Detection of malnutrition status in palliative care and effect of nutritional on malnutrition risk

To protect the health and improve the quality of life of palliative care patients at risk of malnutrition, they need not only energy and protein but also regular micronutrients such as vitamins, minerals, and trace elements. These micro-nutrients play a critical role in regulating biological processes in the body, and their deficiencies can further worsen the already challenging health conditions of patients. Therefore, nutrition plans should be designed to include these micronutrients, as this has the potential to positively impact the prognosis of palliative care patients by preventing or delaying deterioration. This study aims to examine the effect of the nutrition of the same patients on their malnutrition score three months later by detecting the malnutrition degrees of patients with malnutrition screening tools. A total of 250 individuals who were hospitalized and treated on an outpatient basis at the Tokat Gaziosmanpaşa University EAH Palliative Care Unit between 2022-2023 were included in our study. Our study is cross-sectional and descriptive in nature. In the study, the researcher evaluated a primary caregiver for each patient and all caregivers who met the inclusion criteria were evaluated using the Patient Introduction Form, Nutrition Risk Screening Test-2002 (Nutrition Risk Screen-2002(NRS-2002)), and Mini Nutritional Assessment test (MNA). The first data collected in this study included 114 women and 136 men, while the second data collected after 3 months included 94 women, 109 men, and 47 deceased palliative care patients. The NRS-2002 and MNA averages of the patients were found to be 3.08 ± 0.99 and 2.32 ± 0.7, respectively, in the first month, and 3.11 ± 1.1 and 2.23 ± 0.73, respectively, in the third month. The averages of those who died according to the first-month data were 3.71 ± 0.98 and 2.85 ± 0.36, respectively. There was a statistically significant difference between the NRS-2002 and MNA score averages in men in the first and third-month data in the NRS-2002 scale. In this study, a total of 250 palliative care patients who were hospitalized and treated on an outpatient basis at the Tokat Gaziosmanpaşa University EAH Palliative Care Unit between 2022-2023 were included, with 114 women and 136 men in the first data collected and 94 women, 109 men, and 47 deceased palliative care patients in the data collected after 3 months. The NRS-2002 and MNA averages of the patients were found to be 3.08 ± 0.99 and 2.32 ± 0.7, respectively, in the first month, and 3.11 ± 1.1 and 2.23 ± 0.73, respectively, in the third month. The averages of those who died according to the first-month data were 3.71 ± 0.98 and 2.85 ± 0.36, respectively. There was a statistically significant difference between the NRS-2002 and MNA score averages in men in the first and third-month data in the NRS-2002 scale; men were found to be malnourished compared to women. However, there was no significant difference in the MNA scale (p>0.05). According to the NRS-2002 and MNA scores, the prevalence of malnutrition was found to be 68.2% and 45.7%, respectively, in the first month, and 68.5% and 40%, respectively, in the third month. According to the first-month data of the deceased patients, the prevalence of malnutrition was found to be 90.2% and 84.8%, respectively. The most common diseases were gastrointestinal (GIS) tumors with a rate of 22.8% in the first month, respiratory system tumors with a rate of 21.6%, breast cancer with a rate of 21.2%, urogenital system tumors with a rate of 11.6%, head-neck tumors with a rate of 6.4%, female genital tumors with a rate of 6%, brain cancer with a rate of 4.4%, neurological diseases with a rate of 2.8%, dermatological tumors with a rate of 1.2%, trauma with a rate of 0.8%, and chronic diseases with a rate of 1.2% in the first month. In the third month, breast cancer was the most common disease with a rate of 24.1%, and the deceased patients had the highest rate of respiratory system disorders with a rate of 36.2%. According to the first-month data, the rates of those who lived and died with arm circumference less than 21 cm and calf circumference less than 31 cm were 28.4% and 54.3%; 34% and 59.6%, respectively. It was observed that the arm and leg circumferences were lower in the deceased patients (according to the first-month data). There is a statistically significant negative relationship between BMI and NRS-2002 and MNA (p<0.001). An increase of one unit in the MNA value increases the risk of death by 9.711 times (p=0.015). The prevalence of malnutrition in patients is quite high. Early intervention in poor nutrition is effective in preventing malnutrition and increasing survival. The active role of the dietician in the palliative care team in detecting malnutrition risk early, applying nutritional therapy can contribute significantly to preventing malnutrition and reducing mortality. Keywords Palliative Care, Malnutrition, Enteral Nutrition, Parenteral Nutrition