Profiles Advancing Clinical Nutrition
Abbott Fund Institute for Nutrition Science
The Abbott Fund Institute of Nutrition Science (AFINS) is the first program of its kind to advance the understanding and clinical practice of nutrition – first at Shanghai Children’s Medical Center (SCMC) in Shanghai and now at Bach Mai Hospital in Hanoi. AFINS is designed to advance clinical nutrition within hospitals by providing training and health education, clinical research and high-quality nutritional patient care nationwide.
China has a large percentage of children suffering from malnutrition as a result of limited access to nutritious foods and because many families are not educated about good nutrition. Here, Shanghai Children's Medical Center health care workers are discussing patient cases.
In China, the Abbott Fund established AFINS in partnership with Project HOPE and Shanghai Children’s Medical Center (registration counter depicted here). The program is designed to provide a regional model for best practices in hospital-based pediatric nutrition. As part of an educational exchange in late 2009, partners from AFINS Vietnam toured SCMC in China.
Depicted here, SCMC nutrition experts share their techniques while making rounds in hospital intensive care units.
Displayed here are examples of nutritional products, medical devices, drugs and other tools used at SCMC.
AFINS in Vietnam is just one part of Abbott’s global commitment to advancing nutrition science to help people live healthier lives.
AFINS China has already trained almost 800 physicians and nearly 400 nurses and dietitians. In Vietnam, the program has helped integrate nutrition education into the curriculum at local medical schools, leading to the creation of sound nutritional guidelines for hospitals.
Xin Yu, born four weeks premature, weighed only 2 pounds, 13.5 ounces (1.29 kg) at birth. She was immediately admitted to the neonatal intensive care unit at Shanghai Children’s Medical Center.
Today, Xin Yu is a happy, healthy, thriving little girl, thanks to the help she received from the Abbott Fund Institute for Nutrition Science.
The Juans, residents of Shanghai, had experienced difficulties in starting a family, so they were overjoyed when Ms. Juan became pregnant in June 2010. Unfortunately, despite taking great care during her pregnancy, she experienced medical complications that caused her to experience early labor. Her daughter, Xin Yu, arrived four weeks premature, weighing only 2 pounds, 13.5 ounces (1.29 kg) at birth.
Xin Yu (whose name means “happiness”) was immediately admitted to the neonatal intensive care unit at Shanghai Children’s Medical Center (SCMC). One of the immediate concerns was making sure that all of Xin Yu’s nutritional needs were met. “Premature babies will have a significant developmental disadvantage if they don’t meet the nutrient needs for development,” says Hong Li, M.D., Executive Director of the Clinical Nutrition Department at SCMC. “Malnutrition as an infant can have a lasting effect on cognitive ability or IQ later in life.”
Fortunately, Xin Yu was in good hands. The neonatal intensive care unit at SCMC is staffed by a team of doctors and nurses who have received advanced training in clinical nutrition, thanks to the Abbott Fund Institute for Nutrition Science (AFINS). Established in 2007 with an initial $2.5 million grant from the Abbott Fund, AFINS represents a unique collaboration among Abbott, Shanghai Children’s Medical Center and Project HOPE, a respected nonprofit organization that uses education and humanitarian assistance programs to achieve sustainable advances in health care. Two Abbott experts – one from the United States and one from China – work as AFINS senior technical advisory consultants to strengthen program implementation and provide professional consultation.
AFINS is designed to enhance clinical nutrition skills in hospital settings by providing health care professionals with training, education and the opportunity to perform clinical research. So far AFINS has trained more than 2,200 pediatric clinical health professionals in China in the essential components of clinical support and dietitian practice. “Since its establishment, AFINS has further enhanced SCMC’s capacities in nutrition research while providing evidence-based data that will hopefully aid in the development of clinical nutrition support guidelines for China,” says Katherine Pickus, Divisional Vice President for Citizenship at Abbott. “Most importantly, AFINS has demonstrated the impact of nutrition support clinical practice for children with special dietary needs.”
Getting Results, Raising Awareness
There is ample evidence that the training provided by AFINS has had a beneficial impact at Shanghai Children’s Medical Center. For example, the complication rate associated with nutrition support therapy at the hospital has decreased from 1.4 percent to 0.45 percent since the AFINS training began. At the end of 2010, SCMC became the first and only children’s hospital in mainland China to successfully receive accreditation from Joint Commission International, which singled out the hospital’s nutrition screening practices for particular praise. Additionally, 100 percent of SCMC inpatients are now screened, upon admission, against the World Health Organization’s nutritional standards, so health care professionals can flag any potential nutritional needs, risks or problems.
“The establishment of AFINS has significantly improved the awareness of nutrition assessment among SCMC’s health professionals,” says Dr. Hong. “Over the last few years, pediatric malnutrition rates have fallen, due in part to AFINS’ training, as well as growing nutrition awareness in society at large.”
Xin Yu’s Success Story
All of the AFINS research and training proved their value in the care given to baby Xin Yu. A nutrition assessment showed that the child was at high risk for malnutrition. Her prematurity prevented her from tolerating oral glucose supplements. Ordinarily, doctors would have instructed Ms. Juan to pump breast milk, but Ms. Juan was taking a steroid medication that could have been transmitted to her baby via breast milk. So her doctors needed to find another way to get Xin Yu the nutrition she desperately needed. Under the circumstances, SCMC nutritionists determined that it would be best to administer nutrition intravenously.
