Malnutrition Identified by Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Is Associated With More 30‐Day Readmissions, Greater Hospital Mortality, and Longer Hospital Stays: A Retrospective Analysis of Nutrition Assessment Data in a Major Medical Center

Abstract

The AND/ASPEN criteria identified malnourished patients in a high-risk population who had more adverse clinical outcomes. Further studies are needed to determine whether optimal provision of nutrition support can improve these outcomes.

Malnutrition Diagnosis in Critically Ill Patients Using 2012 Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Standardized Diagnostic Characteristics Is Associated With Longer Hospital and Intensive Care Unit Length of Stay and Increased In‐Hospital Mortality

“…As stated, for comparability we provide a secondary analysis using Hudson's stratification; however this did not alter the outcome. Third, Hudson et al adjusted for comorbidities using the Charlson Comorbidity Index (CCI), which the authors noted had been applied to hospitalized patients with malnutrition . Although our study only controlled for demographic variables and not CCI, our study sample was limited to critically ill patients.…”

“…In this study, our primary analyses consider patients coded as E43 as having “severe malnutrition” and patients coded as E44.0, E44.1, or “no diagnosis” as having “no severe malnutrition.” Because the standardized diagnostic characteristics indicate that the difference between mild and moderate malnutrition is clinically indistinguishable, we chose to dichotomize our study populations to those with severe malnutrition and those without severe malnutrition (including those with mild and moderate malnutrition). Prior studies have compared those with severe and those with mild or moderate malnutrition . Therefore, we conducted a secondary analysis dichotomizing malnutrition into “severe and moderate malnutrition” and “mild and no malnutrition” groups to allow for comparability between studies.…”

“…Although malnutrition using various definitions has previously been associated with increased hospital length of stay (LOS) and in‐hospital mortality rates, and the component criteria for the new definition have been associated with increased morbidity and mortality, few studies have directly validated the 2012 AND/ASPEN diagnostic characteristics as a whole. A recent retrospective study by Hudson et al found that among patients diagnosed with severe malnutrition using the AND/ASPEN criteria (n = 3907), 30‐day hospital readmission rates, hospital LOS, and in‐hospital mortality rates were significantly increased . Among critically ill patients assessed by the AND/ASPEN criteria in the intensive care unit (ICU) (n = 327), Ceniccola et al showed that patients with malnutrition had significantly increased mortality rates compared with patients without malnutrition .…”

Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Usability and Association With Outcomes

“…Since the publication of the adult malnutrition consensus characteristics (AMC), numerous studies have been published to assess their usability and feasibility . Usability refers to the ease with which an instrument can be administered, interpreted by the participant, and scored/interpreted by the researcher .…”

“…In 2014, Nicolo et al completed a cross‐sectional survey of 262 consecutive adults admitted to 2 tertiary teaching hospitals in Pennsylvania to assess the feasibility of collecting the data required to use the AMC instrument . Data availability for use of the AMC and subsequent diagnosis of malnutrition was examined.…”