Monitoring of Nutrition Therapy
Measuring the Effectiveness of the Nutritional Therapy
Monitoring the patient’s condition is crucial to achieve an optimal outcome and fast recovery. Proper monitoring with careful documentation and control can assess the effectiveness of the nutritional therapy. Patient status should be monitored by defined measurements and observations, such as recording of dietary intake, body weight and function and, where appropriate, laboratory parameters (e.g. blood parameters). Results of this monitoring may lead to adaptations, if necessary, of the nutrition therapy plan during the course of the patient’s condition.
Monitoring and Follow-Up of Nutrition and Fluid Intake
At least once a week, nutrition and fluid intake should be monitored and followed-up to help define nutrition therapy and guarantee effective nutrition therapy. Documenting weight development helps to provide additional insights into the nutritional status of the patient, as can laboratory testing of different blood parameters. Monitoring can be used to determine adequacy of nutrition therapy.
Regular patient monitoring should include weekly re-screening of weight gain and/or loss.
Daily Nutrition Record
For patients who are given enteral or parenteral nutrition, daily nutritional record and fluid protocols should be maintained to monitor energy, protein and fluid intake.
- Food protocol: Record the food intake and nutrient delivery of a patient to indicate the proportion of nutritional needs that have been achieved (100 percent, 75 percent, 50 percent, 25 percent, 0 percent; corresponding to 4, 3, 2, 1, 0 quarters of a plate).
- Fluid protocol: Record the daily fluid intake and delivery of a patient, indicating the amount of fluid which is consumed over the whole day orally (normal food or oral nutrition supplement), tube feeding and/or parenteral nutrition.
As appropriate, blood parameters1 should be monitored to assess the patient’s nutrition status, to monitor substrate utilization and control nutrition therapy adequacy, and to quantify inflammation and disease severity.
Nutrition experts also recommend measuring hemoglobin, sodium, potassium, magnesium, calcium, phosphate, creatinine, blood urea nitrogen, triglycerides, international normalized ratio (INR), and blood glucose weekly. In severely malnourished patients it even can be appropriate to measure potassium, magnesium, and phosphate daily for the first three days and then twice a week to monitor utilization and detect re-feeding syndrome as early as possible. Monitoring can also include the measurement of alkaline phosphatase, bilirubin and alanine aminotransferase (ALT).
Further blood monitoring parameters include:2
- Albumin: A tracking parameter for long-term interventions; direct negative correlation with mortality and rate of complications; also low in liver function disorders, post-aggression metabolism, proteinuric nephropathy, protein-losing enteropathy.
- However, nutrition deficit is detected only if protein deficiency already exists over a long time, due to long half-life of albumin.2 Moreover, albumin is not very sensitive in malnutrition because it is also low in acute stress, infections, surgery and polytrauma.
- Transferrin: A tracking parameter for short-term interventions; no clear correlation with outcome; also low in anemia, liver diseases and certain antibiotic therapies. Transferrin may be a better and more sensitive indication of nutritional status compared to albumin.
- Prealbumin: A tracking parameter for short-term monitoring of nutritional interventions. Prealbumin may be a better and more sensitive indication of nutritional status compared to albumin.
- Retinol-binding protein: A tracking parameter which is increased in limited kidney function and is also used for identification of malnutrition at an early stage increased in limited kidney function. It is only suitable for short-term monitoring.
Determine the Need for Nutritional Supplementation
Results of the food and fluid protocol documentation and blood parameters can enable clinicians to calculate the required nutritional supplementation and fluid substitution needed by the patient.