Abstract
Malnutrition is still a largely unrecognized problem in hospitals. Malnutrition in hospitalized patients is generally related to increasing morbidity and mortality, and costs and length of stay. The aim of this study was to assess the nutritional status of patients on admission to a general hospital using different nutritional scores and to test the sensitivity and specificity of these scores. Sample population included 60 patients (55% male; 45% female) selected (aged 65.6±15.9 y) at random by using a computer software program. The nutritional state assessment was performed within 48 h of admission, using different nutritional indices (Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Gassull classification, Instant Nutritional Assessment (INA) and a combined index). About 78.3% of patients were found to be malnourished on admission. The frequency of malnutrition degree varied from 63.3% as assessed by the SGA to 90% with the NRI. Malnutrition severity was not related to the diagnosis. However, an elderly population was associated with a higher prevalence of malnutrition. INA was the best single score to identify patients who are malnourished or at risk of malnutrition and who may benefit from nutrition support.
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References
Alastrué A, Sitges A, Faurrieta E et al (1983): Valoracion antropometrica de1 estado nutritional, normas y criterios de desnutricion y obesidad. Med. Clin. 80, 691–699.
American Society for Parenteral and Enteral Nutrition (1995): Standards for nutrition support: hospitalized patients. Nutr. Clin. Pract. 10, 208–219.
Arora NS & Rochester DF (1982): Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am. Rev. Respir. Dis. 126, 5–8.
Baker JP, Detsky AS, Wesson DE et al (1982): Nutritional assessment. A comparison of clinical judgement and objective measurements. N. Engl. J. Med. 306, 969–972.
Bernstein LH, Shaw-Stiffel TA, Schorow M & Brouillette R (1993): Financial implications of malnutrition. Clin. Lab. Med. 13, 491–507.
Bistrian BR, Blackburn GL, Hallowell E & Heddle R (1974): Protein status of general surgical patients. J. Am. Med. Assoc. 230, 858–860.
Bistrian BR, Blackburn GL, Vitale J, Cochran D & Naylor J (1976): Prevalence of malnutrition in general medical patients. J Am. Med. Assoc. 253, 1567–1574.
Blackburn GL & Thornton PA (1979): Nutritional assessment of the hospitalized patient. Med. Clin. North Am. 63, 1103–1115.
Bollet AJ & Owens B (1973): Evaluation of nutritional status of selected hospitalized patients. Am. J. Clin. Nutr. 20, 931–938.
Braunschweig CA (1999): Creating a clinical nutrition registry: prospects, problems and preliminary results. J. Am. Diet. Assoc. 99(4), 467–470.
Bruun LI, Bosaeus I, Bergstad I & Nygaard K (1999): Prevalence of malnutrition in surgical patients: evaluation of nutritional support and documentation. Clin. Nutr. 18(3), 141–147.
Buzby GP, Williford WO, Peterson OL et al (1988): A randomized clinical trial of total parenteral nutrition in malnourished surgical patients: the rationale and impact of previous clinical trials and pilot study on protocol design. Am. J. Clin. Nutr. 47, 357–363.
Campos AC & Meguid MM (1992): A critical appraisal of the usefulness of perioperative nutritional support. Am. J. Clin. Nutr. 55, 117–130.
Carbonnel F (2000): Metabolic adaptation to malnutrition. Ann. Med. lnterne (Paris) 151(8), 644–651.
Cederholm T Jagren C & Hellstrom K (1993): Nutritional status and performance capacity in internal medical patients. Clin. Nutr. 12, 8–14.
Celaya S (1989): Nutrición artificial hospitalaria, pp. 59–91. Venus Industrias Gráficas, Zaragoza, Spain.
Chandra RK (1983): Nutrition, immunity and infection: present knowledge and future directions. Hte Lancet March 26, 688–691.
Chima CS, Barco K, Dewitt ML, Maeda M, Teran JC, Mullen KD (1997): Relationship of nutritional status to length of stay, hospital cost, and discharge status of patients hospitalized in the medicine service. J. Am Diet. Assoc. 97(9), 979–980.
