What do you know about magnesium?

MAGNESIUM

Do you know what magnesium does for the human body, how much we need on a daily basis or what food sources provide it? Magnesium is an abundant mineral and its important to many biochemical processes including regulation of muscle and nerve function, blood glucose control, blood pressure regulation, protein formation and the structural development of bone.

The amount of magnesium we need depends on age and gender. For adults over age 51, the Recommended Dietary Allowance (RDA) is 320 mg/day for women and 420 mg/day for men. 50-60% of the magnesium in the body is found in the bones and most of the rest is present in soft tissue and blood serum. Magnesium balance is controlled by the kidney – when status is low, excretion in the urine is reduced; the body can conserve magnesium if reserves are low.

Magnesium is found naturally in many plant and animal products, as well as fortified foods like some breakfast cereals. It is also available as a dietary supplement and present in some medicines such as antacids and laxatives. The best way to meet the RDA is by choosing a variety of foods, and note that foods with dietary fiber generally contribute more magnesium. Consider these foods in your meal plan:

  • Nuts (almonds, cashews & peanuts including “butters”), legumes (black beans
  • and kidney beans), seeds (pumpkin and sunflower), whole grains (whole wheat
  • bread & brown rice), and green leafy vegetables (spinach and Swiss chard)
  • Fortified breakfast cereals and products fortified with 10% of the
  • “Daily Value” for magnesium
  • Soy products – soymilk and shelled edamame (green soybeans)
  • Dairy products such as plain low fat yogurt and milk

Diets of most Americans provide less than the recommended amounts of magnesium. Men over age 70 and teenage girls are most likely to have low intakes. When magnesium from the diet and supplements are combined, intake is generally above recommended amounts. Deficiency, due to low dietary intake in healthy people, is not generally common due to the kidney’s ability to control excretion, but the following groups of people are more likely to get too little magnesium:

  • Those with gastrointestinal diseases such as Crohn’s disease and celiac disease
  • Those with type 2 diabetes and/or insulin resistance
  • Those with long-term alcoholism
  • Older adults whose intake of magnesium is less than younger adults; they are also more likely to be experiencing chronic diseases and taking medications affecting magnesium absorption

Several types of medications can interfere with magnesium status or function incorrectly if not taken at the right time with magnesium supplements. Those medications include biophosphates which are used to treat osteoporosis; antibiotics because absorption might be affected; diuretics which can increase or decrease magnesium loss depending on type of diuretic; and medications treating acid reflux or peptic ulcer which can affect blood levels of magnesium if taken for a long period of time. Check with your physician or pharmacist about all dietary supplements and medications you take, both prescription and “over the counter”, to avoid drug interference or interactions. Your healthcare provider is the best person to answer your specific health questions.

Information for this article was provided with assistance from “Magnesium” Fact Sheet for Consumers (reviewed 2/2014) and “Magnesium” Fact Sheet for Health Professionals (reviewed 11/2013) NIH Office of Dietary Supplements and National Nutrient Database for Standard Reference, Release 27, 2015.

Nutrition Reconciliation and Nutrition Prophylaxis: Toward Total Health

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ABSTRACT

Malnutrition is a common and debilitating condition in the acute hospital setting that is associated with many adverse outcomes, including prolonged length of hospital stay, increased readmission rates, and increased mortality. However, malnutrition by definition may be an abnormality in either under- or overnutrition. With obesity rates rising, many patients admitted to the hospital may be overnourished from unhealthy eating habits. Unhealthy eating habits and obesity increase a patient’s risk for cardiovascular events and complications in the hospital setting.

Nutrition risk screening or nutrition reconciliation is an underutilized tool in the hospital that would identify patients with over- and undernutrition. Nutrition intervention or nutrition prophylaxis initiated in the hospital may help reduce hospital days, readmissions, and mortality. Nutrition reconciliation is a new term developed to increase the awareness of nutrition in total health. Nutrition reconciliation means that all patients have their nutritional status reconciled on admission to and discharge from the hospital. Nutrition reconciliation is defined as the process of maximizing health by helping align an individual’s current diet to the diet prescribed for him or her by the health care team. Nutrition prophylaxis is a proactive intervention to prevent a medical complication.
Mandatory nutrition reconciliation and nutrition prophylaxis is not widely performed in most hospitals. Such an intervention may help our patients by improving their short- and long-term health. In addition, nutrition reconciliation and nutrition prophylaxis may allow for a more effective use of resources to prevent a preventable disease.

