title: Multi-modal intervention improved oral intake in hospitalized patients. A one year follow-up study.
abstract: BACKGROUND
  Good nutritional practice (GNP) includes screening, nutrition plan and monitoring, and is mandatory for targeted treatment of malnourished patients in hospital.
  
  
  OBJECTIVE
  To optimize energy- and protein-intake in patients at nutritional risk and to improve GNP in a hospital setting.
  
  
  METHODS
  A 12-months observational multi-modal intervention study was done, using the top-down and bottom-up principle. All hospitalized patients (>3 days) were included.
  
  
  METHODS
  A university hospital with 758 beds and all specialities.
  
  
  METHODS
  Record audit of GNP, energy- and protein-intake by 24-h recall, patient interviews and staff questionnaire before and after the intervention.
  
  
  METHODS
  Based on pre-measurements, nutrition support teams in each department made targeted action plans, supervised by an expert team. Education, diagnose-specific nutrition plans, improved menus and eating environment, and awareness were initiated.
  
  
  METHODS
  Mann-Whitney and Kruskal-Wallis test was used for ordinal data, and Pearson Chi square test for nominative data.
  
  
  RESULTS
  Overall 545 patients participated (287 before/258 after) from 26/22 departments. There were no significant differences regarding sex, age, BMI or previous weight loss before and after the intervention. Result-indicators: Energy intake improved from 52% to 68% (p < 0.007), and protein intake from 33% to 52% (p < 0.001) (>75% of requirements). Intake of less than 50% of requirements decreased with 50%. Process-indicators: Screening improved from 56% to 77% (p < 0.001), nutrition plans from 21% to 56% (p < 0.0001), and monitoring food intake from 29% to 58% (p < 0.0001).
  
  
  CONCLUSIONS
  Intake of energy and protein as well as GNP improved using a multi-modal top-down and bottom-up approach.
authors.affiliation: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital and Aalborg University, Denmark. Electronic address: mette.holst@rn.dk.
authors.forename: M
authors.initials: M
authors.lastname: Holst
authors.affiliation: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital and Aalborg University, Denmark. Electronic address: tina.beermann@rn.dk.
authors.forename: T
authors.initials: T
authors.lastname: Beermann
authors.affiliation: Aalborg Central Hospital Kitchen, Aalborg University Hospital, Aalborg, Denmark. Electronic address: mnm@rn.dk.
authors.forename: M N
authors.initials: MN
authors.lastname: Mortensen
authors.affiliation: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital and Aalborg University, Denmark. Electronic address: losk@rn.dk.
authors.forename: L B
authors.initials: LB
authors.lastname: Skadhauge
authors.affiliation: Skills and Simulation Unit, Aalborg University Hospital, Denmark. Electronic address: kgll@rn.dk.
authors.forename: K
authors.initials: K
authors.lastname: Lindorff-Larsen
authors.affiliation: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital and Aalborg University, Denmark. Electronic address: hhr@rn.dk.
authors.forename: H H
authors.initials: HH
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004044:Dietary Proteins; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000503:physiopathology / Q000517:prevention & control; D008875:Middle Aged; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins
keywords: Implementation; Intervention; Multi professional; Nutrition recording; Nutrition teams; Undernutrition