Prevalence of hospital‐acquired malnutrition and modifiable determinants of nutritional deterioration during inpatient admissions: A systematic review of the evidence

Abstract

Background Malnutrition affects between 20% and 50% of hospital inpatients on admission, with further declines expected during hospitalisation. This review summarises the existing literature on hospital‐acquired malnutrition that examines the magnitude of nutritional deterioration amongst adult inpatients and identifies preventable barriers to optimising nutrition support during episodes of care. Methods A systematic review was conducted to answer the question: Among adult hospital inpatients, the presence of which modifiable factors contribute to hospital‐acquired malnutrition? A database search was conducted between the 24 April and 30 June 2020 using CINAHL, MEDLINE, Scopus and PubMed databases according to a protocol registered with PROSPERO (CD42020182728). In addition, issues of the 10 top clinical nutrition journals published during the period of from 1 April 2015 to 30 March 2020 were hand‐searched. Results Fifteen articles were eligible for inclusion from a total of 5944 retrieved abstracts. A narrative synthesis of evidence was completed because of the high level of heterogeneity in methodologies. Nutritional deterioration is common among previously well‐nourished and nutritionally compromised patients, with studies reporting that 10%–65% of patients experienced nutritional decline. Frequently reported barriers were mealtime interruptions, meal dissatisfaction, procedure‐related fasting, effects of illness or treatment, chewing difficulties, poor appetite and malnutrition as a low clinical priority. Conclusions The findings of this review support the need for routine nutritional risk screening throughout each hospital admission with hospital‐acquired malnutrition affecting up to 65% of inpatients. Clear establishment of the roles and responsibilities of each member within multidisciplinary healthcare teams in the provision of nutrition care and cost–benefit analyses are recommended to demonstrate the effectiveness of changes to models of care.

Prevalence of Malnutrition in Eastern Mediterranean Hospitals: Protocol of a Systematic Review and Meta-Analysis

“…Another study reviewed the existing documents on hospital-acquired malnutrition amongst adult inpatients between April and June 2020 and fifteen articles were included with 10%-65% of patients experienced worsened nutritional status. Frequently described barriers were mealtime disruptions, meal displeasure, procedure-related fasting, effects of illness or treatment, chewing problems, poor appetite and low clinical priority of malnutrition (9) . According to the abovementioned issues, it seems that the risk of malnutrition in hospitalized patients is a major challenge to the health care systems around the world and needs immediate attention.…”

Patients’ Experiences with Nutritional Care during Hospitalization and Proposals for Improvement

“…Besides lack of sufficient attention to malnutrition, nurses perceive reasons for nutritional deterioration during hospitalization to include interruptions during meals, fasting due to procedures, problems with chewing and lack of appetite due to the disease and treatment, lack of information about the individual nutritional needs as well as institutional food routines [33][34][35]. Other reasons could be that patients were ignorant about the implications of malnutrition; hence, did not perceive weight loss as problematic [36], or that patients did not like the food, wanted food alternatives and wanted to be included in the decision regarding meals [34,37,38].…”

The vital role of nutrition and dietetics in the clinical management of disease and injury

“…setting, 3 globally, it is accepted that disease-or injuryassociated malnutrition affects between 20% and 50% of patients on admission to hospital. 4 Nutritional status further deteriorates over the course of the hospital stay, for between 10% and 65% of patients. 4 Malnutrition (often referred to as undernutrition) consists of a combination of reduced food intake or assimilation, and varying degrees of acute or chronic inflammation, in turn leading to altered body composition and diminished biological function.…”

“…4 Nutritional status further deteriorates over the course of the hospital stay, for between 10% and 65% of patients. 4 Malnutrition (often referred to as undernutrition) consists of a combination of reduced food intake or assimilation, and varying degrees of acute or chronic inflammation, in turn leading to altered body composition and diminished biological function. 5 The inflammation associated with both chronic and acute disease or injury contributes to malnutrition through anorexia and decreased food intake, as well as causing an elevation in resting energy expenditure and increased muscle catabolism.…”

“…Although the greatest number of those who are malnourished or at risk of malnutrition reside in the community. setting, 3 globally, it is accepted that disease‐ or injury‐associated malnutrition affects between 20% and 50% of patients on admission to hospital 4 4 .…”