May nutritional status worsen during hospital stay? A sub-group analysis from a cross-sectional study
Hospital malnutrition is a detrimental prognostic factor regarding hospital mortality, complications, and length of stay. However, the role of hospitalization itself on nutritional status has not been fully elucidated. We report the results of a secondary analysis from the dataset of a recent cross-sectional study at Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Data from patients evaluated at admission and discharge were collected and compared. One hundred thirty-nine patients were evaluated. Mean length of stay was 13.6 (± 7.7) days. Patients at risk of malnutrition, according to NRS-2002, were 75 (53.9%), while 63 (45.3%) were malnourished according to ESPEN Criteria. Compared to admission, at discharge, patients reported a significant decrease in Mid-Upper Arm Circumference (MUAC)—from 26.5 cm (± 3.6) to 25.9 cm (± 3.7) (p = 0.016), a reduction in Phase angle (PhA)—from 4.25° (± 1.20) to 4.01° (± 1.15) (p = 0.005), fat-free mass (FFM)—from 47.5 kg (± 9.19) to 44.9 kg (± 9.4) (p = 0.03) and fat-free mass index (FFMI)—from 16.9 kg/m2 (± 2.3) to 15.8 kg/m2 (± 2.7) (p = 0.04). Laboratory data showed a reduction of albumin—from 29.2 (± 5.7) to 28.0 (± 5.9) (p = 0.01) and Onodera’s PNI- from 29.1 (± 5.6) to 27.6 kg (± 5.6) (p = 0.039). At the multivariate linear regression analysis, the variables significantly associated with a worsening of PhA at discharge are the PhA value at admission and the diagnosis of malnutrition according to ESPEN Criteria. Hospitalization leads to significative changes in nutritional status. A clinical concern should be raised about the quality of hospital food and meal times and on the need for a clinical nutritionist on the ward.
KeywordsNutritional status Hospital malnutrition Phase angle Fat-free mass Prognostic nutritional index ESPEN criteria Personalized medicine
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.
- 5.Niccoli S, Kolobov A, Bon T, Rafilovich S, Munro H, Tanner K, Pearson T, Lees SJ (2017) Whey protein supplementation improves rehabilitation outcomes in hospitalized geriatric patients: a double blinded, randomized controlled trial. J Nutr Gerontol Geriatr 36:149–165. https://doi.org/10.1080/21551197.2017.1391732 CrossRefGoogle Scholar
- 8.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 CrossRefGoogle Scholar
- 10.Rinninella E, Annetta MG, Serricchio ML, Dal Lago AA, Miggiano GA, Mele MC (2017) Nutritional support in acute pancreatitis: from physiopathology to practice. An evidence-based approach. Eur Rev Med Pharmacol Sci 21:421–432Google Scholar
- 13.Rinninella E, Cintoni M, De Lorenzo A, Addolorato G, Vassallo G, Moroni R, Miggiano GAD, Gasbarrini A, Mele MC (2018) Risk, prevalence, and impact of hospital malnutrition in a Tertiary Care Referral University Hospital: a cross-sectional study. Intern Emerg Med. https://doi.org/10.1007/s11739-018-1884-0 Google Scholar
- 15.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.2015.03.00 CrossRefGoogle Scholar
- 16.BAPEN. Alternative measurements: instructions and tables—estimating height from ulna length. https://www.bapen.org.uk/pdfs/must/must_page6.pdf
- 18.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, Schols MWJ, Pichard C, ESPEN (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 CrossRefGoogle Scholar
- 21.Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85:1001–1005Google Scholar
- 22.Rinninella E, Ruggiero A, Maurizi P, Triarico S, Cintoni M, Mele MC (2017) Clinical tools to assess nutritional risk and malnutrition in hospitalized children and adolescents. Eur Rev Med Pharmacol Sci 21:2690–2701Google Scholar
- 23.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 CrossRefGoogle Scholar
- 26.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 CrossRefGoogle Scholar
- 27.Okada I, Shirahata A, Soda H, Saitou M, Kigawa G, Nemoto H, Sanada Y, Hibi K (2012) Significance of Onodera’s prognostic nutritional index for treating unresectable or recurrent colorectal cancer with chemotherapy. Gan To Kagaku Ryoho 39:231–235Google Scholar
- 29.Matsumoto Y, Zhou Q, Kamimura K, Moriyama M, Saijo Y (2018) The prognostic nutrition index predicts the development of hematological toxicities in and the prognosis of esophageal cancer patients treated with cisplatin plus 5-fluorouracil chemotherapy. Nutr Cancer 70:447–452. https://doi.org/10.1080/01635581.2018.1445765 CrossRefGoogle Scholar
- 30.Zhu MW, Wei JM, Chen W, Yang X, Cui HY, Zhu SN, Zhang PP, Xiong J, Zheng DF, Song HJ, Liang XY, Zhang L, Xu WY, Wang HB, Su GQ, Feng LJ, Chen T, Wu YD, Li H, Sun JQ, Shi Y, Tong BD, Zhou SM, Wang XY, Huang YH, Zhang BM, Xu J, Zhang HY, Chang GL, Jia ZY, Chen SF, Hu J, Zhang XW, Wang H, Li ZD, Gao YY, Gui B (2018) Dynamic investigation of nutritional risk in patients with malignant tumor during hospitalization. Zhonghua Yi Xue Za Zhi 98:1093–1098. https://doi.org/10.3760/cma.j.issn.0376-2491.2018.14.009 Google Scholar
- 31.Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, Erickson N, Laviano A, Lisanti MP, Lobo DN, McMillan DC, Muscaritoli M, Ockenga J, Pirlich M, Strasser F, de van der Schueren M, Van Gossum A, Vaupel P, Weimann A (2017) ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 36:1187–1196. https://doi.org/10.1016/j.clnu.2017.06.017 CrossRefGoogle Scholar
- 36.Navarro DA, Boaz M, Krause I, Elis A, Chernov K, Giabra M, Levy M, Giboreau A, Kosak S, Mouhieddine M, Singer P (2016) Improved meal presentation increases food intake and decreases readmission rate in hospitalized patients. Clin Nutr 35:1153–1158. https://doi.org/10.1016/j.clnu.2015.09.012 CrossRefGoogle Scholar