Prevalence of malnutrition risk and its association with mortality: nutritionDay Latin America survey results

Abstract

Background & aims: Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes. Methods: On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score 2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay. Results: The prevalence of malnutrition risk in the Latin American nDay study population (N ¼ 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospitalmortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P < 0.001) for patients eating one-quarter of their meal (compared with those who ate the full meal), increasing to 6.6 (95% CI [5.02, 8.7]; P < 0.0001) for patients who ate none of the food offered. Conclusions: Based on compilation of nDay surveys throughout Latin America, 2 of every 5 hospitalized patients were at risk for malnutrition. The associated risk for hospital mortality was up to 6-fold higher among patients who ate little or none of their meal on nDay. This high prevalence showed scant improvement over rates two decades agoda compelling rationale for new focus on nutrition education and training of professionals in acute care settings.

Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management

“…An MNA score <17 resulted as an independent factor for in-hospital mortality [52]. Reduced consumption of hospital meals was associated with a higher risk for in-hospital mortality [83]. Of note, nutritional intervention during hospitalization in medical wards is associated with reduced in-hospital mortality and reduced 30-day readmission rates as compared to the absence of nutritional support [84].…”

The effect of urinary essential and non-essential elements on serum albumin: Evidence from a community-based study of the elderly in Beijing

“…The estimated prevalence of malnutrition in the elderly living in the community ranges between 7.8 and 45.4%, which differs by country ( 6 , 7 ). Malnutrition furthermore triggers elevated cardiovascular disease risk and excess mortality ( 8 , 9 ). As a significant transport protein synthesized in the liver, serum albumin was widely utilized to assess the nutritional state and diagnose malnutrition ( 10 ).…”

Can hospitalized patients adequately estimate their own food intake? A cross-sectional pilot study

“…Studies conducted in several countries have shown that 10.3% to 61.5% of hospital patients eat their entire meals [1][2][3]. A study of the Nutrition Day (nDay) in Latin America showed that more than 40% of hospital patients eat half or less than half of their meals [4]. Patients on therapeutic diets, mainly those on low-sodium and texture-modified ones [5,6], often record lower intake than those in regular diets.…”

“…Some studies showed that patients subjected to nutrient-modified diets and/or consistency-modified diets do not meet energy and protein requirements [7][8][9]. Low food intake can lead to higher infection rates, longer hospital stays, as well as higher hospital readmission and mortality rates [4,[10][11][12]. Agarwal et al [10] and Hiesmayr et al [11] found that low food intake is also an independent risk factor for in-hospital deaths.…”

“…The direct food-weighing method is the gold standard, but it is unfeasible for clinical practice [6,16,17]. Other methods include dietary assessment methods, such as the 24-hour food recall [9,18,19], food intake Visual/Verbal Analogue Scale [20], digital photography [21], energy and protein intake expressed in points [22,23], and food charts, including visual food-intake percentage-estimation charts [3][4][5]10,11,[24][25][26][27][28][29][30][31][32][33][34][35].…”