Coats KG Morgan SL Bartolucci AA & Weinsier RL (1993): Hospital-associated malnutrition: a reevaluation 12 years later. J. Am. Diet. Assoc. 93, 27–33.
Collins N (2000): Assessment and treatment of involuntary weight-loss and protein-calorie malnutrition. Adv. Skin Wound Care 13(1 Suppl), 4–10.
Corish CA & Kenedy NP (2000): Protein-energy undernutrition in hospital in-patients. Br. J. Nutr. 83, 575–591.
Corish CA, Flood P, Mulligan S & Kenedy NP (2000): Apparent low frequency of undernutrition in Dublin hospital in-patients: should we review the anthropometric thresholds for clinical practice?. Br. J. Nutr. 84, 325–335.
Correia MI, Caiaffa WT, da Silva AL & Waitzberg DL (2001): Risk factors in malnutrition in patients undergoing gastroenterological and hernia surgery: an analysis of 374 patients. Nutr. Hosp. 216(2), 59–64
Covinsky KE, Martin GE, Beyth RJ, Justice AC, Seghal AR & Landefeld CS (1999): The relationship between clinical assessments of nutritional status and adverse outcome in older hospitalized medical patients. J. Am. Geriatr. Sot. 47, 532–538.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Mendelson RA & Jeejeebhoy KN (1987): What is subjective global assessment of nutritional status?. J. Parenter. Enteral Nutr. 11, 8–11.
Duerksen DR, Yeo TA, Siemens JL & O'Connor MP (2000): The validity and reproducibility of clinical assessment of nutritional status in the elderly. Nutrition 16(9), 740–744.
Enia G, Sicuso C, Alati G et al (1993): Subjective global assessment of nutrition in dialysis patients. Nephrol. Dial. Transplant. 8, 1094–1098.
Ferguson M, Capra S, Bauer J & Banks M (1999): Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 15(6), 458–464.
Ferreira IM, Brooks D, Lacasse Y & Goldstein RS (2000): Nutritional support for individuals with COPD: a meta-analysis. Chest 117, 672–678.
Fuenzalida CE, Petty TL, Jones ML, Jarrett S, Harbeck RJ, Terry RW & Hambidge KM (1990): The immune response to short-term nutritional intervention in advanced chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 142, 49–56.
Garriballa SE, Parker SG, Taub N & Castleden M (1998): Nutritional status of hospitalized acute stroke patients. Br. J. Nutr. 79, 481–487.
Gassull MA, Cabre E, Vilar L, Alastrue A & Montserrat A (1984): Protein-energy malnutrition: an integral approach and a simple new classification. Human nutrition. Clin. Nutr. 38C, 419–431.
Gianotti L, Braga M, Radaelli G, Mariani L, Vignali A & Carlo VD (1995): Lack of improvement of prognostic performance of weight loss when combined with other parameters. Nutrition 11, 12–16.
Gibbs J, Cull W, Henderson W, Daley J, Hur K & Khuri SF (1999). Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch. Surg. 134(1), 36–42.
Hebuterne C & Schneider S (2000): Screening and prognostic value of malnutrition in the hospital setting. Ann. Med. Interne (Paris) 151(7), 557–562.
Heymsfield SB Bethel RA Ansley JD Gibbs DM Felner JM & Nutter DO (1978): Cardiac abnormalities in cachetic patients before and during nutritional repletion. Am. Heart J. 95, 584–594.
Himes D (1999): Protein-calorie malnutrition and involuntary weight-loss: the role of aggressive nutritional intervention in wound healing. Ostorny Wound Manage. 45(3), 46–51,54-55.
Klein S, Kinney J, Jeejeebhoy K, Alpers D, Hellerstein M, Murray M & Twomey P (1997): Nutrition support in clinical practice. Review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health. American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. Am. J. Clin. Nutr. 66, 683–706.
Kovacevich DS, Boney AR, Braunschweig CL, Perez A & Stevens M (1997): Nutrition risk classification: a reproducible and valid tool for nurses. Nutr. Clin. Pract. 12, 20–25.
Larsson J, Akerlind I, Permerth J & Hornqvist JO (1994): The relation between nutritional state and quality of life in surgical patients. Eur. J. Surg. 160, 329–334.