Following ten days of this intravenous therapy, Xin Yu’s condition had improved. Her weight increased to 4 pounds, 4 ounces (1.92 kg). As Xin Yu’s gastrointestinal system developed, the neonatal intensive care team decided to supplement her intravenous treatment with a little oral nutrition using a special infant formula designed for premature children.
By her three-week birthday, Xin Yu had improved to the point where intravenous treatment could be discontinued and she could drink enough formula to meet all her nutritional needs. Four weeks after she was born, Xin Yu’s weight had reached 4 pounds, 7 ounces (2.02 kg). Now her parents could cradle their child in their arms, and Xin Yu was well enough to be successfully discharged from the medical center. Thanks to the efforts of the AFINS-trained neonatal intensive care team, the therapy had been a great success, without any complications from the prolonged intravenous nutrition support. As part of the AFINS-designed protocol, the nutritionists and dietitians at SCMC gave the Juan family both verbal and written information on proper infant feeding.
“When we visited Xin Yu later at home, we were so happy to see that she has grown into a healthy baby girl,” says Jenny Xu, Senior Program Manager at Project HOPE’s Shanghai office. “She is very active and curious, and you can tell that she is totally healthy and has no lasting effects from her prematurity. Of course, Xin Yu is just one of the many children who have received essential medical treatment at SCMC. The establishment of the AFINS has benefited many critically ill children through the work of the nutrition support team at SCMC.”
Xin Yu still returns to SCMC for regular examinations, all of which indicate that she is in fine health, with her height, weight and overall development in line with normal criteria. For Dr. Hong, Xin Yu’s recovery just underscores the extent to which clinical nutrition plays a key role in the supportive medical care of critically ill patients. “Without proper nutrition support, a patient’s wound will not heal properly, a child’s immune system will be compromised and a patient’s body weight will significantly decrease,” says Dr. Hong. “Patients need energy to fight their diseases and to boost their immune system. Nutrition status is a critical driving force in a patient’s recovery. As medical science continues to strive to save lives, nutrition and other forms of supportive care become even more essential components to a patient’s full recovery from acute or chronic diseases.”
Extending SCMC’s Successes Throughout China and Beyond
The initial Abbott Fund $2.5 million three-year grant that created AFINS in 2007 was intended primarily to train physicians and nurses at SCMC and to prove the value of nutritional training in a Chinese hospital setting. In 2010, the Abbott Fund awarded SCMC-based AFINS another $2.5 million three-year grant through Project HOPE to ensure the program’s ongoing sustainability.
During this second phase of the project, AFINS has worked to disseminate nutritional training to seven major regional Chinese children’s hospitals and sponsor a dozen research projects on nutritional assessments and clinical care in China. The publication of these research results, which are currently under review by respected peer-reviewed research journals, is intended to encourage the Chinese hospital community to develop and enhance hospital-based nutritional assessments and standard of care in clinical nutrition throughout the country.
Meanwhile, AFINS research and training activities continue at SCMC and at the seven Chinese regional hospitals, through nutrition education workshops. Numerous training sessions are held throughout the year in order to maintain high quality and testing standards.
One long-term goal is to promote the standardization of China’s nutrition support guidelines by showing the government the importance of clinical nutrition in disease recovery. With greater awareness, AFINS hopes to expand the role of dietitians in clinical service, health education and disease prevention.
Building on its success in Shanghai, AFINS expanded its program activities to Vietnam in 2010. In Vietnam, the Abbott Fund is partnering with Boston University to support the National Institute of Nutrition, Bach Mai Hospital and Hanoi Medical University. Funded through 2013 with $3.8 million in Abbott Fund grants, AFINS Vietnam seeks to improve the nutritional status of patients in Vietnamese hospitals across the country by establishing a center of excellence at Bach Mai Hospital, which will serve as a model for hospital-based clinical nutrition best practices.
The program focuses on development and implementation of clinical nutrition guidelines, providing training and health education as well clinical nutrition research and expansion of undergraduate and postgraduate training in clinical nutrition. To date, AFINS Vietnam has conducted in-service training in clinical nutrition for more than 300 staff members at Bach Mai, the National Institute of Nutrition, Hanoi Medical University and other regional hospitals. In 2010, AFINS organized Vietnam’s first-ever national conference on clinical nutrition. The conference has become an annual event; it will be held this year for the third time.
Closely aligned and coordinated with the strategy of the Vietnamese Ministry of Health, AFINS developed a training curriculum for a one-year specialty program in clinical nutrition at Hanoi Medical University, enrolling the program’s first class in 2011. Planning is already under way to design a more comprehensive bachelor’s program in clinical nutrition for nursing students at the university, as well as a postgraduate specialty training program in clinical nutrition there for nurses and, at Bach Mai, for medical doctors.
AFINS has developed clinical nutrition guidelines within Bach Mai Hospital that are being shared with provincial hospitals nationwide, along with supporting guidance and training for implementation. Under AFINS’ guidance, the National Institute of Nutrition conducted the country’s first-ever large-scale hospital-based malnutrition study at Bach Mai Hospital in 2011, presenting the results of the study at a medical conference in Bangkok. AFINS’ program partners in Vietnam have taken enthusiastic ownership of the effort to build a hospital-based clinical nutrition infrastructure, generating confidence that the program will achieve sustainable success far beyond the four-year grant time frame.
Note: All data in the Global Citizenship section reflects activities prior to the separation of Abbott and AbbVie on January 1, 2013.