Behavioral Risk Factors for Acute and Chronic Disease-Related Malnutrition

Abstract

Abstract Objectives To determine the association between mental health and substance use and the risk of developing malnutrition. Methods Mental health, substance abuse, and malnutrition were defined by ICD-10 codes. Diseases were classified as either acute or chronic based on the Beta Chronic Condition Indicator for ICD-10 codes. Age, sex, race, primary language, marital status, Medicaid status, cigarette use, and median household were taken from the EMR. No patients were identified with pure SRM. Cases were matched by disease status. Conditional logistic regression was used to determine odds ratio and 95% confidence intervals. Pearson chi-square test was used to assess the demographic differences between malnutrition categories. Results We analyzed 2356 matched pairs for CDRM and 1935 for ADRM. ADRM was associated with age, race, and primary language (all P < 0.004), while CDRM was associated with race, primary language, Medicaid, and median household income (all P-value < 0.037). For both ADRM and CDRM, a mental health diagnoses was associated with increased odds of malnutrition (OR: 1.370, CI: 1.169, 1.605) and (OR: 1.484, CI: 1.296, 1.700) respectively, while substance use was not associated with either sub-category of malnutrition. Among ADRM, a mental health diagnosis was associated with being 80 years and older (OR: 1.313, CI: 1.031, 1.672), Asian and Pacific Islander (OR: 1.472, CI: 1.030, 2.105) and Hispanic (OR: 2.404, CI: 1.707, 3.385) compared to White, female (OR: 0.863, CI: 0.755, 0.985), widowed (OR: 0.768, CI: 0.615, 0.959) compared to single, and being on Medicaid (0.860, CI: 0.756, 0.978). Among CDRM, a mental health diagnosis was associated with being Hispanic (OR: 2.911, CI: 2.098, 4.040), primary language being Spanish (OR: 2.771, CI: 1.112, 1.644), married and/or life partner (OR: 0.851, CI: 0.752, 0.964) and widowed (OR: 0.780, CI: 0.635, 0.958) compared to single, and on Medicaid (OR: 0.817, 0.733, 0.910). Conclusions This study provides the first known assessment of the relationship between mental health, substance abuse, and malnutrition diagnosed based on the AND/ASPEN guidelines. Only a mental health diagnosis, but not substance use, was associated with the development of both ADRM and CDRM. Future research with a larger sample size is needed to better understand these effects. Funding Sources None.