title: The Indigenous Australian Malnutrition Project: the burden and impact of malnutrition in Aboriginal Australian and Torres Strait Islander hospital inpatients, and validation of a malnutrition screening tool for use in hospitals-study rationale and protocol.
abstract: BACKGROUND
  Malnutrition is associated with adverse outcomes for hospital inpatients and is a significant economic burden on hospitals. Malnutrition is frequently under-recognised in this setting and valid screening and early diagnosis are important for timely nutritional management. Aboriginal Australian and/or Torres Strait Islander peoples (Indigenous Australians) are likely to be at increased risk of malnutrition due to their disproportionate burden, pattern and age-distribution of chronic diseases. Despite this increased risk, the burden and impact of malnutrition in Indigenous Australians is poorly understood. Furthermore, a suitable screening tool has not been validated for this vulnerable patient group. The aim of this study is to determine the burden of malnutrition, understand its impact, and validate a malnutrition screening tool for Indigenous Australian inpatients.
  
  
  METHODS
  This project involves cross-sectional, prospective cohort and diagnostic validation methodologies to assess the burden and impact of malnutrition and to validate a malnutrition screening tool. A target of 752 adult Indigenous and non-Indigenous Australian inpatients will be recruited across three different public hospitals in the Northern Territory and far north Queensland of Australia. Cross-sectional data collection will be used to determine the prevalence of malnutrition using the Subjective Global Assessment and to stratify participants based on the International Consensus Guideline Committee malnutrition aetiology-diagnostic framework. Subjects will then be followed prospectively to measure short and long-term health outcomes such as length of hospital stay, in-hospital mortality, 30-day and 6-month readmission rates. Finally, the utility of a new screening tool, the Australian Nutrition Tool, will be assessed against an existing screening tool, the malnutrition screening tool, used in these settings and the malnutrition reference standard, the Subjective Global Assessment.
  
  
  CONCLUSIONS
  Indigenous Australians continue to experience poorer levels of health than non-Indigenous Australians and issues such as food insecurity, poor diet, and a disproportionate burden of chronic disease play a key contributing role for malnutrition in Indigenous Australians. To improve the health and hospital outcomes of Indigenous and non-Indigenous Australians, it is important that patients are routinely screened using a validated screening tool. It is also imperative that the burden and impact of malnutrition is properly understood, and fully appreciated, so that early and appropriate nutritional management can be provided to this group of hospital patients.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia ; Baker IDI Heart and Diabetes Institute, PO Box 1294, Alice Springs, NT 0871 Australia.
authors.forename: Natasha F
authors.initials: NF
authors.lastname: Morris
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia ; NHMRC Centre Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.affiliation: CSIRO Food, Nutrition and Bio-Based Products, PO Box 10041, Adelaide BC, SA 5000 Australia.
authors.forename: Malcolm D
authors.initials: MD
authors.lastname: Riley
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia ; Baker IDI Heart and Diabetes Institute, PO Box 1294, Alice Springs, NT 0871 Australia ; James Cook University, School of Medicine and Dentistry, Townsville, QLD Australia ; Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3084 Australia.
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Maguire
keywords: Australian Nutrition Tool; Indigenous Australians; Malnutrition; Malnutrition screening; Malnutrition screening tool; Subjective Global Assessment