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Nutrition – The Solution for Improved Post-Surgery Recovery

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In 1974, Dr. Charles Butterworth used the phrase “The Skeleton in the Hospital Closet” to  raise awareness of physician and hospital induced malnutrition (iatrogenic malnutrition) in patients.1  The premise was that patients came into the hospital and became malnourished because of a variety of reasons including fluid and food withdrawal prior to surgery or diagnostic tests, failure to assess the patient, failure to monitor food intake, and others. Failure to maintain the nutritional stature of the patient through hospitalization and after are causes of longer length of stay, poor outcomes, and early return to hospital.

With the new enhanced recovery protocols post-surgery, “patients still can’t eat after midnight before an early morning surgery, but two or three hours before surgery they do get a carbohydrate-loaded drink fortified with electrolytes, minerals and vitamins. They are pretreated for pain with non-narcotic painkillers and epidurals that are kept in place postoperatively. With careful monitoring, patients receive only necessary levels of IV fluid during surgery. Soon afterward they get out of bed to walk and may ingest solid food, and they are discharged earlier with careful instructions for home care.”

Another surgeon, Dr. Hedrick, who is the co-author of a study published online in February in the Journal of the American College of Surgeons, “found that the new protocol, used in colorectal-surgery patients at the UVA health system, helped reduce the length of hospital stay by 2.2 days compared with a control group who had conventional treatment. It also reduced complications by 17% and increased patient satisfaction with pain control by 55%. There was a cost savings of $7,129 per patient.”

Dr. Butterworth also noted that nutrition education is critical to physicians understanding the risk to their patients.  It has taken quite a few years, but, finally it appears that the lessons may have been learned. An article in the Wall Street Journal (March 31, 2015) by Laura Landro discusses the concept of “enhanced recovery” which is a method to reduce the stress on patients while reducing the potential for “surgery procedure induced malnutrition.”  Shortening the fasting time before surgery and feeding as soon as tolerable after surgery are hallmarks of the enhanced recovery process.   Many studies have shown that proper nutrition during hospitalization shortens length of stay, improves patient outcome, and helps prevent readmissions.

It is too bad that it has taken such a long time for the implementation of the holistic approach to patient care.

Sources:
1 Butterworth C. The skeleton in the hospital closet. Nutr Today. 1974;9: 4-8.
2 Thiele, RH, et al., 2015. Standardization of Care: Impact of an Enhanced Recovery Protocol on Length of Stay, Complications, and Direct Costs after Colorectal Surgery.  J. Am. College of Surgeons, 220:4 430–443.  http://www.wsj.com/articles/patients-bounce-back-faster-from-surgery-with-hospitals-new-protocol-1427739292
MARCH IS NATIONAL NUTRITION MONTH

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Designated by the Academy of Nutrition and Dietetics (AND), the 2015 theme for National Nutrition Month is “Bite into a Healthy Lifestyle.” Choosing tasty and nutritious foods in proper serving sizes along with adequate physical activity is important in staying healthy and avoiding chronic disease. This month, let’s focus on “food bites” containing calcium and its role in keeping us active and healthy — no matter our age or activity level.

A mineral found in many foods, calcium is known for its storage in bones and teeth where it supports their structure and hardness. But, we also need calcium for muscle movement and for effective nerve transmission between the brain and every part of the body. In addition, calcium is used to help blood vessels move blood through the body and assists in the release of hormones and enzymes affecting many functions. The amount of calcium needed varies with age, but the current guideline for women and men over 70 years of age is 1200 mg/day. Certain groups of people are more likely to have trouble getting enough calcium. Those groups include:

  • Postmenopausal women
  • Those with lactose intolerance who cannot digest lactose
  • Vegans (vegetarians who eat no animal products)
  • Ovo-vegetarians (vegetarians who eat eggs but not dairy)

