High prevalence of malnutrition in Internal Medicine wards – a multicentre ANUMEDI study

Marinho, R.C.; Pessoa, Ana; Lopes, Marta; Rosinhas, J.; Pinho, João Pedro; Silveira, Joana; Amado, Ana; Silva, Sandra Gomes; Oliveira, Bruno; Marinho, A.; Jager‐Wittenaar, Harriët

doi:10.1016/j.ejim.2020.02.031

Cited by 19 publications

(20 citation statements)

References 34 publications

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“…Previous studies have shown that the prevalence of malnutrition on hospital admission is in the range from 22% to 73%. [1][2][3] In our study, depending on the NSAPs we used, malnutrition on hospital admission was diagnosed in 7.7-31.7% of patients, which is partly in accordance with the results of the other authors. Probably, a lower percentage of malnutrition could be explained by the specificity of our series, which only included gastroenterological patients.…”

Section: Discussionsupporting

confidence: 91%

“…Malnutrition is a serious health problem that affect more than 20% patients on hospital admission. [1][2][3] It significantly contributes to the many adverse outcomes, such as cardiovascular and infective complications, increased morbidity and mortality, prolonged hospitalization, increased hospitalization costs and increased re-admission rates after discharge from the hospital. [4][5][6][7][8] Although these consequences of poor nutritional status are well known, malnutrition is often undiagnosed on hospital admission.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies investigated the risk factors for malnutrition among the patients on hospital admission. 1,[11][12][13] However, there is a lack of data regarding the prevalence and risk factors for malnutrition during hospitalization. Some authors highlight gender, age, malignant tumors, reduced food intake, prolonged therapeutic fasting, as factors associated with malnutrition, but the significance of these factors has not been precisely determined.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for malnutrition among hospitalized gastroenterological patients

et al. 2022

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Background / Aims. Risk factors for malnutrition of patients during hospitalization have not been precisely determined. The aim of the study was to determine these factors in hospitalized gastroenterological patients. Methods. Nutritional status (NS) of 650 gastroenterological patients was assessed on admission and at discharge by the six parameters: unintentional weight loss, lymphocyte counts, serum albumin concentration, body mass index, triceps skinfold thickness and midupper arm muscle circumference. The influence on NS at discharge was tested for ten factors: gender, age, affected organ, the nature, severity and complications of the disease, the lenght of hospitalization, mobility worsening during hospitalization, Karnofsky score and NS on admission. Primary and secondary risk factors were defined among the factors influencing significantly the malnutrition. Results. Seven factors were found to be the independent predictors for malnutrition in hospitalized gastroenterological patients. NS on admission was considered as primary risk factor (Forwald: Wald multivariate logistic regression analysis, p<0.001 for five applied assessment parameters). The other factors, obtained in the evaluation according to 1-3 parameters, were considered as secondary risk factors: severe disease activity, malignancy, the existence of complications, male gender, hospitalization >14 days, and mobility worsening during the hospitalization (Forwald:Wald multivariate logistic regression analysis, p from 0.001 to 0.027). Conclusion. There are seven risk factors for malnutrition among gastroenterological patients during hospitalization. Timely nutritional support in these patients can prevent the development of intrahospital malnutrition and its negative influence on clinical outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors for malnutrition among hospitalized gastroenterological patients

et al. 2022

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“…The difference in magnitude is related to patient heterogeneity, as we included patients from both surgical and medical wards in the current study, and found a higher prevalence of malnutrition risk, and a larger difference in classification between PG-SGA SF and MUST in medical as compared to surgical wards. This indicates a higher prevalence of risk factors for malnutrition in patients admitted to medical wards, consistent with a previous multi-center study on Internal Medicine wards [43]. Our previous cross-sectional analysis of the current cohort, moreover, indicates that BMI is a major factor affecting differences in diagnostic properties of MUST as compared to PG-SGA SF, with the most pronounced difference in patients with an overweight or obese BMI [28].…”

Section: Discussionsupporting

confidence: 90%

Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment Short Form and their predictive validity in hospitalized patients

