It's officially March, and you know what that means… it's National Nutrition Month! To all the RDs and Dietetic Interns out there, thank you for all that you do to help improve the lives of our patients and their families every day! As RDs and RD2Bs, it's our job to help our clients navigate the world of nutrition and maintain optimal nutritional wellness. As we all know, this is often easier said than done. In the acute care setting, we typically screen patients for malnutrition using a universal screening tool, but is that tool capable of capturing all malnourished patients that enter our facility? The answer may surprise you!
The Malnutrition Universal Screening Tool (MUST) is commonly used to assess nutrition status and is scored based on current BMI, weight loss within the past 6 months, and acute illness concerns. While this tool is relatively effective, one population feels their nutritional needs are not met and that they often fall through the cracks. In recent years, patients with Crohn's Disease have spoken up about their treatment apprehensions and have begun looking to improve their quality of care.
Crohn's Disease (CD) is a chronic illness with no cure, as these patients are either experiencing a flare-up or in a state of remission. During a flare-up, patients with Crohn's are frequently malnourished due to malabsorption issues, significant weight loss, and a range of other complications. Once the flare is resolved, patients spend their remission period trying to get back to a healthy nutritional state.
Can you guess why the MUST doesn't flag these patients?
If you said timing, you are correct!
The MUST tool limits the window for weight loss and illness concerns to only the previous six months, which is an unrealistic time frame for these patients. This limitation means that if a patient with CD had a flare-up 9 months ago and is now in remission trying to recover, they would not be flagged as malnourished. The growing concerns surrounding chronic illness and treatment insufficiencies have inspired the development of an IBD-specific nutrition screening tool, which is one of the first disease-specific tools to be created.
In 2019, researchers from Oxford University created and tested the first version of this new screening tool on 101 patients with an IBD diagnosis. The IBD-specific tool screened for BMI, weight loss within the past 12 months, acute illness concerns, and other information, including the patient's last flare-up experience and complications from treatment. These patients completed both the IBD tool and the MUST tool. The researchers divided into two groups to analyze the responses from the two screening tools. After comparing results, they found that 12 patients were marked as low risk for malnutrition using the MUST tool but marked as high risk using the IBD tool. The IBD tool likely took their last flare-up experiences into consideration, putting them at greater risk for malnutrition.
Although this screening method is still in the developmental stage, it has already inspired the creation of universal, disease-specific screening tools for diabetes, heart failure, and other common illnesses. These tools are exciting for us as nutrition professionals because they will help us take better care of our patients and show them that their concerns are heard and valid.
With the future of nutrition in our hands, it's important to remember that there is always room for improvement, even in our universally trusted practices!
- Data and Statistics. (2020, August 11). Retrieved December 06, 2020, from https://www.cdc.gov/ibd/data-statistics.htm
- Diet and Nutrition Research Updates. (n.d.). Retrieved December 06, 2020, from https://www.crohnscolitisfoundation.org/diet-and-nutrition/research-updates
- Overview of Crohn's Disease. (n.d.). Retrieved December 06, 2020, from https://www.crohnscolitisfoundation.org/what-is-crohns-disease/overview
- Understanding Crohn's Disease. (n.d.). Retrieved December 06, 2020, from https://www.crohnsandcolitis.com/crohns?cid=ppc_ppd_ggl_cd_da_crohn%27s_syndrome_Exact_64Z1867745
- Wall, C., Wilson, B., Sanderson, J., & Lomer, M. (2019). P599 Development of an inflammatory bowel disease-specific nutrition screening tool (IBD-NST). Journal of Crohn's and Colitis, 13(Supplement_1). doi:10.1093/ecco-jcc/jjy222.723