nutritionDay: the largest international database on nutrition risk and care in healthcare facilities
nutritionDay (nDay) is a worldwide initiative aiming to raise awareness on disease-related malnutrition and nutritional care processes currently in use in hospital wards, intensive care units and nursing homes facilities. The nutritionDay audit was founded in 2006 by experts of the European Society for Clinical Nutrition and Metabolism (ESPEN) and of the Medical University of Vienna and it has been carried on every year as a one-day cross-sectional audit in November. To date, the project has collected data from more than 276,000 patients and residents in over 70 countries worldwide.
The audit aims to serve as a tool to assess the prevalence of malnutrition in the participating units and to collect data on patients’ characteristics, malnutrition risk factors and quality indicators of nutritional care. Annual participation to nutritionDay allows benchmarking and annual monitoring of nutrition care structures and processes in the unit.
Participation to the audit is easy and free of charge. All documents and information for participation are downloadable from the nutritionDay website.
The nutritionDay questionnaires
The audit is based on questionnaires specifically developed through the years for four different settings hospital wards, oncology wards, ICU and nursing homes. Hospital questionnaires were updated in 2016 to include quality indicators of nutrition care. In 2018, the Hospital Express version was launched. This is a compact form of the original hospital questionnaires representing only short assessment of selected aspects of nutrition care in the unit. No prior knowledge is needed to fill out the questionnaires.
Questionnaires systematically record data about patient food intake, weight loss and nutritional support, as well as other factors related to the facility, staff and current clinical practices . In the year 2020, specific questions on COVID-19 have also been included in the questionnaires. Outcome of patients recruited on nutritionDay is collected 30, 60 or 180 days after nDay respectively for the category Hospital, ICU and Nursing Homes.
The audit is patient-centered as patients themselves are asked to respond to an easy set of questions about their food intake, habits and health status. Information are also collected by the unit healthcare professionals (doctors, nurses, dietitians) which give clinical feedback on the health status of the same patients. Questionnaire are available in more than 30 languages to be able to include the majority of the patients in the unit.
The nutritionDay unit reports for benchmarking
Upon participation, units receive a comprehensive graphical report on their unit data with regional and worldwide comparison to units from the same specialty. Repeated participation allows benchmarking as well as monitoring of the nutrition care and its structure elements in the unit. Units are thus empowered, by available data, to determine local needs, to bring attention to specific area which need changes as well as to allow unit data comparison at a local and international level. Only for hospital category nutritionDay provides National Reports which show aggregated results from all participating units in a country in a year.
The nutritionDay worldwide research
The large nDay database, with data from 276000 patients and residents, allows national and international analysis on nutrition care elements and processes in hospitalized patients and nursing homes residents. Large data analysis results, published in more than 35 peer-reviewed publications highlight the importance of monitoring major risk factors associated to malnutrition and poor outcome, point out to current practices and existing quality indicators of nutrition care and its association with possible gaps in the management of patients who are malnourished or at risk of malnutrition.
Researchers interested in carrying on a research project using nutritionDay data are welcome to submit a research proposal in English to the nDay scientific Board.
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1: Pearcy J, Agarwal E, Isenring E, Somani A, Wright C, Shankar B. Ward-based nutrition care practices and a snapshot of patient care: Results from nutritionDay in the ICU. Clin Nutr ESPEN. 2021 Feb; 41:340-345. doi:10.1016/j.clnesp.2020.10.022. Epub 2020 Nov 17. PMID: 33487287.
2: Ostrowska J, Sulz I, Tarantino S, Hiesmayr M, Szostak-Węgierek D. Hospital Malnutrition, Nutritional Risk Factors, and Elements of Nutritional Care in Europe: Comparison of Polish Results with All European Countries Participating in the nDay Survey. Nutrients. 2021 Jan 18;13(1):E263. doi: 10.3390/nu13010263. PMID: 33477640.
3: Wright C, Shankar B, Marshall S, Pearcy J, Somani A, Agarwal E. Prevalence of malnutrition risk and poor food intake in older adults in Indian hospitals: A prospective observational nutritionDay study with novel mapping of malnutrition risk to the Malnutrition Screening Tool. Nutr Diet. 2020 Sep 28. doi: 10.1111/1747-0080.12641. Epub ahead of print. PMID: 32985081.