Gomes-Neto

Vliet

Osté

et al. 2021

Clinical Nutrition ESPEN

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Background and aims: Malnutrition screening is a first step in the nutrition care process for hospitalized patients, to identify those at risk of malnutrition and associated worse outcome, preceding further assessment and intervention. Frequently used malnutrition screening tools including the Malnutrition Universal Screening Tool (MUST) mainly screen for characteristics of malnutrition, while the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) additionally includes risk factors for development of malnutrition, yielding a higher percentage of patients at risk. To investigate whether this translates into higher risk of worse outcome, we aimed to determine the predictive validity of MUST and PG-SGA SF for prolonged hospitalization >8 days, readmission, and mortality <6 months after hospital discharge. Methods: In this observational study, MUST was performed according to university hospital protocol. Additional screening using PG-SGA SF was performed within 24 h of hospital admission (high risk: MUST 2, PG_SGA SF 9). Associations of MUST and PG-SGA SF with outcomes were analyzed by logistic-and Cox PH-regression. Results: Of 430 patients analyzed (age 58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m 2 ), MUST and PG-SGA SF identified 32 and 80 at high risk, respectively. One-hundred-eight patients had prolonged hospitalization, 109 were readmitted and 20 died. High risk by MUST was associated with mortality (HR ¼ 3.9; 95% CI 1.3e12.2, P ¼ 0.02), but not with other endpoints. High risk by PG-SGA SF was associated with prolonged hospitalization (OR ¼ 2.5; 95% CI 1.3e5.0, P ¼ 0.009), readmission (HR ¼ 1.9; 95% CI 1.1e3.2, P ¼ 0.03), and mortality (HR ¼ 34.8; 95% CI 4.2e289.3, P ¼ 0.001), independent of age, sex, hospital ward and previous hospitalization <6 months. In the 363/430 patients classified as low risk by MUST, high risk by PG-SGA SF was independently associated with higher risk of readmission (HR ¼ 1.9; 95% CI 1.0e3.5, P ¼ 0.04) and mortality (HR ¼ 19.5; 95% CI 2.0e189.4, P ¼ 0.01). Conclusions: Whereas high malnutrition risk by MUST was only associated with mortality, PG-SGA SF was associated with higher risk of prolonged hospitalization, readmission, and mortality. In patients considered as low risk by MUST, high malnutrition risk by PG-SGA SF was also predictive of worse outcome. Our findings support the use of PG-SGA SF in routine care to identify patients at risk of malnutrition and worse outcome, and enable proactive interventions.

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“…PG-SGA is an instrument to diagnose malnutrition and has been used in oncology, acute medical, surgical, and elderly patients. 3,[7][8][9][10] Scores range from 0 to 52, and patients were considered malnourished with a score !9. 3…”

Section: Measurementsmentioning

confidence: 99%

Evaluation of the Validity and Feasibility of the GLIM Criteria Compared with PG-SGA to Diagnose Malnutrition in Relation to One-Year Mortality in Hospitalized Patients

IJmker-Hemink¹,

Heerschop²,

Wanten³

et al. 2022

Journal of the Academy of Nutrition and Dietetics

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Background The Global Leadership Initiative on Malnutrition (GLIM) approach to diagnose malnutrition was published in 2018. An important next step is to use the GLIM criteria in clinical investigations to assess their validity and feasibility.Objective To compare the validity and feasibility of the GLIM criteria with Patient-Generated Subjective Global Assessment (PG-SGA) in hospitalized patients and to assess the association between malnutrition and 1-year mortality.Design Post hoc analysis of a prospective cohort study. Participants/setting Hospitalized patients (n ¼ 574) from the Departments of Gastroenterology, Gynecology, Urology, and Orthopedics at the Radboudumc academic facility in Nijmegen, The Netherlands, were enrolled from July 2015 through December 2016. Main outcome measuresThe GLIM criteria and PG-SGA were applied to identify malnourished patients. Mortality rates were collected from electronic patient records. Feasibility was assessed by evaluating the amount of and reasons for missing data.Statistical analyses performed Concurrent validity was evaluated by assessing the sensitivity, specificity, and Cohen's kappa coefficient for the GLIM criteria compared with PG-SGA. Cox regression analysis was used for the association between the GLIM criteria and PG-SGA and mortality. ResultsOf 574 patients, 160 (28%) were classified as malnourished according to the GLIM criteria and 172 (30.0%) according to PG-SGA (k ¼ 0.22, low agreement). When compared with PG-SGA, the GLIM criteria had a sensitivity of 43% and a specificity of 79%. Mortality of malnourished patients was more than two times higher than for nonmalnourished patients according to the GLIM criteria (hazard ratio [HR], 2.68; confidence interval [CI], 1.33-5.41). Data on muscle mass was missing in 454 of 574 (79%) patients because of practical problems with the assessment using bioimpedance analysis (BIA).Conclusions Agreement between GLIM criteria and PG-SGA was low when diagnosing malnutrition, indicating that the two methods do not identify the same patients. This is supported by the GLIM criteria showing predictive power for 1-year mortality in hospitalized patients in contrast to PG-SGA. The assessment of muscle mass using BIA was difficult to perform in this clinical population.

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High prevalence of malnutrition in Internal Medicine wards – a multicentre ANUMEDI study

Cited by 19 publications

References 34 publications

Risk factors for malnutrition among hospitalized gastroenterological patients

Risk factors for malnutrition among hospitalized gastroenterological patients

Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment Short Form and their predictive validity in hospitalized patients

Evaluation of the Validity and Feasibility of the GLIM Criteria Compared with PG-SGA to Diagnose Malnutrition in Relation to One-Year Mortality in Hospitalized Patients

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