The best advice: choose a variety of foods that provide calcium including:

  • Milk, yogurt and cheese – 8 oz. of milk = 300 mg calcium
  • Kale, broccoli, Chinese cabbage and dark green leafy vegetables
  • Fish with edible soft bones such as canned sardines and salmon
  • Legumes including black-eyed peas and white beans
  • Some breakfast cereals, fruit juices, soy and rice beverages, and tofu have calcium added. Check labels for calcium

Other factors affecting the amount of calcium absorbed in the digestive tract include:

  • Age because efficiency of calcium absorption decreases with age.
  • Vitamin D intake, present in some foods and produced in the body when skin is exposed to sunlight, increases calcium absorption.
  • Other components in food such as oxalic acid and phytic acid can reduce calcium absorption.

There are no obvious symptoms to indicate low calcium levels since the body maintains these levels in the blood by taking it from bones. Long term impact of calcium intake below recommended levels can cause low bone mass (osteopenia) and increased risk of osteoporosis (bones becoming porous, fragile and prone to fracture), a major health problem for more than 10 million adults over age 50 in the US.

Calcium dietary supplements vary depending on type and amount of calcium used, along with the use of other nutrients such as vitamin D. Before considering a supplement, consult with your doctor, pharmacist or registered dietitian as it may interact or interfere with prescribed medications.

Information source for this article: “Eating Well as You Get Older: Benefits of Eating Well” (National Institutes of Health. Senior Health) Topic last reviewed: November 2014.

BENEFITS OF EATING WELL

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According to the National Institute of Health (NIH) Senior Health website, healthy food choices make a difference in our health and quality of life. In an article, “Eating Well as You Get Older”, staff at NIH stress the impact food choice has on your health and how you look and feel. So, if you are a person who sets New Year’s Resolutions, maybe this will motivate you.

Eating Well Promotes Health

Eating a well-planned, balanced mix of foods every day has many health benefits such as reducing the risk of heart disease, stroke, type 2 diabetes, bone loss, some cancers, and anemia. If you already have one or more of these chronic diseases, eating well and being physically active may help you better manage them. Healthy eating may also help you reduce high blood pressure and lower high cholesterol. Eating well gives you the nutrients needed to keep your muscles, bones, organs and other parts of your body healthy throughout your life. These nutrients include vitamins, minerals, protein, carbohydrates, fats, and water.

Eating Well Promotes Energy

Eating well helps keep your energy level up, too. By consuming enough calories, you give your body the fuel it needs throughout the day. The number of calories needed depends on how old you are, whether you’re a man or woman, your height and weight, and how active you are.

Food Choices Affect Digestion

Your food choices also affect your digestion. For instance, not getting enough fiber or fluids may cause constipation. Eating more whole-grain foods with fiber, fruits and vegetables or drinking more water may help with constipation.

Too much of a good thing…becomes a slice of trouble

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I like pizza. My kids like pizza. I bet you like pizza too. It sounds as if we all like pizza too much. A recent study in the journal Pediatrics showed that when pizza is eaten by kids and teens they eat 84 and 230 calories more in the day, respectively. Importantly, sodium intake increases also with almost 400 milligrams higher intake per day when pizza is eaten. Now you might not think that sodium intake is a concern for kids, but, rethink – we are training their palette to prefer high sodium foods. Consumption of high sodium foods over time can lead to hypertension, which is a factor for developing further chronic conditions including diabetes, renal disease, heart disease and others.  Costs associated with hypertension are estimated to be over $40 billion each year with half of this going to medication to help reduce fluid build-up. It is interesting to hear heart docs talk about patients that they release from the hospital with orders to consume a low sodium diet but who wind up back in the hospital. The patient gets home and has nothing to eat so they call the local pizza place for takeout or delivery. Wham, high sodium results in fluid retention and a trip back to the hospital. This will cost the hospital for the readmission.

Does pizza or any food need to be high in sodium to taste good? NO. One of the hardest parts of going on a lower sodium diet is adjusting to the taste of food that is much lower in sodium. Mom’s Meals Nourishcare dietitians and chefs work to develop meals with low to moderate amounts of sodium while being highly flavored by herbs and other seasonings…and supportive of heart health.