4: Moick S, Hiesmayr M, Mouhieddine M, Kiss N, Bauer P, Sulz I, Singer P, Simon J. Reducing the knowledge to action gap in hospital nutrition care – Developing and implementing nutritionDay 2.0. Clin Nutr. 2020 Jul 2:S0261-5614(20)30332-0. doi: 10.1016/j.clnu.2020.06.021. Epub ahead of print. PMID: 32747205.
5: Kontogianni MD, Poulia KA, Bersimis F, Sulz I, Schindler K, Hiesmayr M, Chourdakis M. Exploring factors influencing dietary intake during hospitalization: Results from analyzing nutritionDay's database (2006-2013). Clin Nutr ESPEN. 2020 Aug;38:263-270. doi: 10.1016/j.clnesp.2020.04.001. Epub 2020 Apr 25. PMID: 32690167.
6: Cardenas D, Bermúdez C, Pérez A, Diaz G, Cortes LY, Contreras CP, Pinzón- Espitia OL, Gomez G, Gonzalez MC, Fantin R, Gutierrez J, Sulz I, Moick S, Tarantino S, Hiesmayr M. Nutritional risk is associated with an increase of in- hospital mortality and a reduction of being discharged home: Results of the 2009-2015 nutritionDay survey. Clin Nutr ESPEN. 2020 Aug;38:138-145. doi: 10.1016/j.clnesp.2020.05.014. Epub 2020 Jun 25. PMID: 32690148.
7: Hiesmayr M, Tarantino S, Moick S, Laviano A, Sulz I, Mouhieddine M, Schuh C, Volkert D, Simon J, Schindler K. Hospital Malnutrition, a Call for Political Action: A Public Health and NutritionDay Perspective. J Clin Med. 2019 Nov 22;8(12):2048. doi: 10.3390/jcm8122048. PMID: 31766583; PMCID: PMC6947230.
8: Barazzoni R, Sulz I, Schindler K, Bischoff SC, Gortan Cappellari G, Hiesmayr M; nutritionDay Research Group. A negative impact of recent weight loss on in-hospital mortality is not modified by overweight and obesity. Clin Nutr. 2020 Aug;39(8):2510-2516. doi: 10.1016/j.clnu.2019.11.007. Epub 2019 Nov 12. PMID: 31761390.
9: Rattanachaiwong S, Warodomwichit D, Yamwong P, Keawtanom S, Hiesmayr M, Sulz I, Singer P. Characteristics of hospitalized patients prescribed oral nutrition supplements in Thailand: A cross-sectional nutrition day survey. Clin Nutr ESPEN. 2019 Oct;33:294-300. doi: 10.1016/j.clnesp.2019.05.012. Epub 2019 Jun 6. PMID: 31451271.
10: Sauer AC, Goates S, Malone A, Mogensen KM, Gewirtz G, Sulz I, Moick S, Laviano A, Hiesmayr M. Prevalence of Malnutrition Risk and the Impact of Nutrition Risk on Hospital Outcomes: Results From nutritionDay in the U.S. JPEN J Parenter Enteral Nutr. 2019 Sep;43(7):918-926. doi: 10.1002/jpen.1499. Epub 2019 Jan 22. PMID: 30666659.
11: Wirth R, Pourhassan M, Streicher M, Hiesmayr M, Schindler K, Sieber CC, Volkert D. The Impact of Dysphagia on Mortality of Nursing Home Residents: Results From the nutritionDay Project. J Am Med Dir Assoc. 2018 Sep;19(9):775-778. doi: 10.1016/j.jamda.2018.03.016. Epub 2018 May 31. PMID:29778638.
12: Sun H, Zhang L, Zhang P, Yu J, Kang W, Guo S, Chen W, Li X, Wang S, Chen L, Wu J, Tian Z, Wu X, Liu X, Liu Y, Wang X. A comprehensive nutritional survey of hospitalized patients: Results from nutritionDay 2016 in China. PLoS One. 2018 Mar 22;13(3):e0194312. doi: 10.1371/journal.pone.0194312. PMID: 29566016;
13: Van der Werf A, Arthey K, Hiesmayr M, Sulz I, Schindler K, Laviano A, Langius J, de van der Schueren M. The determinants of reduced dietary intake in hospitalised colorectal cancer patients. Support Care Cancer. 2018 Jun;26(6):2039-2047. doi: 10.1007/s00520-018-4044-1. Epub 2018 Jan 19. PMID: 29352452; PMCID: PMC5919993.
14: Henriksen C, Gjelstad IM, Nilssen H, Blomhoff R. A low proportion of malnourished patients receive nutrition treatment - results from nutritionDay. Food Nutr Res. 2017 Oct 25;61(1):1391667. doi: 10.1080/16546628.2017.1391667. PMID: 29151831; PMCID: PMC5678450.
