The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.

Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients.

Prevalence of hospital malnutrition in Latin America: the multicenter ELAN study.

Objective To assess the association between changes in nutritional status in hospitalized patients and the occurrence of infections, complications, length of stay in hospital, and hospital charges. Design A prospective observational study with a retrospective component was conducted over a 7-month interval at a university hospital. Subjects A total of 404 adults (≥18 years old) admitted to the inpatient service for more than 7 days who were not pregnant or lactating and not a psychiatric patient were included. Main outcome measures Major outcome variables included changes in nutritional status as assessed by subjective global assessment (SGA) at hospital admission and discharge, length of stay, hospital charges, complications, and infections. Statistical analysis performed Analysis of variance with a Tukey adjustment for multiple comparisons was used to examine the impact of changes in nutritional status between nutrition change categories for continuous variables (charges and length of stay). Discrete variables were assessed using χ 2 analysis. Logistic regression was used to calculate odds ratios with 95% confidence intervals for the development of complications and infections when compared with the reference group. Results Compared with the reference group (normally nourished at admission and discharge), patients who declined nutritionally, regardless of nutritional status at admission, had significantly higher hospital charges ($28,631±1,835 vs $45,762±4,021). Odds of complications were significantly greater for patients who declined nutritionally, regardless of nutritional status at admission, compared with the reference group. Applications/conclusions Declines in patients' nutritional status while they are hospitalized, regardless of their nutritional status at admission, were associated with significantly higher hospital charges and a higher likelihood of complications. Practicing clinicians should make reducing declines in patients' nutritional status a priority regardless of patients' nutritional status at admission. J Am Diet Assoc. 2000:100:1316–1322 .

Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days

Malnutrition is not a new or a rare problem. In studies involving more than 1,327 hospitalized adult patients, 40% to 55% were found to be either malnourished or at risk for malnutrition, and up to 12% were severely malnourished. Surgical patients with likelihood of malnutrition are two to three times more likely to have minor and major complications as well as increased mortality; and their length of stay can be extended by 90% compared with the stay of well-nourished patients. Hospital charges are reported to be from 35% to 75% higher for malnourished patients than for well-nourished patients. Obtaining data to assess the nutritional status of patients is essential to optimal patient care, especially for patients at high risk for malnutrition. Nutrition assessment can be done with readily available and relatively inexpensive methods. But it is not enough to assess and identify malnutrition. Outcomes are improved and costs are saved only when appropriate intervention follows. This article identifies many well-conducted, published studies that support the findings that health outcomes of malnourished patients can be improved and that overall use of resources can be reduced by nutrition counseling, oral diet and oral supplements, enteral formula delivered via tube, and parenteral nutrition support via central or peripheral line. Early nutrition assessment and appropriate nutrition intervention must be accepted as essential for the delivery of quality health care. Appropriately selected nutrition support can address the problem of malnutrition, improve clinical outcomes, and help reduce the costs of health care.

Malnutrition and clinical outcomes: the case for medical nutrition therapy.

The incidence of malnutrition and the effect of hospitalization was evaluated in 100 consecutive admissions to the Clinical Pathology R Department of the University of Genoa. Nutritional deficiencies were evaluated at the time of admission and discharge from the Hospital, among patients hospitalized 2 weeks or longer, using the following nutrition-related parameters: body fat, muscle proteins, weigh, rate of weight loss plasma proteins level, vitamin B12 and folic acid plasma level, plasma iron and ferritin. We also considered the nutritional alterations in malnourished patients with relation to appetite decrease and to pathological status. At the admission to the hospital, the findings showed a high incidence (79%) of alterations in some nutritional parameters. In patients with nutritional impairments we observed a worsening of most of the nutritional parameters during hospitalization, especially in patients with severe appetite decrease and those affected by sepsis, neoplastic, gastric and renal diseases.

M Venturini

Papers

Hospital malnutrition: incidence and prospective evaluation of general medical patients during hospitalization.