Powell LM1, Nguyen BT2, Dietz WH3 2015.  Energy and Nutrient Intake From Pizza in the United States Pediatrics. 2015 Jan 19. pii: peds.2014-1844. [Epub ahead of print] Davis, K. Expenditures for Hypertension among Adults Age 18 and Older, 2010: Estimates for the U.S. Civilian Noninstitutionalized Population. Statistical Brief #404. April 2013. Agency for Healthcare Research and Quality, Rockville, MD.

DASH Rated #1 Best Overall Diet

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Recently, U.S. News and World Report did a comprehensive review of the 35 leading diet programs using input from health experts.  Surprisingly, they ranked the DASH Diet (Dietary Approaches to Stop Hypertension), a lesser known diet developed to fight high blood pressure, as the #1 Best Diet Overall  for people to use in trying to maintain a healthy lifestyle.  The experts felt it offered the most “nutritional completeness, safety, ability to prevent or control diabetes and support heart health.”  We applaud this finding.  The evidence from Dr. Scott Hummel a cardiologist at the University of Michigan Hospitals shows that a low sodium diet has significant beneficial effects on the heart muscle itself.  Improvements in heart function are apparent in certain cardiac patients when they consumed a modified DASH diet.  Mom’s Meals is proud to be a part of the on-going clinical trial of Dr. Hummel and the teams at University of Michigan and Columbia University.  For more on the DASH diet, go to dashdiet.org.  To see the complete diet reviews and rankings at US News and World Report go to:  http://health.usnews.com/best-diet.

Type 2 Diabetes…Sugar’s Unsweet Results

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Over the years, the United States has addressed several important public health issues through social marketing avenues.  An example is the anti-smoking campaigns “Cancer cures smoking” where educational materials were both graphic and impactful.  The recent “truth®” campaign is estimated to have avoided around $1.9 Billion in health care costs because 1.6% (approximately 300,000) fewer youths were smoking over the course of the campaign (Holtgrave et al., 2009).  The costs of smoking to society are immense and these types of campaigns are cost effective.

Another area that is ripe for a social marketing campaign is the escalating epidemic of Type II diabetes.  Data shared by the International Diabetes Foundation shows that diabetes affects over 380 million people worldwide.  In the United States alone, diabetes affects over 29 million people and costs over $69 Billion in medical bills, disabilities and early death.  It is not getting better as 1.7 million people are diagnosed with diabetes yearly and a third of our citizens are pre-diabetic.  Picture this, 73,000 foot and leg amputations occur in this country each year.  Most of these are preventable because they are caused by a failure of individuals to know how to take control of their diabetes.

For the most part Type II diabetes is preventable and controllable.  (Agree and changed to controllable.  Although there is information regarding pre-diabetes relatively few on actual diabetics although Jenny Craig did fund a study that showed A1C drops.  Diet and exercise being the most successful prescription.  A recent article by Dr. Robert Pearl (http://www.forbes.com/sites/robertpearl/2014/12/18/type-2-diabetes/), suggests that it is time for a marketing campaign to help people take control and understand the impact that their diet has on their condition.  Dr. Pearl suggests that it may be useful to begin labeling high fat, high sugar products with graphic illustrations of what happens when diabetes is uncontrolled (see his article in Forbes Magazine for a very graphic concept).

Mom’s Meals believes that consumption of adequate and appropriate nutrition can be an important part of helping control various chronic conditions including diabetes.  If you look at other places on this website you will find testimonials from individuals who have documented an improvement in their control of Type II diabetes.  Prepared, ready-to-eat meals like Mom’s Meals can be the convenient solution in the first step to an alternative lifestyle that supports health and combats chronic disease.

Source:  Holtgrave DR, Wunderink KA, Vallone DM, Healton CG. Cost-utility analysis of the National truth campaign to prevent youth smoking. Am J Prev Med. 2009;36(5):385–8.

