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.
Highlights
Hospital protein-energy malnutrition (PEM) occurs worldwide [1,2,3]
Several reports have shown that the presence of PEM results in an impairment of the response to therapeutic planning [10], inefficiency and delay in wound healing and a decrease in wound bursting strength related to sutures, development of pressure ulcers [11,12], as well as increases in the frequency of infectious and noninfectious complications
The relative frequency of malnutrition among patients hospitalized on the oncology ward (0.535) was significantly higher than among the patients hospitalized on the internal medicine ward (0.148; P = 0.000)
Summary
Hospital protein-energy malnutrition (PEM) occurs worldwide [1,2,3]. Studies conducted in Latin America [4] and in Brazil [5] have demonstrated PEM in approximately 50%of hospitalized patients. Despite the demonstration in clinical studies of a high prevalence of malnutrition among hospitalized patients, in clinical practice PEM is not yet recognized as an illness and not always diagnosed [9]. Several reports have shown that the presence of PEM results in an impairment of the response to therapeutic planning [10], inefficiency and delay in wound healing and a decrease in wound bursting strength related to sutures, development of pressure ulcers [11,12], as well as increases in the frequency of infectious and noninfectious complications [13], the duration of hospitalization, and the mortality rate [14,15]. It has been established that the impact of hospital malnutrition on health and social costs is significant [16]. According to Correia and Waitzberg [17], in developing countries, hospital costs for the public health system were on average 60% higher for the hospitalization and treatment of malnourished patients compared to well-nourished ones
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