critical to support these patients.

During three expert-led sessions hosted by dsm-firmenich at the ESPEN 2021 Virtual Congress, Prof. Philip Schütz, Marcel J.G Smets and Markus Biedermann explored the importance of optimal nutritional management in preventing – or reversing – malnutrition in clinical settings, plus the latest guidelines for nutritional care in older people specifically. Below, we outline four key insights from the event. 

Interested in catching up on-demand? Click here to watch the webinar session.

1. Malnutrition in older people: Where are we in 2021?

Increasing evidence shows that malnutrition is a modifiable risk factor in hospitalized patients, especially in elderly and frail patients with multiple illnesses. During his presentation, Prof. Philip Schütz, Kantonspital Aarau AG, reviewed the latest findings from a sub-group investigation of the EFFORT trial focusing on older patients.² In the study, one group received individualized early nutritional therapy according to guidelines for best nutritional management. The second group received standard nutrition provided by the hospital kitchen.

The research found that targeted medical nutrition therapy helped to increase protein and energy levels in vulnerable patients and had a positive effect on clinical outcomes. In fact, nutritional support – which included nutrition during hospitalization and nutritional advice – reduced the risk of mortality by 50% in the short term (i.e., 30 days after hospitalization). Mortality risk was also lower in the long run (six months after hospitalization) in those receiving nutritional support.

2. Assessing and addressing malnutrition

Proactive, early screening and effective nutritional support could have a significant positive influence on elderly patients in helping them overcome or prevent malnutrition. Prof. Schütz shared some recommendations for the management of malnutrition in hospital settings³, which are aligned with the ESPEN guidelines:

• Malnutrition screening within 24-48 hours of hospital admission using a validated screening tool (like NRS 2002). It is important to note that BMI is not good measure of malnutrition. Low appetite accompanied by weight loss are the biggest red flags. Assessing muscle mass via a hand grip strength test is also an indication of malnutrition that can be easily measured and monitored over time.
• If risk is identified, an individual patient assessment is needed to explore why there is malnutrition. It may be related to disease or illness, metabolic disease, depression or medication use for instance.
• Diagnosis is made and severity of malnutrition is determined.
• Individual nutritional goals are defined, including calorie requirements, protein requirements, micronutrient requirements and other nutritional targets.
• Deliver nutritional support via oral nutrition as a first step. If this is not sufficient enteral nutrition or parenteral nutrition should be introduced. It is important to take patient preferences into account at this stage.
• Continue to monitor the patient. Older people should continue to receive nutritional care after their hospital stay so they lower the risk of being readmitted to hospital malnourished.

3. Best practice for well-nutrition in care homes

There is an important shift in attitude taking place towards long-term nutritional care in the elderly. With more senior adults wanting to maintain independence for as long as possible, the focus in nursing home settings is increasingly on well-nutrition and prevention, rather than simply providing palliative care. There is already increasing recognition that nutritional management in older people is a shared responsibility among care facility management and other stakeholders.

During his session, Marcel J.G Smets from the European Aging Network (EAN) – which supports more than 10,000 care providers across 25 European countries, and champions millions of older people in Europe – introduced new practical guidelines for long-term nutritional management in elder care setting. The guidelines take into account a range of factors, like individual preferences and emphasize the importance of a supportive environment.

4. Creating a 5-star dietary culture

To conclude dsm-firmenich’s Satellite Symposium, Markus Biedermann discussed the importance of creating appealing foods via innovation in nursing homes. To date, the role of food in care homes has been to preserve and maintain life, and medical nutrition has been used for acute recovery purposes. However, the spotlight is now on quality of life. Biedermann explained that mealtimes are an important way of staying connected to others and one’s life story, and therefore a food first approach is always highly recommended to protect human dignity and independence. To champion this, it is important to develop truly appealing nutritional plans that include foods with high nutritional value and which meet the preferences of older people. Those involved in the care of senior adults should therefore consider how we can innovate new food products that provide a positive and fun eating experience, and help to overcome challenges often seen in elderly, like dysphagia.

At dsm-firmenich, we have a deep understanding of the nutritional needs of patients of all ages. That’s why we have an unparalleled record of delivering science-led innovation at every stage of your product’s development. This takes more than ingredients. It takes a partner.