About the Project

Malnutrition in hospital patients is a growing problem, with 20-45% of patients already malnourished at admission. As 70% of malnourished patients are also frail, early detection and treatment of malnutrition is one way to improve the outcomes of frail older adults.

To improve the detection and treatment of these conditions, researchers developed the Integrated Nutrition Pathway for Acute Care (INPAC) that guides hospital staff on when to conduct key nutrition care activities to improve outcomes (e.g. screening at admission). In More-2-Eat (April 2015-March 2017), 5 Canadian hospital units in 4 provinces received funding to implement INPAC over 12 months.

With the support of a research team, all were successful in improving detection and treatment of malnutrition. Clinical care was transformed in the study units; for example sites with no nutrition screening for patients at admission progressed to a rate of 75% or higher. Findings also demonstrate improvement in clinical outcomes such as a shorter length of stay. An internet-based INPAC Implementation Toolkit was developed to promote mobilization of this knowledge. What is not known is whether or not the results can be replicated under normal circumstances (i.e., no external funding for implementation at a hospital site).

To sustain and expand on this success, a Phase 2 knowledge translation project is proposed that will involve the five original Phase 1 sites and five further hospitals as Phase 2 sites. The goal of the second phase is to see if Phase 1 sites can spread their success to other units within their hospitals and if Phase 2 sites can achieve similar results across a broader group of patients. The end product will be a sustainable model including a community of practice supported by our partner the Canadian Malnutrition Task Force, and a self-serve registry that allows sites to collect and report data to change their practice. We will also confirm capacity of INPAC activities to improve clinical outcomes across diverse settings. This KT study will demonstrate the potential to transform clinical nutrition care, benefiting all prefrail and frail older adults in Canada.

Read more about the More-2-Eat study by clicking here.

Project Team

Principal Investigator:

Heather Keller, PhD, RD — University of Waterloo


Celia Laur — University of Waterloo

Jack Bell — University of Queensland & The Prince Charles Hospital, Austrailia

Helen Chen — University of Waterloo

Lori Curtis — University of Waterloo

Joel Dubin — University of Waterloo

Leah Gramlich — University of Alberta

Sumantra Ray — NNEdPro Global Centre for Nutrition and Health

Renata Valaitis — University of Waterloo