Hospital Malnutrition, a Call for Political Action: A Public Health and NutritionDay Perspective.

Michael Hiesmayr,Karin Schindler,Alessandro Laviano,Isabella Sulz,Sigrid Moick,Judit Simon,Christian Schuh,Silvia Tarantino,Dorothee Volkert,Mohamed Mouhieddine

doi:10.3390/jcm8122048

Abstract

Disease-related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analysed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical, surgical, long-term care and other patients (n = 153,470). In 59,126 medical patients included between 2006 and 2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. A similar pattern is found in all four patient groups. Nutrition care processes increase slightly with the presence of risk factors but are never done in more than 50% of the patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM.

Highlights

Disease-related malnutrition (DRM) is highly prevalent in hospitalized patients and associated with complications and poor outcome [1,2,3]
Association between body mass index (BMI) and mortality is U-shaped in the general population and J-shaped in patients, especially with chronic diseases, meaning that mortality is higher if BMI is low and lower in patients with increased lean body mass and even obesity [4,5]
The key points appear to be the raised awareness about all the described aspects related to DRM to all stakeholders, as well as the proposal of easy and standardized nutrition care processes, defined responsibilities within hospitals, and the establishment of adequate reimbursement schemes

Summary

Introduction

Disease-related malnutrition (DRM) is highly prevalent in hospitalized patients and associated with complications and poor outcome [1,2,3]. Malnutrition in hospitals originates from imbalances, either deficiencies or excesses, in nutrients intake compared with body needs. Association between body mass index (BMI) and mortality is U-shaped in the general population and J-shaped in patients, especially with chronic diseases, meaning that mortality is higher if BMI is low and lower in patients with increased lean body mass and even obesity [4,5]. This observation called “obesity paradox” underscores the importance of a “good” nutrition status for patients with illnesses for short and long-term outcomes

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Conclusion