The Academy of Nutrition and Dietetics Foundation and dollars raised through its Second Century Member Campaign have supported significant research in the area of malnutrition, including the Malnutrition in Older Adults: Evidence Analysis Project.

 Project Goals 

The objective of this project is to conduct scoping and systematic reviews, develop and evidence-based nutrition practice guideline, and produce position papers on controversial topics with high quality evidence as determined by the Malnutrition in Older Adults (MOA) Panel.  Scoping review content experts advised focus on long term care and community settings because evidence-based nutrition guidance is lacking in these settings and is essential for quality care.  Based on the results of the scoping review and MOA panel discussion and survey results, the systematic reviews focused on nutrition assessment, and the following nutrition interventions:  oral nutrition supplement, food fortification, and medical nutrition therapy.  The MOA panel prioritized mortality, nutrition status, anthropometrics, dietary intake, cost effectiveness, and functional status as the top nutrition intervention outcomes of interest.

Background

In 2018, DHCC DDPG collaborated with Evidence Analysis Center (EAC) to conduct scoping and systematic reviews and develop a guideline and position paper(s) on the topic detailed under the project goal(s) above. The scoping review is complete and was published in October 2020.1  The MOA nutrition assessment systematic reviews are also complete and will be published on the Evidence Analysis Library in fall 2021.  The nutrition assessment recommendations are currently under development, and the MOA nutrition assessment manuscript will commence in fall 2021.  The MOA Nutrition Assessment systematic search identified 1,326 articles, 65 were marked for full text review, and 17 articles were included in the systematic review.

The MOA Nutrition Intervention systematic reviews are currently in progress.  The systematic search identified 8,382 articles, 89 were marked for full text review, and 70 are currently marked for inclusion.

Dissemination

A scoping review manuscript was published in JAND in October 2020.1  Future publications will include 1-2 systematic reviews, the guideline, and a position paper.  The MOA project will be presented at this year’s FNCE.

Application

The MOA nutrition assessment and nutrition intervention recommendations will provide evidence-based practice guidance for registered dietitians working in long term care and the community.  The MOA panel has so far identified the Malnutrition Assessment and Subjective Global Assessment as valid malnutrition assessment tools that should be used in LTC and the community.  A need for additional research on use of malnutrition assessment tools has been identified.  Identification of effective and feasible nutrition interventions will provide further evidence-based guidance for RDNs working the community and LTC.  Nutrition intervention systematic reviews have so far identified ONS as a cost-effective method to improve energy protein intake and improve weight gain in LTC.

Significance

The findings from this scoping review and future systematic reviews will provide an evidence base that focuses on a variety of successful nutrition management strategies for this population. The results will help RDNs improve person-centered care and clinical outcomes.

Project status

The MOA scoping review manuscript has been published, nutrition assessment systematic reviews will be published on the EAL in Fall 2021, and the nutrition assessment manuscript will commence in fall 2021.  The nutrition intervention systematic reviews are in progress.  The ONS reviews are near completion, and the remaining should be completed by the end of 2021.  Anticipated publication of the MOA guideline is spring 2022, and position paper following in summer 2022.

Our Foundation thanks the Dietetics in Health Care Communities (DHCC) Dietetic Practice Group for their generous support this guideline project.

 

Reference:

  1. Moloney L, Jarret B. Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review. 2020; in press.