Original articleUnsatisfactory knowledge and use of terminology regarding malnutrition, starvation, cachexia and sarcopenia among dietitians
Introduction
Malnutrition can be described as “a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat-free mass) and body cell mass, leading to diminished physical and mental function and impaired clinical outcome from disease” [1], [2]. Malnutrition is being used as an umbrella term for various nutrition-related disorders [2], like starvation, cachexia and sarcopenia. Starvation can be described as a pure deficit of food intake resulting in gradual loss of both fat mass and muscle mass [3]. Cachexia has been defined as “a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass” [4]. Whereas cachexia is related to chronic to subacute disease, sarcopenia can be considered a geriatric syndrome [5], characterized by the age-associated loss of skeletal muscle mass and function [6].
Clinical signs of malnutrition, starvation, cachexia and sarcopenia overlap, as they all imply muscle wasting to a various extent, however the underlying mechanisms differ fundamentally and therefore distinction between these phenomena has therapeutic and prognostic implications. In contrast to starvation, optimal nutritional therapy will not fully reverse decline of muscle mass in cachectic patients [7], although this depends on the stage of the cachexia process [8]. Furthermore, sarcopenia is a multifactorial condition in which not only nutritional deficits play a role, but also age-related hormonal deregulation, changes in the neuromuscular system and mitochondrial function, as well as genetic susceptibility and sedentary behavior [5].
It has been reported that better nutritional knowledge results in better nutritional practice [9]. To be able to distinguish starvation, cachexia, and sarcopenia from the umbrella term malnutrition, sufficient knowledge on the characteristics and underlying etiology of these phenomena is of utmost importance, to select adequate treatment. Thus far, the level of knowledge on the mentioned nutrition-related disorders among dietitians has not been extensively explored. A study in Australian dietitians reported that only 6% of the respondents correctly identified starvation, 21% cachexia and 46% sarcopenia in provided cases [10]. Furthermore, an American survey showed that only 50% of the respondents, mostly dietitians, were familiar with the 2012 Consensus Statement from the Academy of Nutrition and Dietetics on adult malnutrition [11].
In this study, we primarily aimed to determine whether dietitians in selected European countries have sufficient knowledge regarding malnutrition, starvation, cachexia and sarcopenia, and use these terms in their daily clinical work. We hypothesized that respondents with more experience or treating more malnourished patients, or those working in a hospital or in municipality (including nursing homes), have more sufficient knowledge. Secondly, we aimed to provide an overview of current practices regarding diagnosis and treatment of nutrition-related disorders.
Section snippets
Study population
This study was performed among dietitians in Belgium, the Netherlands, Sweden, and Norway, who were recruited via national and regional Associations of Dietitians. Members of these associations received an email request from their association, with information on the study and a link to the anonymous online questionnaire. Dutch dietitians were invited to participate in the study via social media as well. In Belgium, both the Flemish and the French Association of Dietitians participated in
Results
A total number of 712 persons responded to the online questionnaire, of which 369 respondents were included in the analysis (Fig. 1). The group of 343 excluded respondents consisted of 53 students and 290 persons with incomplete answers to the key questions. Demographic characteristics of the respondents are shown in Table 2. Respondents that did not complete the mandatory questions included a larger percentage with little or no experience (27%; 77/290), as compared to those that completed all
Discussion
In this survey performed in four Western European countries, we found a low percentage (13%) of dietitians with ‘sufficient knowledge’ regarding malnutrition, starvation, cachexia and sarcopenia. We also found that the terms starvation, cachexia and sarcopenia are not often used by dietitians in daily clinical work. Less than half of the respondents sufficiently scored on the definition of malnutrition. Moreover, only one third of the respondents identified all cases correctly. The findings of
Conflict of interest
No conflicts of interest.
Acknowledgements
We would like to thank Alison Yaxley and Michelle D. Miller for their original research and for providing us the questionnaire used in their study. Also we would like to thank Nieske de Boer and Elke Lammens, for participating in the data collection in the Netherlands and Belgium.
References (23)
- et al.
Diagnostic criteria for malnutrition – an ESPEN consensus statement
Clin Nutr
(2015 Jun) Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia
Clin Nutr
(2007 Aug)- et al.
Cachexia: a new definition
Clin Nutr
(2008 Dec) - et al.
Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia
J Am Med Dir Assoc
(2011 May) - et al.
Suggestions for terminology in clinical nutrition
e-SPEN J
(2014 4) - et al.
Insufficient nutritional knowledge among health care workers?
Clin Nutr
(2008 Apr) - et al.
Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status
J Nutr Health Aging
(2009 Nov) - et al.
Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials
Clin Nutr
(2003 Jun) - et al.
Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ)
Clin Nutr
(2005 Feb) - et al.
The SNAQ(RC), an easy traffic light system as a first step in the recognition of undernutrition in residential care
J Nutr Health Aging
(2010 Feb)
Cited by (30)
A survey of nurses' knowledge, attitudes, and practice of sarcopenia: A cross-sectional study
2024, Nurse Education in PracticeDeveloping a knowledge, attitude, and practice questionnaire on nutrition, physical activity, and body image for 13–14-year-old female adolescents
2023, Journal of Taibah University Medical SciencesDevelopment and validation of a new tool: The sarcopenia knowledge questionnaire
2023, Geriatric NursingMalnutrition risk screening: New insights in a new era
2022, Clinical NutritionFactors affecting the assessment of cancer cachexia by nurses caring for patients with advanced cancer undergoing chemotherapy: A cross-sectional survey
2022, Asia-Pacific Journal of Oncology NursingCitation Excerpt :Therefore, the focus of cancer cachexia research and treatment has shifted to the condition's early stages.5,6,17 Cancer cachexia differs from starvation, the gradual loss of both fat and muscle mass due to decreased food intake, and sarcopenia, associated with aging.6,7,18,19 A comprehensive assessment of all the metabolic changes, anorexia, nutrition impact symptoms, physical function, and the psychosocial effects is therefore desirable.6,20
Reimagining Nutrition Care and Mealtimes in Long-Term Care
2022, Journal of the American Medical Directors AssociationCitation Excerpt :Lack of monitoring around nutrition and hydration was also a common official complaint in a Finnish LTC database.21 The scope of dietitian practice in LTC varies widely within and between regions,18 nations,22 and globally.23 Once created by dietitians, the communication of the nutrition care plan with staff is also an issue, resulting in some residents receiving the wrong food as noted in reports from Canada and Finland.19,21