Hospital Malnutrition, A Call for Political Action: A Public Health and nutritionDay Perspective

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 analyzed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical patients. In 59126 medical patients included between 2006-2015 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. Nutrition care processes increases slightly with presence of risk factors but never done in more than 50% of 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.

Validation of Malnutrition Clinical Characteristics in Critically Ill Patients

“…Several other studies have confirmed the association between malnutrition and increased mortality rates 13,41–43 . Also, the Nutrition Day showed that largest association with hospital death was observed in patients with reduced mobility or those who were bedridden 44 …”

Impact of Malnutrition in Patients With Infective Endocarditis

“…However, in work conducted by Hiesmayr et al and Sauer et al, it was determined that malnourished patients, in general, had higher 30-day in-hospital mortality when compared with well-nourished patients. 3,10 Our study did not specifically track 30-day outcomes for patients, which might explain lack of similar mortality observance. In addition, patients in the aforementioned studies were not necessarily in the intensive care unit (ICU), which may suggest less aggressive management, hence leading to higher mortality, especially in those cases of supportive care only.…”

Proceso de cuidado nutricional y desnutrición asociada a la enfermedad: ¿negligencia o injusticia?

“…La DAE es una entidad multifactorial en la que se ha reconocido el papel de factores socioeconómicos y patológicos del paciente para su instauración y progresión (3) , pero también se debe tener presente la influencia de la práctica clínica deficiente de cuidado nutricional y conocimiento respecto a la importancia de la nutrición clínica, como se ha identificado en estudios anteriores (1,2,4) . Se ha observado que el proceso de cuidado nutricional es aplicado en menos del 50 % de los pacientes, de los cuales el 11,9 % es identificado con DAE y el 17,6 % es identificado con riesgo de DAE; en menos del 50 % se monitoriza la ingesta alimentaria (aunque haya antecedentes de disminución de esta y de pérdida de peso no intencional), en menos del 46 % hay intervención de personal de nutrición, y menos del 41 % de expedientes tienen datos de riesgo nutricional o DAE (5) .…”