Leardi S, Altilia F, Delmonaco S et al (2000): Blood levels of cholesterol and postoperative septic complications. Ann. Ital. Chir. 71(2), 233–237.
Lupo L, Pannarale O, Altormare D, Memeo V & Rubino M (1993): Reliability of clinical judgement in evaluation of the nutritional status of surgical patients. Br. J. Surg. 80, 1553–1556.
Madden MA, McCornick PA, Davidson B, Rolles K, Burroughs AK & Morgan MY (1994): Nutritional status and survival of patients after liver transplant. Nutrition 10, 504.
McClave SA, Snider HL & Spain DA (1999): Preoperative issues in clinical nutrition. Chest 115, 64S–70S.
McWhirter JP & Pennington CR (1994): Incidence and recognition of malnutrition in hospital. BMJ 308, 945–948.
Mullen J, Gertner M, Buzby G et al (1979): Implications of malnutrition in the surgical patient. Arch. Surg. 114, 121–125.
Naber T, de Bree A, Nusteling K et al (1997): Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am. J. Clin. Nutr. 66, 1232–1239.
Naber THJ, de Bree A, Schermer TRJ et al (1997): Specificity of indices of malnutrition when applied to apparently healthy people: the effect of age. Am. J. Clin. Nutr. 65, 1721–1725.
Nakamura K, Moriyama Y, Kariyazono H, Hamada N et al (1999): Influence of preoperative nutritional state on inflammatory response after surgery. Nutrition 15(11–12), 834–841.
Pareja A, Aznarte P, de la Rubia A & Lopez F (2000): Assessment of nutritional status at hospital admission: identification of patients with risk of malnutrition. Nutr. Hosp. 15(4), 156–163.
Pennington CR (1998): Disease-associated malnutrition in the year 2000. Postgrad. Med. J. 74, 65–71.
Pikul J, Sharpe M, Lowndes R et al (1994): Degree of percipient. Transplantation 57, 469–472.
Reilly HM Martineau JK Moran A & Kennedy H (1995): Nutritional screening—evaluation and implementation of a simple nutrition risk score. Clin. Nutr. 14, 269–273.
Rogers RM, Donahoe M & Costantino J (1992): Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 146, 1511–1517.
Schneider SM & Hebuterne X (2000): Use of nutritional scores to predict clinical outcomes in chronic diseases. Nutr. Rev. 1, 31–38.
Seltzer MM, Bastidas JA, Cooper DM et al (1979): Instant nutritional assessment. J. Parenter. Enteral 3, 157–159.
Servicio Central de Publicaciones de1 Gobierno Vasco (1994): “Encuesta de Nutrición de la Comunidad Autonoma del País Vasco”. Vitoria-Gasteiz.
Shulkin DJ, Kinosian B, Glick H, Glen-Puschett C, Daly J & Eisenberg JM (1993): The economic impact of infections: an analysis of hospital costs and charges in surgical patients with cancer. Arch. Surg. 128, 449–452.
Waitzberg DL, Caiffa WT & Correia ITD (2001): Hospital malnutrition: The Brazilian National Survey (IBRANUTRI): a study of 4000 patients. Nutrition 17, 573–580.
Weinsier RL, Hunker EM, Krumdieck CL & Butterworth CE (1979): Hospital malnutrition: a prospective evaluation of general medical patients during the course of hospitalization. Am. J. Clin. Nutr. 32, 418–426.
Windsor JA (1993): Underweight patients and the risks of major surgery. World J. Surg. 17, 165–172.
Yamanaka H, Nishi M, Kanemai T et al (1989): Preoperative nutritional assessment to predict postoperative complication in gastric cancer patients. J. Parenter Enteral Nutr. 13, 286–291.
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This work was supported by the UPV 101.123.EA089/99 project.
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Appendix A. SGA of nutritional status
Appendix A. SGA of nutritional status
See Table A1.
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Pablo, A., Izaga, M. & Alday, L. Assessment of nutritional status on hospital admission: nutritional scores. Eur J Clin Nutr 57, 824–831 (2003). https://doi.org/10.1038/sj.ejcn.1601616
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DOI: https://doi.org/10.1038/sj.ejcn.1601616
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