A longitudinal study of hospital undernutrition in the elderly: Comparison of four validated methods
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Undernutrition/nutritional risk were evaluated longitudinally in 531 hospitalized elderly by four validated methods to appraise the most feasible for routine use.
Within 48hrs of admission&24hrs before discharge: the following data were collected: clinical data, nutritional status (BMI, %weight loss) & risk (MNA, MUST), energy requirements (Owen et al), diet.
Significant changes from admission to discharge in risk/undernutrition prevalence, were not shown by BMI (≈17% vs 22%), ≥5% weight loss (≈53% vs ≈56%) or MNA 83% vs ≈81%; at admission, 93% patients were MUST high risk declining to ≈47% (p=0.001) at discharge, alongside eating resumption. By multivariate analysis comparing all methods&differences between patient groups during hospitalization, only %weight loss clarified nutritional progression: more surgical patients had ≥10% weight loss vs medicine, p<0.01. Only admission ≥5% weight loss was predictive of longer hospitalizations (OR:1.57; 95% CI 1.02–2.40; p<0.003), though MNA&MUST undernourished/high risk had significantly longer stays. MNA and MUST were the most concordant methods, p<0.001. Eating compromising symptoms were prevalent in surgery/medicine with ≥5% weight loss, MNA risk/undernutrition, and MUST high risk, p<0.005. Overall, mean energy requirements/diet were not significantly different between admission/discharge: requirements ≈1400kcal were always lower than on offer ≈2128kcal, p=0.0001.
Rigid diets create costly waste which do not counteract nutritional deterioration. Different nutritional risk/status prevalences were unveiled at admission&discharge: >50% patients were at risk/undernourished by significant weight loss, MNA or MUST, all associated with longer stays. Recent weight loss is unarguably essential, comprehensive MNA & MUST similarly reliable; in this study dynamic MUST seemed easier to practise. Quality nutritional care before/during/after hospitalization is mandatory in the elderly.
- MIAH — Merck Institute on Ageing and Health. The state on ageing and health in the America’s 2004. Washington, 2004.
- Bales C. What does it mean to be “at nutritional risk”? Seeking clarity on behalf of the elderly. Am J Clin Nutr 2001;74:155–156.
- Bienia R, Ratcliff S, Barbour GL, Kummer M. Malnutrition in the hospitalized geriatric patient. J Am Geriatr Soc 1982;30:433–436.
- Constans T, Bacq Y, Brechot JF, Guilmot JL, Choutet P, Lamisse F. Protein-energy malnutrition in elderly medical patients. J Am Geriatr Soc 1992;40:263–268.
- Paillaud E, Herbaud S, Caillet P, Lejonc JL, Campillo B, Bories PN. Relations between undernutrition and nosocomial infections in elderly patients. Age Ageing 2005;34:619–625. CrossRef
- Harris C, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage 2004;50:54–63.
- Correia M, Waitzberg D. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235–239. CrossRef
- Green C. Existence, causes and consequences of disease-related malnutrition in the hospital and community, and clinical and financial benefits of nutritional intervention. Clin Nutr 1999;18(suppl):3–28.
- McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994;308:945–948.
- Gomez Ramos M, Gonzalez Valverde F, Sanchez Alvarez C. Nutritional status of an hospitalised aged population. Nutr Hosp 2005;20:286–292.
- Holmes S. Barriers to effective nutritional care for older adults. Nurs Stand 2006;21:50–54.
- Perier C, Triouleyre P, Terrat C, Chomette MC, Beauchet O, Gonthier R. Energy and nutrient intake of elderly hospitalized patients in a steady metabolic status versus catabolic status. J Nutr Health Aging 2004;8:518–520.
- Heymsfield SB, Wang Z, Baumgartner RN, Ross R. Human body composition: advances in models and methods. Annu Rev Nutr 1997;17:527–558. CrossRef
- Heymsfield SB, Baumgartner RN, Pan SF. Nutritional assessment of malnutrition by anthropometric methods. 9th. ed. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern nutrition in health and disease. Baltimore: Williams and Wilkins, 1998:903–921.