Americans Become Heavier

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Almost one-third of all Americans are now obese according to the American Public Health Association.    According to the study, Americans are gaining weight and are less active than ever before.  Last year the obesity rate of adults in the United States increased from 27.6% to 29.4%.There has been an increase in obesity rates while at the same time a significant decline in adults activity levels. The study shows nearly 24% of adults have not exercised in the past 30 days.

Obesity is a serious health concern tied to many chronic and costly diseases. The good news … while obesity and its related health issues are serious, they are, in many cases, also preventable and reversible. High blood pressure and diabetes are among the few diseases that are directly correlated to diet and exercise. Those impacted by these diseases are encouraged to increase their activity level and boost their consumption of fruits and vegetables along with eating more lean meats. Read the full story and to see how your state ranked on the health scale. http://www.usatoday.com/story/news/nation/2014/12/10/public-health-obesity-inactivity-state-rankings/20095261/

Nutrition Support Helps lower Health Care Cost

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A recent “What’s Hot” from the Gerontology Society of America focused on elder malnutrition, a topic that Mom’s Meals has been very involved with for a couple of years.  Malnutrition in this population has been identified for many years.  However, it has taken until now for the realization that elder malnutrition may impact health care costs and that by simply feeding people an adequate and appropriate diet may have positive effects.  Interestingly, one of the articles mentions that current models of Transition Care (moving the patient from hospital to home) may have over emphasized the medico-pharma aspects of patient care.  A more holistic approach that includes nutritional care is recommended.  Mom’s Meals has recognized and been preaching that nutrition support is critical to the well being of the elderly population.  It is encouraging that policymakers are finally seeing that feeding people is good for them and good for the health care system.

Sam Beattie, Ph.D.

What you can do about malnutrition

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We understand that seniors want to continue to live independently yet may not know all the steps they can take to help avoid malnutrition.  Even small dietary changes can make a big difference in an older adult’s health and well-being. For example:

Engage doctors. If your loved one is losing weight, work with his or her doctors to identify — and address — any contributing factors. This might include changing medications that affect appetite, suspending any diet restrictions until your loved one is eating more effectively, and working with a dentist to treat oral pain or chewing problems. Request screenings for nutrition problems during routine office visits, and ask about nutritional supplements. You might also ask for a referral to a registered dietitian.

Encourage your loved one to eat foods packed with nutrients. Spread peanut or other nut butters on toast and crackers, fresh fruits, and raw vegetables. Sprinkle finely chopped nuts or wheat germ on yogurt, fruit and cereal. Add extra egg whites to scrambled eggs and omelets and encourage use of whole milk. Add cheese to sandwiches, vegetables, soups, rice and noodles.

Restore life to bland food. Make a restricted diet more appealing by using lemon juice, herbs and spices. If loss of taste and smell is a problem, experiment with seasonings and recipes.

Plan between-meal snacks. A piece of fruit or cheese, a spoonful of peanut butter, or a fruit smoothie can provide nutrients and calories.

Make meals social events. Drop by during mealtime or invite your loved one to your home for occasional meals. Encourage your loved one to join programs where he or she can eat with others.

Encourage regular physical activity. Daily exercise — even if it’s light — can stimulate appetite and strengthen bones and muscles.

Provide food-savings tips. If your loved one shops for groceries, encourage him or her to bring a shopping list, check store fliers for sales and choose less expensive brands. Suggest splitting the cost of bulk goods or meals with a friend

Remember, identifying and treating nutrition issues early can promote good health, independence and increased longevity. Take steps now to ensure your loved one’s nutrition.

How to spot malnutrition

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Over the last few weeks, we have been focusing on how to prevent and detect malnutrition in seniors. The signs of malnutrition in older adults can be tough to spot, especially in people who don’t seem at risk — but uncovering problems at the earliest stage can help prevent complications later. To detect malnutrition:

Observe your loved one’s eating habits. Spend time with your loved one during meals at home, not just on special occasions. If your loved one lives alone, find out who buys his or her food. If your loved one is in a hospital or long term care facility, visit during mealtimes.

Watch for weight loss. Help your loved one monitor his or her weight at home. You might also watch for other signs of weight loss, such as changes in how clothing fits.

