Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010
01 Oct 2013-
TL;DR: The Australasian Nutrition Care Day Survey (ANCDS) ascertained if malnutrition and poor food intake are independent risk factors for health-related outcomes in Australian and New Zealand hospital patients as mentioned in this paper.
Abstract: Background & aims
The Australasian Nutrition Care Day Survey (ANCDS) ascertained if malnutrition and poor food intake are independent risk factors for health-related outcomes in Australian and New Zealand hospital patients.
Methods
Phase 1 recorded nutritional status (Subjective Global Assessment) and 24-h food intake (0, 25, 50, 75, 100% intake). Outcomes data (Phase 2) were collected 90-days post-Phase 1 and included length of hospital stay (LOS), readmissions and in-hospital mortality.
Results
Of 3122 participants (47% females, 65 ± 18 years) from 56 hospitals, 32% were malnourished and 23% consumed ≤ 25% of the offered food. Malnourished patients had greater median LOS (15 days vs. 10 days, p < 0.0001) and readmissions rates (36% vs. 30%, p = 0.001). Median LOS for patients consuming ≤ 25% of the food was higher than those consuming ≤ 50% (13 vs. 11 days, p < 0.0001). The odds of 90-day in-hospital mortality were twice greater for malnourished patients (CI: 1.09–3.34, p = 0.023) and those consuming ≤ 25% of the offered food (CI: 1.13–3.51, p = 0.017), respectively.
Conclusion
The ANCDS establishes that malnutrition and poor food intake are independently associated with in-hospital mortality in the Australian and New Zealand acute care setting.
Citations
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TL;DR: In this article, a range of simple and validated screening tools can be used to identify malnutrition in older adults, e.g. MST, MNA-SF and MUST, at diagnosis, admission to hospitals or care homes and during follow up at outpatient or General Practitioner clinics, at regular intervals depending on clinical status.
363 citations
TL;DR: To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1‐month follow‐up in older adults with nondisabling conditions.
Abstract: Objectives
To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions.
Design
Prospective cohort study.
Setting
Internal medicine wards in two Israeli medical centers.
Participants
Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem.
Measurements
Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge. In-hospital mobility, continence care, sleep medication consumption, satisfaction with hospital environment, and nutrition intake were assessed using previously tested self-report instruments.
Results
Two hundred eighty-two participants (41.2%) reported functional decline at discharge and 317 (46.3%) at 1 month after discharge. Path analysis indicated that in-hospital mobility (standardized maximum likelihood estimate (SMLE) = −0.48, P < .001), continence care (SMLE = −0.12, P < .001), and length of stay (LOS) (SMLE = 0.06, P < .001) were directly related to functional decline at discharge and, together with personal risk factors, explained 64% of variance. In-hospital mobility, continence care, and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge (SMLE = 0.45, P < .001). Nutrition consumption (SMLE = −0.07, P < .001) was significantly related to functional decline at 1 month after discharge, explaining, together with other risk factors, 32% of variance.
Conclusion
In-hospital low mobility, suboptimal continence care, and poor nutrition account for immediate and 1-month posthospitalization functional decline. These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory.
300 citations
TL;DR: Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL.
176 citations
TL;DR: The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy, and build on previous ASPEN clinical guidelines and consensus recommendations for PN safety.
Abstract: Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings.
143 citations
TL;DR: In this paper, the authors highlight the problems associated with nutrition that occur in patients with squamous cell carcinoma of the head and neck (SCCHN) and highlight the importance of early screening, assessment of nutritional status and appropriate intervention.
121 citations
References
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01 May 2014
TL;DR: There is substantial global variation in the relative burden of stroke compared with IHD, and the disproportionate burden from stroke for many lower-income countries suggests that distinct interventions may be required.
Abstract: Background—Although stroke and ischemic heart disease (IHD) have several well-established risk factors in common, the extent of global variation in the relative burdens of these forms of vascular disease and reasons for any observed variation are poorly understood. Methods and Results—We analyzed mortality and disability-adjusted life-year loss rates from stroke and IHD, as well as national estimates of vascular risk factors that have been developed by the World Health Organization Burden of Disease Program. National income data were derived from World Bank estimates. We used linear regression for univariable analysis and the Cuzick test for trends. Among 192 World Health Organization member countries, stroke mortality rates exceeded IHD rates in 74 countries (39%), and stroke disability-adjusted life-year loss rates exceeded IHD rates in 62 countries (32%). Stroke mortality ranged from 12.7% higher to 27.2% lower than IHD, and stroke disability-adjusted life-year loss rates ranged from 6.2% higher to 10.2% lower than IHD. Stroke burden was disproportionately higher in China, Africa, and South America, whereas IHD burden was higher in the Middle East, North America, Australia, and much of Europe. Lower national income was associated with higher relative mortality (P 0.001) and burden of disease (P 0.001) from stroke. Diabetes mellitus prevalence and mean serum cholesterol were each associated with greater relative burdens from IHD even after adjustment for national income. Conclusions—There is substantial global variation in the relative burden of stroke compared with IHD. The disproportionate burden from stroke for many lower-income countries suggests that distinct interventions may be required. (Circulation. 2011; 124:314-323.)
7,265 citations
TL;DR: It is concluded that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible.
Abstract: Presented and described in detail is a clinical technique called subjective global assessment (SGA), which assesses nutritional status based on features of the history and physical examination. Illustrative cases are presented. To clarify further the nature of the SGA, the method was applied before gastrointestinal surgery to 202 hospitalized patients. The primary aim of the study was to determine the extent to which our clinician's SGA ratings were influenced by the individual clinical variables on which the clinicians were taught to base their assessments. Virtually all of these variables were significantly related to SGA class. Multivariate analysis showed that ratings were most affected by loss of subcutaneous tissue, muscle wasting, and weight loss. A high degree of interobserver agreement was found (kappa = 0.78, 95% confidence interval 0.624 to 0.944, p less than 0.001). We conclude that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible.
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TL;DR: It was concluded that malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor impacting on higher complications and increased mortality, length of hospital stay and costs.
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TL;DR: This review focuses on the studies investigating the prognostic implications of disease-related malnutrition and concludes that nutritional assessment is mandatory in order to recognise malnutrition early and initiate timely nutritional therapy.
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TL;DR: The malnutrition screening tool (MST), which consisted of two questions regarding appetite and recent unintentional weight loss, is a simple, quick, valid, and reliable tool which can be used to identify patients at risk of malnutrition.
736 citations