Risk, prevalence, and impact of hospital malnutrition in a Tertiary Care Referral University Hospital: a cross-sectional study
- 39 Downloads
Hospital malnutrition is still underestimated among physicians, even in internal medicine settings. This is a cross-sectional study, aiming to estimate the risk, the prevalence and the impact of malnutrition in an Internal Medicine and Gastroenterology Department of a large Italian hospital (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome). Patients were evaluated within 72 h from admission according to Nutritional Risk Screening-2002 (NRS-2002) and European Society for Clinical Nutrition and Metabolism (ESPEN) Criteria. Anthropometric, laboratory tests and Bioelectrical Impedance Analysis (BIA) derived phase angle were also performed. Length of hospital stay (LOS) and in-hospital mortality were collected. Univariate and multivariate analyses were conducted to correlate nutritional status with LOS and hospital mortality. In 10 months, 300 patients were enrolled: male patients were 172 (57.3%); mean age was 63.7 (± 17.6). At admission, 157 (52.3%) patients were at risk of malnutrition; 116 (38.7%) were malnourished. Malnourished patients had a mean LOS of 11.5 (± 8.0) days, not-malnourished 9.4 (± 6.2) days (p < 0.05). In-hospital mortality did not significantly differ between the two groups. Multivariate analysis shows that both malnutrition (p = 0.04; 95% CI 0.03–3.41) and phase angle (p = 0.004; 95% CI − 1.92 to − 0.37) independently correlate with LOS. In an Internal Medicine and Gastroenterology Department, over half (52.3%) of the patients were found at risk of malnutrition, and over a third (38.7%) were malnourished at hospital admission. Malnutrition and BIA-derived phase angle are independently associated with LOS. ESPEN Criteria and phase angle could be performed at admission to identify patients deserving specific nutritional support.
KeywordsHospital malnutrition NRS-2002 ESPEN Criteria Phase angle Length of hospital stay Hospital mortality Personalized medicine
The Authors wish to sincerely thank the dietitians Dr. Basso L., Dr. Egidi G. and Dr. Leone S. for their contributions in collecting patients’ data.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human and animal rights
The study was carried out according to Declaration of Helsinki and obtained the approval of the local Ethics Committee (Fondazione Policlinico A. Gemelli). Protocol number 53572/17.
Patients gave their informed consent to participate to the survey.
- 4.Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (2003) Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 22:415–421. https://doi.org/10.1016/S0261-5614(03)00098-0 CrossRefPubMedGoogle Scholar
- 7.Orlandoni P, Venturini C, Jukic Peladic N, Costantini A, Di Rosa M, Cola C, Giorgini N, Basile R, Fagnani D, Sparvoli D, David S (2017) Malnutrition upon hospital admission in geriatric patients: why assess it? Front Nutr 4:50. https://doi.org/10.3389/fnut.2017.00050 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, Compher C, Correia I, Higashiguchi T, Holst M, Jensen GL, Malone A, Muscaritoli M, Nyulasi I, Pirlich M, Rothenberg E, Schindler K, Schneider SM, de van der Schueren MA, Sieber C, Valentini L, Yu JC, Van Gossum A, Singer P (2017) ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 36:49–64. https://doi.org/10.1016/j.clnu.2016.09.004 CrossRefPubMedGoogle Scholar
- 12.Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, Miyake M, Hama N, Miyamoto A, Ikeda M, Nakamori S, Sekimoto M, Fujitani K, Tsujinaka T (2015) Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol 22(Suppl 3):S778–S785. https://doi.org/10.1245/s10434-015-4820-9 CrossRefPubMedGoogle Scholar
- 18.Raphael BP (2015) Nutritional management in cholestatic liver disease. In: Koletzko B et al (eds) Pediatric nutrition in practice, vol 113. Karger, Basel, pp 178–181Google Scholar
- 24.Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H (2004) Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 23:1430–1453. https://doi.org/10.1016/j.clnu.2004.09.012 CrossRefPubMedGoogle Scholar
- 26.Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM, de van der Schueren MA, Singer P (2015) Diagnostic criteria for malnutrition—an ESPEN consensus statement. Clin Nutr 34:335–340. https://doi.org/10.1016/j.clnu.2015.03.001 CrossRefPubMedGoogle Scholar
- 29.Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, King C, Elia M (2004) Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr 92:799–808. https://doi.org/10.1079/BJN20041258 CrossRefPubMedGoogle Scholar
- 30.Knudsen AW, Naver A, Bisgaard K, Nordgaard-Lassen I, Becker U, Krag A, Slinde F (2015) Nutrition impact symptoms, handgrip strength and nutritional risk in hospitalized patients with gastroenterological and liver diseases. Scand J Gastroenterol 50:1191–1198. https://doi.org/10.3109/00365521.2015.1028994 CrossRefPubMedGoogle Scholar
- 34.Gupta D, Lammersfeld CA, Burrows JL, Dahlk SL, Vashi PG, Grutsch JF, Hoffman S, Lis CG (2004) Bioelectrical impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer. Am J Clin Nutr 80:1634–1638. https://doi.org/10.1093/ajcn/80.6.1634 CrossRefPubMedGoogle Scholar
- 35.Belarmino G, Gonzalez MC, Torrinhas RS, Sala P, Andraus W, D’Albuquerque LA, Pereira RM, Caparbo VF, Ravacci GR, Damiani L, Heymsfield SB, Waitzberg DL (2017) Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis. World J Hepatol 9:401–408. https://doi.org/10.4254/wjh.v9.i7.401 CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Visser M, van Venrooij LM, Wanders DC, de Vos R, Wisselink W, van Leeuwen PA, de Mol BA (2012) The bioelectrical impedance phase angle as an indicator of undernutrition and adverse clinical outcome in cardiac surgical patients. Clin Nutr 31:981–986. https://doi.org/10.1016/j.clnu.2012.05.002 CrossRefPubMedGoogle Scholar
- 41.do Amaral Paes TC, de Oliveira KCC, de Carvalho Padilha P, Peres WAF (2018) Phase angle assessment in critically ill cancer patients: relationship with the nutritional status, prognostic factors and death. J Crit Care 44:430–435. https://doi.org/10.1016/j.jcrc.2018.01.006 CrossRefPubMedGoogle Scholar
- 42.Uccella S, Mele MC, Quagliozzi L, Rinninella E, Nero C, Cappuccio S, Cintoni M, Gasbarrini A, Scambia G, Fagotti A (2018) Assessment of preoperative nutritional status using BIA-derived phase angle (PhA) in patients with advanced ovarian cancer: correlation with the extent of cytoreduction and complications. Gynecol Oncol 149:263–269. https://doi.org/10.1016/j.ygyno.2018.03.044 CrossRefPubMedGoogle Scholar
- 43.Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36:11–48. https://doi.org/10.1016/j.clnu.2016.07.015 CrossRefPubMedGoogle Scholar
- 46.Rinninella E, Persiani R, D’Ugo D, Pennestrì F, Cicchetti A, Di Brino E, Cintoni M, Miggiano GAD, Gasbarrini A, Mele MC (2018) NutriCatt protocol in the enhanced recovery after surgery (ERAS) program for colorectal surgery: the nutritional support improves clinical and cost-effectiveness outcomes. Nutrition 50:74–81. https://doi.org/10.1016/j.nut.2018.01.013 CrossRefPubMedGoogle Scholar