A multi-center survey on hospital malnutrition and cachexia in Slovenia

Abstract

Background Malnutrition has become a prevalent condition, with European and international studies reporting rates of approximately 25-40% in hospitals. We set out to perform a multi-center cross-sectional study to assess malnutrition rates in Slovenian hospitals and to convert the findings into a mobile application suitable for use by nurses and staff at the bedside. In addition, we examined the association of the results of this mobile application with parameters for body composition measured by bioimpedance method, muscle strength, anthropometrics, and specific blood markers. Methods We selected the Nutritional Risk Screening 2002 (NRS-2002) method, the second version of the modified shortform of Mini-Nutritional Assessment (MNA-SF), and the diagnostic criteria for cachexia proposed by Evans (CDE) as evidence-based methods for estimating the risk of and prevalence of malnutrition or/and cachexia. The methods were converted into the Android mobile application named MalNut that was used in three Slovenian hospitals by nurses and dietitians. Results We applied NRS-2002 and MNA-SF to screen for malnutrition risk and to assess malnutrition in 207 individuals aged 18 years and older, regardless of gender or reason for hospitalization during 1-week periods. Totally, 98% of these patients consider nutrition an important part of medical treatment care. NRS-2002 estimated the malnutrition risk to be 66.3%, which includes both patients to be at risk for malnutrition and patients that are truly malnourished. The malnutrition risk in the elderly (65+) estimated by MNA-SF was 39.6% and malnutrition 42.5%. When applying the CDE score in these two categories, 66.7% were identified as cachectic and 21.4% as pre-cachectic. In the patients assessed with the CDE score, malnutrition risk increased with higher extracellular water and decreased body mass index, hemoglobin, phase angle, and muscle strength. In all, 75% of patients assessed as high risk for malnutrition by NRS-2002, were identified as cachectic and 15.7% as pre-cachectic. In NRS-2002 assessed patients, this risk increased with higher C-reactive protein and lower phase angle. Conclusions The study showed that both malnutrition and cachexia are largely overlapping notions and are common in hospitalized adults in Slovenia. The MNA-SF and NRS-2002 tools showed that malnutrition risk was not significantly correlated with age, gender, serum albumin, but was correlated with lower phase angle, CRP, and muscle strength in elderly patients. The results have been used to develop further nutritional interventions in Slovenia.

Phase Angle as a Comprehensive Tool for Nutritional Monitoring and Management in Patients with Crohn’s Disease

“…The PhA can serve as a sensitive indicator for monitoring the nutritional status of CD patients. According to several studies, the PhA is related to the nutritional status of patients in other diseases, with a lower PhA indicating poorer nutritional status [ 7 , 45 , 46 , 47 , 48 ]. These findings are similar to those in our study, which showed a positive correlation between PhA and nutritional status [ 14 , 15 , 49 ]; PhA < 6.11° and < 5.55° could be used as cut-off points for diagnosing malnutrition in males and females, respectively.…”

“…Considered to be a new promising nutritional status assessment method, bioelectrical impedance analysis (BIA) is a noninvasive tool that can be used to assess body composition based on the relationship between total body impedance and total body water. The phase angle (PhA), which represents an indicator of cellular health and membrane integrity, is a variable that is easily calculated using resistance (R) and reactance (Xc) values determined by BIA [ 7 ]. Recently, several studies have indicated that the BIA-derived PhA, a superior prognostic marker, can be considered as a screening tool for the identification of at-risk patients with impaired nutritional and functional status [ 8 ].…”

Factores de riesgo de la desnutrición hospitalaria y mortalidad en pacientes hospitalizados: Una revisión sistemática, periodo 2018-2023

“…Estudios han encontrado que la edad del paciente es un factor que puede influenciar en el grado de desnutrición una vez que estos han sido hospitalizados (Behiry & Salem, 2019;González-Franco et al, 2020;Lovera Montilla & Cáceres Villota, 2023). Mientras más edad presente el paciente, el riesgo de desnutrición aumenta y por tanto también aumenta el riesgo de fallecer (Bhirommuang et al, 2019;Boaz & Kaufman-Shriqui, 2023;Koroušić Seljak et al, 2020;Pereira et al, 2021;Ting et al, 2019) sobre todo con afectaciones como el COVID 19 (Velázquez Alva et al, 2021) y enfermedades renales (Sánchez-Tocino et al, 2022). En el caso de los pacientes oncológicos hospitalizados, no hubo diferencias respecto a las edades, sin embargo presentan las tasas más elevadas de desnutrición hospitalaria (Chimera-Khombe et al, 2022).…”

Extracellular water to total body water ratio predicts survival in cancer patients with sarcopenia: a multi-center cohort study

“…Higher levels of inflammation with higher ECW/TBW may indicate that patients have a great nutritional risk and a worse prognosis. Researchers had found that the malnutrition was associated with greater ratio of ECW [ 49 , 50 ]. We found higher ECW/TBW showed worse prognosis in patients with malnutrition.…”