15: Streicher M, Wirth R, Schindler K, Sieber CC, Hiesmayr M, Volkert D. Dysphagia in Nursing Homes-Results From the NutritionDay Project. J Am Med Dir Assoc. 2018 Feb;19(2):141-147.e2. doi: 10.1016/j.jamda.2017.08.015. Epub 2017 Oct 10. PMID: 29030310.
16: Schindler K, Pichard C, Sulz I, Volkert D, Streicher M, Singer P, Ljungqvist O, Van Gossum A, Bauer P, Hiesmayr M. nutritionDay: 10 years of growth. Clin Nutr. 2017 Oct;36(5):1207-1214. doi: 10.1016/j.clnu.2016.11.004. Epub 2016 Nov11. PMID: 27916337.
17: Zheng H, Huang Y, Shi Y, Chen W, Yu J, Wang X. Nutrition Status, Nutrition Support Therapy, and Food Intake are Related to Prolonged Hospital Stays in China: Results from the NutritionDay 2015 Survey. Ann Nutr Metab. 2016;69(3-4):215-225. doi: 10.1159/000451063. Epub 2016 Nov 29. PMID: 27894108.
18: Schindler K, Themessl-Huber M, Hiesmayr M, Kosak S, Lainscak M, Laviano A, Ljungqvist O, Mouhieddine M, Schneider S, de van der Schueren M, Schütz T, Schuh C, Singer P, Bauer P, Pichard C. To eat or not to eat? Indicators for reduced food intake in 91,245 patients hospitalized on nutritionDays 2006-2014 in 56 countries worldwide: a descriptive analysis. Am J Clin Nutr. 2016 Nov;104(5):1393-1402. doi: 10.3945/ajcn.116.137125. Epub 2016 Oct 12. PMID: 27733401.
19: Streicher M, Themessl-Huber M, Schindler K, Sieber CC, Hiesmayr M, Volkert D. nutritionDay in Nursing Homes-The Association of Nutritional Intake and Nutritional Interventions with 6-Month Mortality in Malnourished Residents. J Am Med Dir Assoc. 2017 Feb 1;18(2):162-168. doi: 10.1016/j.jamda.2016.08.021. Epub 2016 Oct 11. PMID: 27742584.
20: Streicher M, Themessl-Huber M, Schindler K, Sieber CC, Hiesmayr M, Volkert D. Who receives oral nutritional supplements in nursing homes? Results from the nutritionDay project. Clin Nutr. 2017 Oct;36(5):1360-1371. doi:10.1016/j.clnu.2016.09.005. Epub 2016 Sep 17. PMID: 27692932.
21: Bendavid I, Singer P, Theilla M, Themessl-Huber M, Sulz I, Mouhieddine M, Schuh C, Mora B, Hiesmayr M. NutritionDay ICU: A 7 year worldwide prevalence study of nutrition practice in intensive care. Clin Nutr. 2017 Aug;36(4):1122-1129. doi: 10.1016/j.clnu.2016.07.012. Epub 2016 Aug 9. PMID:27637833.
22: Timing of parenteral nutrition in ICU patients: a transatlantic controversy. Veraar C, Geilen J, Fischer A, Sulz I, Tarantino S, Mouhieddine M, Mora B, Schuh C, Singer P, Hiesmayr MJ Clinical Nutrition ESPEN, https://doi.org/10.1016/j.clnesp.2021.08.007.
23: Predictors of incident malnutrition-a nutritionDay analysis in 11,923 nursing home residents. Torbahn G, Sulz I, Großhauser F, Hiesmayr MJ, Kiesswetter E, Schindler K, Sieber CC, Visser M, Weber J, Volkert D. Eur J Clin Nutr. 2021 Jul 8. doi: 10.1038/s41430-021-00964-9. Epub ahead of print. PMID: 34239065.
24: Are traditional screening tools adequate for monitoring the nutrition risk of in-hospital patients? An analysis of the nutritionDay database. Cardenas D, Bermúdez C, Pérez A, Diaz G, Cortes LY, Contreras CP, Pinzón-Espitia OL, Gómez G, González MC, Fantin R, Gutierrez J, Sulz I, Tarantino S, Hiesmayr M. JPEN J Parenter Enteral Nutr. 2021 Feb 7. doi: 10.1002/jpen.2085. Online ahead of print. PMID: 33554364