Be alert to other red flags. In addition to weight loss, malnutrition can cause poor wound healing, easy bruising and dental difficulties.

Know your loved one’s medications. Many drugs affect appetite, digestion and nutrient absorption.

In the final excerpt of how to prevent and detect malnutrition in seniors we will discuss what steps you can take to help avoid malnutrition.

How Malnutrition Begins

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In our second installment on the serious health consequences of malnutrition in seniors focuses on how malnutrition begins. Information is courtesy of the Mayo Clinic staff writers

The causes of malnutrition might seem straightforward — too little food or a diet lacking in nutrients. In reality, though, malnutrition is often caused by a combination of physical, social and psychological issues. For example:

Health concerns. Older adults often have health problems, such as dementia or dental issues that can lead to decreased appetite or trouble eating. Other factors that might play a role include a chronic illness, use of certain medications, difficulty swallowing or absorbing nutrients, a recent hospitalization, or a diminished sense of taste or smell.

Restricted diets. Dietary restrictions — such as limits on salt, fat, protein or sugar — can help manage certain medical conditions, but might also contribute to inadequate eating.

Limited income. Some older adults might have trouble affording groceries, especially if they’re taking expensive medications.

Reduced social contact. Older adults who eat alone might not enjoy meals as before, causing them to lose interest in cooking and eating.

Depression. Grief, loneliness, failing health, lack of mobility and other factors might contribute to depression — causing loss of appetite.

Alcoholism. Too much alcohol can interfere with the digestion and absorption of nutrients. Nutrients might also be lacking if alcohol is substituted for meals.

Be alert of the early triggers and warning signs of malnutrition to prevent the onset of malnutrition before it begins.  The next blog in our series will focus on how to spot malnutrition in seniors.

Senior health: How to prevent and detect malnutrition

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Over the next several weeks we will be sharing information from the Mayo Clinic staff writers on the importance of nutrition for seniors.  Specifically, we will focus on malnutrition and the serious health consequences.

Good nutrition is critical to overall health and well-being — yet many older adults are at risk of inadequate nutrition. Know the causes and signs of nutrition problems in older adults, as well as steps you can take to ensure a nutrient-rich diet for an older loved one.

Problems caused by malnutrition

Malnutrition in older adults can lead to various health concerns, including:

A weak immune system, which increases the risk of infections

Poor wound healing

Muscle weakness, which can lead to falls and fractures

In addition, malnutrition can lead to further disinterest in eating or lack of appetite — which only makes the problem worse.

Malnutrition is a serious senior health issue. Know the warning signs and how to help an older loved one avoid poor nutrition.  Next week we will focus on how malnutrition begins.

How Mom’s Meals NourishCare Gets Nutritious Food to Your Table

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Much like the meals you make at home, Mom’s Meals NourishCare prepares meals from fresh ingredients that are purchased from our local suppliers. For some recipes, we go through a pallet of fresh green peppers, cleaning and trimming just like you do at home. Meal components are made and then plated under the direction of Quality Assurance chefs, who are formally trained and come from restaurant backgrounds.

Prior to the finalizing a recipe, we go through a rigorous testing process to come up with the finished product. First, we determine our target meal nutritionals. For this process, we always use reputable sources, such as American Heart Association or American Diabetes Association. Once the chefs and dietitians determine the nutritional profile of the meal, a brainstorming session occurs in which some general meal concepts are developed.

During this process, we may go to local restaurants and grocery stores to sample comparable foods that have the flavor but not necessarily the “right” nutritional composition. You would be amazed at the sodium and fat content of some commercially available products – heart attacks in a jar. We recently reformulated our marinara sauce and in doing so tasted 15 different brands of marinara. What was amazing to us was that some of the commercial brands had over 1,000 milligrams of sodium per serving!  Who Knew?

Once we have a chance to taste and evaluate commercial samples, our chefs produce a couple of versions, looking for the “gold standard” that reflects both nutritional requirements as well as great taste. This recipe is tasted and evaluated by our employees (their favorite part of their job) and then customers. Once we have the final stamp of approval from them, the recipe is scaled and piloted in the kitchen to ensure that we can produce it in quantity for our customers.