- Stratton R, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (’MUST’) for adults. Br J Nutr 2004;92:799–808. CrossRef
- Roebuck J. When does old age begin?: the evolution of the English definition. J Social History 1979;12:416–428.
- Heiat A, Vaccarino V, Krumholz H. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med 2001;161:1194–1203. CrossRef
- Stratton R, Green CJ, Elia M. Disease-related malnutrition: an evidence-based approach to treatment. Wallingford: CABI Publishing, 2003.
- American Society of Parenteral and Enteral Nutrition Board of Directors and Task Force on Standards for Specialized Nutrition Support for Hospitalized Adult Patients: Russell M, Brewer C, Rogers J, Seidner D. Standards for Specialized Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract 2002;17:384–391. CrossRef
- Guigoz Y, Vellas B, Garry P. Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts & Research in Gerontology 1994;4(suppl 2):15–59.
- Kondrup J, Allison S, Elia M, Vellas B, Plauth M. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003;22:415–421. CrossRef
- Shetty P, James WPT. Body mass index: a measure of chronic energy deficiency in adults. Rome: FAO, 1994:1–57.
- Elia M. Screening for Malnutrition: A Multidisciplinary Responsibility. Development and Use of the ‘Malnutrition Universal Screening Tool’ (’MUST’) for Adults. BAPEN 2003, Malnutrition Advisory Group (MAG), a Standing Committee of BAPEN
- Owen OE, Kavle E, Owen RS. A reppraisal of the caloric requirements in healthy women. Am J Clin Nutr 1986;4:4–19.
- Owen OE, Kavle E, Owen RS. A reppraisal of the caloric requirements in healthy men. Am J Clin Nutr 1987;46:875–885.
- Garrel D, Jobin N, Jonge L. Should we still use the Harris and Benedict equations? Nutr Clin Pract 1996;11:99–103. CrossRef
- Campbell S, Avenell A, Walker A. Assessment of nutritional status in hospital inpatients. Quart J Med 2002;95:83–87.
- Mastrangelo G, Fedeli U, Visentin C, Milan G, Fadda E, Spolaore P. Pattern and determinants of hospitalization during heat waves: an ecologic study. BMC Public Healt 2007;7:200–205. CrossRef
- Committee of Experts on Nutrition. Food and nutritional care in hospitals: how to prevent undernutrition. Report and recommendations of the Committee of Experts on Nutrition, Food Safety and Consumer Protection. Starsbourg: Council of Europe, 2002.
- Council of Europe — Committee of Ministers. Resolution ResAP (2003)3 on food and nutritional care in hospitals. Council of Europe, 2003.
- Perry L, Mclaren S. Nutritional support in acute stroke: the impact of evidence-based guidelines. Evid Based Nurs 2003;6:68–71. CrossRef
- Visvanathan R. Under-nutrition in older people: a serious and growing global problem! J Postgrad Med 2003;49:352–360.
- Donini L, et al. MNA predictive value in the follow-up of geriatric patients. J Nutr Health Aging 2003;7:282–293.
- Quadri P, Fraggiacomo C, Guigoz Y. MNA and cost of care. In: Vellas B, Garry P, Guigoz Y, eds. Mini nutritional Assessment (MNA): Research and practice in elderly. Philadelphia: Lippincott-Raven, 1998.
- Barton A, Beigg CL, Macdonald IA, Allison SP. High food wastage and low nutritional intakes in hospital patients. Clin Nutr 2000;19:445–449. CrossRef
- A longitudinal study of hospital undernutrition in the elderly: Comparison of four validated methods
JNHA - The Journal of Nutrition, Health and Aging
Volume 13, Issue 2 , pp 159-164
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- food waste
- nutritional risk
- energy requirements
- energy intake
- Industry Sectors
- Author Affiliations
- 1. Centro Hospitalar do Baixo Alentejo S.A. — Hospital José Joaquim Fernandes, Beja, Portugal
- 2. Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Unidade de Nutrição e Metabolismo, Lisboa, Portugal
- 3. Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Unidade de Nutrição e Metabolismo, Avenida Prof. Egas Moniz, 1649-028, Lisboa, Portugal