Incidence and criteria used in the diagnosis of hospital-acquired malnutrition in adults: a systematic review and pooled incidence analysis

Abstract

Despite advances in identifying malnutrition at hospital admission, decline in nutritional status of well-nourished patients can be overlooked. The aim of this systematic review was to investigate the incidence of hospital-acquired malnutrition (HAM), diagnostic criteria and health-related outcomes. PubMed, CINAHL, Embase and Cochrane Library were searched up to July 2021. Studies were included if changes in nutritional status was assessed with a validated nutrition assessment tool in acute and subacute adult (≥18 yrs) hospitalised patients. A random-effects method was used to pool the incidence proportion of HAM in prospective studies. The certainty of evidence was appraised using the Grading of Recommendation Assessment, Development and Evaluation system. We identified 12 observational cohort studies (10 prospective and 2 retrospective), involving 35,324 participants from acute (9 studies) and subacute settings (3 studies). Retrospective studies reported a lower incidence of HAM (<1.4%) than prospective studies (acute: 9–38%; subacute: 0–7%). The pooled incidence of HAM in acute care was 25.9% (95% confidence interval (CI): 17.3–34.6). Diagnostic criteria varied, with use of different nutrition assessment tools and timeframes for assessment (retrospective studies: >14 days; prospective studies: ≥7 days). Nutritional decline is probably associated with longer length of stay and higher 6-month readmission (moderate certainty of evidence) and may be association with higher complications and infections (low certainty of evidence). The higher incidence of HAM in the acute setting, where nutritional assessments are conducted prospectively, highlights the need for consensus regarding diagnostic criteria and further studies to understand the impact of HAM.

Research and exploration of quality control indicators for nutritional therapy in critically ill patients—a multicenter before-and-after controlled study

“…Malnutrition has negative effects on quality of life and patient outcomes, and can lead to increased healthcare costs ( 15 , 16 ). Its incidence can be as high as 12.6–52% ( 17 ), and research has shown that the incidence of hospital-acquired malnutrition can reach 25.9%, which is associated with longer hospital stays, higher readmission rates at 6 months, and may be related to higher rates of complications and infections ( 18 ). The ratio of EN/EN + PN is negatively correlated with mortality ( 19 ).…”

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

“…Esto también provoca que exista un desperdicio de alimentos preocupante, que afecta a la economía de los hospitales y causa consecuencias medioambientales (Schiavone et al, 2019). Una estancia hospitalaria prolongada provoca que el estado nutricional del paciente se deteriore (Botero et al, 2023;Cuong et al, 2018;Rinninella et al, 2018). Sufrir de desnutrición hospitalaria provoca que la estancia hospitalaria sea mayor y viceversa, a comparación de aquellos pacientes con buenos niveles de nutrición (Behiry & Salem, 2019;Ouaijan et al, 2023;Poudineh et al, 2021;Rabeh et al, 2019;Woodward et al, 2020), además que aumenta los costos hospitalarios (Bhirommuang et al, 2019;Cheng et al, 2019;Yárnoz-Esquíroz et al, 2019).…”

Exploring adult inpatients' perceptions, understanding and preferences regarding the term ‘malnutrition’: A qualitative study

“…Older age, low income, immobility and a long length of hospital stay can increase the risk of malnutrition (Uhl et al., 2021). It is estimated that 20%–50% of hospital inpatients are malnourished (Bellanti et al., 2022) and a quarter of long‐stay patients become malnourished during their hospital stay (Botero et al., 2023). Malnutrition is associated with an increased risk of complications, pressure injury and falls and a decline in muscle strength (Bellanti et al., 2022).…”