A lot of time and effort is put into each meal — just like Mom made it herself.

The Critical Role of Good Nutrition in Chronic illness and Disease An Interview with Sam Beattie, PhD, Food Science Expert

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When someone is diagnosed with a chronic or potentially life-threatening disease, their nutrition plays a critical role in their recovery. We asked Dr. Sam Beattie Ph.D. for his view on the topic, as he is an expert in the field of food safety and quality and is the Director of Nutrition Services and Education at Mom’s Meals NourishCare.

Dr. Beattie received his undergraduate degree in Food Technology from Iowa State University, his Master’s degree from South Dakota State University, and his PhD from Oregon State University in Food Science and Technology with minors in Biochemistry and Microbiology.

“Healthy eating is critical to all, and for those with a chronic illness, eating the appropriate diet can have significant impacts. For example, recent clinical studies by Dr. Scott Hummel at the University of Michigan have shown that a low sodium diet can actually improve heart function in those diagnosed with a specific type of heart failure. Consuming the appropriate nutrition can mitigate symptoms, slow disease progression and, in some cases, even reverse signs of the disease in some chronic conditions such as renal failure, diabetes, obesity, heart disease and high blood pressure.”

The root cause for many chronic diseases is, in fact, poor nutrition. Consider the incidence of obesity, high blood pressure, and heart disease — these are almost always caused by poor food choices and the amount consumed.

Nutrition is equally critical in recovery from a hospital stay or surgery, as it is central to supporting the body’s ability to heal itself. Before starting Mom’s Meals NourishCare or making a change to your diet, we recommend talking to a physician and dietitian regarding the best nutrition plan for your particular circumstance.

Narrowing the Malnutrition Gap

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By Staci Hemesath, Board Certified Specialist in Renal Nutrition, Registered Dietitian

Based on new research published in the Journal of Parenteral and Enteral Nutrition (Corkins, et al., 2014), there is an alarming number of undiagnosed malnourished patients in U.S. hospitals. Findings from the 2010 Healthcare Cost and Utilization Project revealed that only 3.2% of hospitalized patients were correctly coded as malnourished.

The Malnutrition Gap

But how many patients arrive at the hospital malnourished? Between 33%-54%, depending on the study.  This means roughly 1/3 to 1/2 of hospitalized patients are not being properly coded as malnourished! Plus, among patients that are not malnourished upon admission, approximately one third may become malnourished while in the hospital.

If left untreated, two thirds of these malnourished patients will suffer a greater decline in nutritional status during their hospital stay. This translates to a significant number of patients leaving the hospital in a nutritionally compromised state.

As an outpatient dialysis dietitian, I have witnessed the post-discharge downward spiral of many of my patients. It’s concerning that they go to the hospital to “get better,” but often leave in a weak, malnourished state.  And in many cases, they either:

1) Get readmitted after suffering a fall at home or being diagnosed with an infection or

2) Get admitted to a nursing home with a further decline in functional status

It is sad to see and makes me ponder what can be done to improve this reality.

This “malnutrition gap” reveals a tremendous opportunity to optimize quality of patient care, improve clinical outcomes, and reduce cost.  My example above highlights a few of the common adverse outcomes of malnutrition, but there are many others.

Prompt Diagnosis is Critical – New ICD-10 Codes May Help

Identifying and treating malnutrition early on is a critical step in addressing hospital malnutrition.

  • New ICD-10 Codes:  A promising step in the right direction is the mandatory implementation of ICD-10 codes, effective October 1, 2015.  The new codes require users to more specifically define each health condition. In doing so, nutrition-related issues are more likely to be identified and institutions can be reimbursed appropriately.  Successful implementation of this process can result in significant gains in hospital revenue.

Nutrition Care Model: The Alliance to Advance Patient Nutrition, an interdisciplinary collaboration of the Academy of Nutrition & Dietetics and other industry leaders, has developed a nutrition care model (Tappenden, et al., 2013) with six principles designed to improve hospital nutrition practices. One of the key principles, which is often overlooked, is the inclusion of nutrition in the discharge planning process. Ensuring that nutrition is part of the transition to home is crucial in preventing hospital readmissions.

