Characteristics and Outcomes of Adult Inpatients With Malnutrition

Vest, Michael T.; Papas, Mia A.; Shapero, Mary; McGraw, Patty; Capizzi, Amanda; Jurkovitz, Claudine

doi:10.1002/jpen.1042

Cited by 18 publications

(22 citation statements)

References 18 publications

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“…Based on the degree of the reduction in energy intake, weight loss, muscle loss, fat loss or fluid accumulation, we classified malnutrition as moderate or severe as described by White et al (27) . Vest et al (3) further describe the methods used at Christiana Care to identify malnutrition.…”

Section: Identification Of Malnutritionmentioning

confidence: 99%

“…Malnutrition can be caused by starvation, chronic disease-related inflammation and acute disease-related inflammation (2) . The prevalence of malnutrition varies widely among hospitalised adults, with estimates ranging from 4% to 45% (3)(4)(5)(6)(7)(8) . Multiple studies report adverse effects of malnutrition, which include a prolonged length of stay (5)(6)(7) , increased overall and in-hospital mortality (5)(6)(7) , increased risk of readmission (6,7,9,10) and higher hospitalisation costs (6,10) .…”

Section: Introductionmentioning

confidence: 99%

“…The majority of malnourished patients become malnourished as a result of chronic disease, suggesting that interventions need to continue well beyond the hospitalisation to be successful . Despite physician support for performing nutrition assessments at discharge, a Canadian task force survey found that this is not achieved on a regular basis .…”

Section: Introductionmentioning

confidence: 99%

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Malnourished adults’ receipt of hospital discharge nutrition care instructions: a pilot study

Brooks

Vest

Shapero

et al. 2019

J Human Nutrition Diet

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Background Malnutrition remains an important yet under‐recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition‐focused discharge care provided to malnourished adults. Methods We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4‐month period. Results Seventy‐six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake. Conclusions A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post‐discharge nutrition care instructions.

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Section: Identification Of Malnutritionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Malnourished adults’ receipt of hospital discharge nutrition care instructions: a pilot study

Brooks

Vest

Shapero

et al. 2019

J Human Nutrition Diet

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“…[2][3][4] Within the US, malnutrition still goes unrecognized by the clinicians and is associated with longer hospital length of stay and higher morbidity, mortality, and healthcare costs. 5,6 Health-related quality of life (HRQOL) assesses patients' physical, psychological, social, and emotional functioning from their own experience and perspective, therefore identifying individuals who might benefit from clinical interventions. [7][8][9] Prospective studies among HNC patients have shown an association between nutrition status and HRQOL outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment‐related side effects such as dry mouth, decreased appetite, and difficulties with chewing and swallowing compromise oral intake, leading to significant weight loss and malnutrition 2‐4 . Within the US, malnutrition still goes unrecognized by the clinicians and is associated with longer hospital length of stay and higher morbidity, mortality, and healthcare costs 5,6 …”

Section: Introductionmentioning

confidence: 99%

Nutrition Status and Health‐Related Quality of Life Among Outpatients With Advanced Head and Neck Cancer

et al. 2020

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This pilot study evaluated nutrition status and health-related quality of life (HRQOL) outcomes among outpatients with head and neck cancer (HNC). Data were collected from 19 patients (18 males, 1 female) during 3 time points: once before chemoradiotherapy (CRT) initiation and 1 and 3 months after CRT. Nutrition status was evaluated using the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Malnutrition was defined as PG-SGA stage B (moderate/suspected malnutrition) or stage C (severely malnourished). HRQOL was assessed through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its HNC-specific module (QLQ-H&N35). We found that well-nourished patients reported having fewer issues with pain, fatigue, appetite loss, chewing, sticky saliva, coughing, and social eating than those categorized as malnourished (P < .05). The association between the global quality-of-life score and PG-SGA score was statistically significant but weak in strength (r = −0.37, P = .012). Although PG-SGA identified 70% as either moderately or severely malnourished before treatment initiation, the mean body mass index was in the overweight category (29 ± 5 kg/m 2). Compared with pretreatment, patients reported more severe problems with chewing, swallowing, sticky saliva, dry mouth, speech, social eating, and taste and smell sensations at 1-month follow-up, although issues with dry mouth persisted 3 months post treatment (P = .003). In conclusion, malnourished patients reported having worse HRQOL symptoms compared with well-nourished patients. Routine nutrition and psychosocial assessment through PG-SGA and EORTC tools might help identify patients in need of nutrition and psychosocial care.

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Prevalence and characteristics of starvation‐related malnutrition in a mid‐Atlantic healthcare system: A cohort study

Smith

Vest

Rovner

et al. 2021

J Parenter Enteral Nutr

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Background: Malnutrition in the hospital negatively impacts outcomes, including readmissions, mortality, and cost. Starvation-related malnutrition (SRM) is a state of chronic undernutrition with little to no inflammation. Research on SRM within the hospital setting is lacking. Our objective was to determine the prevalence and characteristics of malnutrition within the hospital, focusing on characteristics associated with readmissions in those with SRM. Methods:We conducted a retrospective cohort study analyzing characteristics of adult in patients with acute disease-related malnutrition (ADM) and chronic diseaserelated malnutrition (CDM) compared with patients with SRM. Prevalence of all malnutrition types was calculated as the total number of malnourished patients divided by the total number of hospital discharges. Analysis of variance with Tukey post hoc analysis was performed to determine differences between characteristics of patients with SRM and other forms of malnutrition.Results: Total prevalence of malnutrition was 2.8%. Of malnourished patients, 17.6%, 79.9%, and 2.5% had ADM, CDM, and SRM, respectively. Patients with SRM had lower body mass index (BMI) (P < .001) and higher rates of readmission (P = 0.046), infectious disease (P < .001), psychiatric disease (P < .001), and substance abuse (P < .001) than patients with ADM or CDM. Readmitted patients with SRM had lower BMI and higher rates of infection and drug abuse than those without readmission. Conclusion:The high incidence of comorbid substance abuse and mental illness in patients with SRM provide important targets for treatment that might reduce readmission and improve outcomes.

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Characteristics and Outcomes of Adult Inpatients With Malnutrition

Cited by 18 publications

References 18 publications

Malnourished adults’ receipt of hospital discharge nutrition care instructions: a pilot study

Malnourished adults’ receipt of hospital discharge nutrition care instructions: a pilot study

Nutrition Status and Health‐Related Quality of Life Among Outpatients With Advanced Head and Neck Cancer

Prevalence and characteristics of starvation‐related malnutrition in a mid‐Atlantic healthcare system: A cohort study

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