Clinical outcome of protein-energy malnourished patients in a Brazilian university hospital

Abstract

Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant.

Quantitative and Qualitative Nutritional Evaluation of the General Oral Diet Served in a University Hospital

“…However, due to the influence of the commitment of the nutritional status in the clinical evolution of individuals exposed to disease 4,16,17 some investigators have reported the supply of energy and protein in quantities greater than those calculated nutritional needs. In studies carried out by several investigators 7,[18][19][20] the general and specialized oral diets presented energy supply around 1.900 to 2.700 kcal/day, i.e., higher values than the calculated energy for patients included in these studies (1.400 to 2.200 kcal/day).…”

“…Since in a previous study developed in our hospital it was demonstrated that 33.2% of patients that were evaluated within the first 48 hours of admission presented protein-energy malnutrition 4 the identification of such a prolonged overnight fasting period is highly worrying. In accordance with these considerations, in a study developed by Söderström et al 23 analyzing elderly hospitalized individuals (n = 1771) it was demonstrated that inadequate dietary habits including prolonged overnight fasting (> 11h) increased the risk of malnutrition 23 .…”

“…The harmful effect of hospitalization on the nutritional status of inpatients has been demonstrated by several investigators 3,4 . In one study developed by Waitzberg et al 3 the prevalence of malnutrition of 33.2%, identified among patients assessed within the first 48 hours of hospitalization (291 malnourished patients in a total of 878 patients), increased to 61.0% in patients with a length of hospital stay of 16 days or more (651 malnourished patients in a total of 1068 patients, p < 0.05).…”

Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials

“…As a result of this stress response, critically ill patients are bound to develop protein and energy deficits, added by total or partial inability of oral feeding. In order to prevent nutrition deficits related with the morbidity and mortality of hospitalized patients (2) and their associated worse clinical outcomes, enteral nutrition (EN) is the recommended first-line therapy for critically ill patients (3).…”

Severe Intestinal Failure in a Chagas’s Disease Patient After Total Colectomy Plus Partial Ileectomy

“…These considerations are consistent with the results of a study recently published. Using a logistic model, the investigators demonstrated that malnourished patients had a significantly increased risk of developing infectious complications compared with well-nourished patients (odds ratio=19.80) 14 .…”