Patients and caregivers must be given detailed instructions for nutrition care at home, and nutrition should be an essential component of follow-up appointments. Also, dietitians should be involved in the care transitions process so that appropriate interventions can be implemented, recommended, and monitored.

Dr. Sam Beattie’s discussion of nutrition reconciliation sums up this process well.

The new ICD-10 Codes and the Alliance nutrition care model are some great tools to help combat malnutrition and improve outcomes.  What other tools or resources do you know of that could help?

Sources:

http://pen.sagepub.com/content/38/2/186.full.pdf+html

http://www.journals.elsevierhealth.com/periodicals/yjada/article/S0002-8223(00)00373-4/abstract

http://pen.sagepub.com/content/38/2/186

http://www.andjrnl.org/article/S2212-2672(13)00641-2/fulltext

http://www.journals.elsevierhealth.com/periodicals/yjada/article/S0002-8223(00)00373-4/abstract

CMS Policy Change – Dietitians to Order Diets

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By Staci Hemesath, Board Certified Specialist in Renal Nutrition, Registered Dietitian

Have you heard the good news? On May 12, CMS announced its final rule stating that “all patient diets, including therapeutic diets, must be ordered by a practitioner responsible for the care of the patient, or by a qualified dietitian or qualified nutrition professional as authorized by the medical staff and in accordance with State law governing dietitians and nutrition professionals.

What Does This Mean For You?

If you are an RD/RDN or qualified nutritional professional (per State law) working in a hospital, you will have the independent authority to order therapeutic diets for your patients, including home-delivered meals, as long as you are granted privileges from your medical institution. No more delays in tracking down the busy physician or mid-level practitioner to discuss recommendations or have an order co-signed. If you identify a patient that would benefit from a therapeutic diet order or nutrition supplement, you will be able to order it on the spot.

A hospital can also grant dietitians/qualified nutrition professionals the privilege to order lab tests to monitor the effectiveness of dietary plans and orders, in accordance with individual state laws. Therefore, if you write orders for enteral or parenteral nutrition, you may also be able to write the follow-up laboratory orders to monitor blood glucose, pre-albumin, LFTs, etc. Upon reviewing results, you can then alter the diet order as warranted.

What Does This Mean For Your Patients?

How many times have your patients waited hours to have their diet liberalized, to advance from NPO, for nutrition support to be initiated, or for a supplement to be delivered, only because of a delay in tracking down a physician to co-sign a diet order? This greatly reduces patient satisfaction and jeopardizes their health.

CMS expects this new rule to greatly improve the efficiency and efficacy of nutritional care. CMS states, “The addition of ordering privileges enhances the ability that RDs already have to provide timely, cost-effective, and evidence-based nutrition services as the recognized nutrition experts on a hospital interdisciplinary team.”

Cost Savings Underestimated

The ruling could save up to $459 million in annual hospital costs, CMS estimates. However, this dollar amount is based solely on the difference in labor cost between a physician/MLP and RD ($291,104,100) and the estimated cost of reducing inappropriate parenteral nutrition usage ($167,730,675).

The savings is likely much greater when accounting for the reduced morbidity and mortality benefits, as predicted in some professional literature. Imagine a patient who lacks appropriate nutritional care while in the hospital, gets discharged in a malnourished state, suffers a fall at home, and is readmitted with a hip fracture. The cost of hospital readmissions, caused by poor nutrition, isn’t even factored into this cost savings estimate.

What You Can Do Now

The ruling officially takes effect on July 11, 2014. In the meantime, RDN’s will need to work on obtaining diet and laboratory ordering privileges from their medical institution.

If you don’t know how to get privileges granted to you, The Academy of Nutrition & Dietetics (AND) will be offering resources to assist in this effort.  For now, the ruling only applies to hospital dietitians, but AND will be working with CMS to extend authority to those working in long-term care facilities as well.

This policy change is a huge step forward for nutrition professionals. Dietitians ordering diets for their patients makes sense, doesn’t it?