Nutritional care routines in Italy: results from the PIMAI (Project: Iatrogenic MAlnutrition in Italy) study

Abstract

Background/Objectives: Disease-related malnutrition is a common comorbidity at hospital admission. The purpose of the present report was to describe the data on nutritional care routines collected during the Project: Iatrogenic MAlnutrition in Italy (PIMAI) study, as these may be helpful to avoid iatrogenic malnutrition and improve nutritional policies. Subjects/Methods: Standards of nutritional care were assessed on the basis of (1) adherence to study protocol (completeness of data collected); (2) attitude in assessing the nutritional status; (3) prescription of nutritional therapy (within 3 days) at least in patients presenting with overt malnutrition (body mass index (BMI) o18.5 kg/m 2 or significant weight loss (X10% in 3 months and/or X5% in the last month)), regardless of its adequacy, and adherence to current guidelines and (4) attitude in monitoring nutritional status during the stay (number of weight measurements performed compared with those expected). Results: In total, 1583 subjects were assessed. A minimum data set for performing the Nutritional Risk Screening 2002 tool was available in 1284 patients (81.1%), but nutritional screening was possible in every patient by alternative analytical criteria related to food intake, anthropometry and biochemistry. However, several missing values were recorded, particularly in biochemical parameters due to lack of prescription by admission wards. According to ward practices, only 38.2% of the patients had the BMI calculated. A nutritional support was prescribed only to 26/191 patients (13.6%) presenting with overt malnutrition. Finally, we recorded that only 21.6% of the patients (207/960 were randomly selected) had their weight monitored on a scheduled basis. This reality was worse in surgical rather than medical departments (17 vs 26%; Po0.001). Conclusion: Present results confirm that in Italy, nutritional care routines are still poor and need improvements.

Nutritional predictors of mortality after discharge in elderly patients on a medical ward

“…Our results also paralleled those observed by others noting that low MNA scores predict poor outcomes in geriatric hospitalized patients [37]. While this was not surprising, the fact that the relationship was not modified by PA at 48 months suggests that both could potentially be biomarkers for death in this at-risk population, at least in the long run.…”

Prevalence of malnutrition in a tertiary care hospital in India

“…Various studies have estimated that about 30-50% of critically ill patients have clinical evidence of malnutrition. [9101112] These studies have also reported that the nourishment status of ICU patients generally deteriorates during the stay at the hospital, possibly due to inadequate nutritional supplementation.…”

Mini Nutritional Assessment

“…Along with this, as previously reported for the Geriatric Nutritional Risk Index (GNRI) tool [10], the MNA seems to describe the potential patient's 'journey' across the different healthcare settings. In addition, also the poor nutritional routines and attitudes among healthcare professionals may be involved in the process of nutritional deterioration [122]. This need significantly increases in those admitted to hospitals.…”