JNHA - The Journal of Nutrition, Health and Aging

, Volume 13, Issue 2, pp 159–164

A longitudinal study of hospital undernutrition in the elderly: Comparison of four validated methods

JNHA: Geriatric Science

Abstract

Background

Undernutrition/nutritional risk were evaluated longitudinally in 531 hospitalized elderly by four validated methods to appraise the most feasible for routine use.

Design

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.

Results

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.

Conclusions

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.

Key words

Elderly hospital food waste undernutrition nutritional risk energy requirements energy intake MNA MUST 

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References

  1. 1.
    MIAH — Merck Institute on Ageing and Health. The state on ageing and health in the America’s 2004. Washington, 2004.Google Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    Bienia R, Ratcliff S, Barbour GL, Kummer M. Malnutrition in the hospitalized geriatric patient. J Am Geriatr Soc 1982;30:433–436.PubMedGoogle Scholar
  4. 4.
    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.PubMedGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    Harris C, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage 2004;50:54–63.PubMedGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.Google Scholar
  9. 9.
    McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994;308:945–948.PubMedGoogle Scholar
  10. 10.
    Gomez Ramos M, Gonzalez Valverde F, Sanchez Alvarez C. Nutritional status of an hospitalised aged population. Nutr Hosp 2005;20:286–292.PubMedGoogle Scholar
  11. 11.
    Holmes S. Barriers to effective nutritional care for older adults. Nurs Stand 2006;21:50–54.PubMedGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    Heymsfield SB, Wang Z, Baumgartner RN, Ross R. Human body composition: advances in models and methods. Annu Rev Nutr 1997;17:527–558.PubMedCrossRefGoogle Scholar
  14. 14.
    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.Google Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Roebuck J. When does old age begin?: the evolution of the English definition. J Social History 1979;12:416–428.Google Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    Stratton R, Green CJ, Elia M. Disease-related malnutrition: an evidence-based approach to treatment. Wallingford: CABI Publishing, 2003.Google Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.Google Scholar
  21. 21.
    Kondrup J, Allison S, Elia M, Vellas B, Plauth M. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003;22:415–421.PubMedCrossRefGoogle Scholar
  22. 22.
    Shetty P, James WPT. Body mass index: a measure of chronic energy deficiency in adults. Rome: FAO, 1994:1–57.Google Scholar
  23. 23.
    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 BAPENGoogle Scholar
  24. 24.
    Owen OE, Kavle E, Owen RS. A reppraisal of the caloric requirements in healthy women. Am J Clin Nutr 1986;4:4–19.Google Scholar
  25. 25.
    Owen OE, Kavle E, Owen RS. A reppraisal of the caloric requirements in healthy men. Am J Clin Nutr 1987;46:875–885.PubMedGoogle Scholar
  26. 26.
    Garrel D, Jobin N, Jonge L. Should we still use the Harris and Benedict equations? Nutr Clin Pract 1996;11:99–103.PubMedCrossRefGoogle Scholar
  27. 27.
    Campbell S, Avenell A, Walker A. Assessment of nutritional status in hospital inpatients. Quart J Med 2002;95:83–87.Google Scholar
  28. 28.
    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.CrossRefGoogle Scholar
  29. 29.
    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.Google Scholar
  30. 30.
    Council of Europe — Committee of Ministers. Resolution ResAP (2003)3 on food and nutritional care in hospitals. Council of Europe, 2003.Google Scholar
  31. 31.
    Perry L, Mclaren S. Nutritional support in acute stroke: the impact of evidence-based guidelines. Evid Based Nurs 2003;6:68–71.PubMedCrossRefGoogle Scholar
  32. 32.
    Visvanathan R. Under-nutrition in older people: a serious and growing global problem! J Postgrad Med 2003;49:352–360.PubMedGoogle Scholar
  33. 33.
    Donini L, et al. MNA predictive value in the follow-up of geriatric patients. J Nutr Health Aging 2003;7:282–293.PubMedGoogle Scholar
  34. 34.
    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.Google Scholar
  35. 35.
    Barton A, Beigg CL, Macdonald IA, Allison SP. High food wastage and low nutritional intakes in hospital patients. Clin Nutr 2000;19:445–449.PubMedCrossRefGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2009

Authors and Affiliations

  1. 1.Centro Hospitalar do Baixo Alentejo S.A. — Hospital José Joaquim FernandesBejaPortugal
  2. 2.Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de LisboaUnidade de Nutrição e MetabolismoLisboaPortugal
  3. 3.Instituto de Medicina Molecular, Faculdade de Medicina de LisboaUnidade de Nutrição e MetabolismoLisboaPortugal

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