Internal and Emergency Medicine

, Volume 13, Issue 5, pp 689–697 | Cite as

Risk, prevalence, and impact of hospital malnutrition in a Tertiary Care Referral University Hospital: a cross-sectional study

  • Emanuele RinninellaEmail author
  • Marco Cintoni
  • Antonino De Lorenzo
  • Giovanni Addolorato
  • Gabriele Vassallo
  • Rossana Moroni
  • Giacinto Abele Donato Miggiano
  • Antonio Gasbarrini
  • Maria Cristina Mele


Hospital malnutrition is still underestimated among physicians, even in internal medicine settings. This is a cross-sectional study, aiming to estimate the risk, the prevalence and the impact of malnutrition in an Internal Medicine and Gastroenterology Department of a large Italian hospital (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome). Patients were evaluated within 72 h from admission according to Nutritional Risk Screening-2002 (NRS-2002) and European Society for Clinical Nutrition and Metabolism (ESPEN) Criteria. Anthropometric, laboratory tests and Bioelectrical Impedance Analysis (BIA) derived phase angle were also performed. Length of hospital stay (LOS) and in-hospital mortality were collected. Univariate and multivariate analyses were conducted to correlate nutritional status with LOS and hospital mortality. In 10 months, 300 patients were enrolled: male patients were 172 (57.3%); mean age was 63.7 (± 17.6). At admission, 157 (52.3%) patients were at risk of malnutrition; 116 (38.7%) were malnourished. Malnourished patients had a mean LOS of 11.5 (± 8.0) days, not-malnourished 9.4 (± 6.2) days (p < 0.05). In-hospital mortality did not significantly differ between the two groups. Multivariate analysis shows that both malnutrition (p = 0.04; 95% CI 0.03–3.41) and phase angle (p = 0.004; 95% CI − 1.92 to − 0.37) independently correlate with LOS. In an Internal Medicine and Gastroenterology Department, over half (52.3%) of the patients were found at risk of malnutrition, and over a third (38.7%) were malnourished at hospital admission. Malnutrition and BIA-derived phase angle are independently associated with LOS. ESPEN Criteria and phase angle could be performed at admission to identify patients deserving specific nutritional support.


Hospital malnutrition NRS-2002 ESPEN Criteria Phase angle Length of hospital stay Hospital mortality Personalized medicine 



The Authors wish to sincerely thank the dietitians Dr. Basso L., Dr. Egidi G. and Dr. Leone S. for their contributions in collecting patients’ data.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

The study was carried out according to Declaration of Helsinki and obtained the approval of the local Ethics Committee (Fondazione Policlinico A. Gemelli). Protocol number 53572/17.

Informed consent

Patients gave their informed consent to participate to the survey.


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Copyright information

© SIMI 2018

Authors and Affiliations

  • Emanuele Rinninella
    • 1
    Email author
  • Marco Cintoni
    • 1
    • 2
  • Antonino De Lorenzo
    • 2
  • Giovanni Addolorato
    • 3
  • Gabriele Vassallo
    • 3
  • Rossana Moroni
    • 4
  • Giacinto Abele Donato Miggiano
    • 1
  • Antonio Gasbarrini
    • 3
  • Maria Cristina Mele
    • 1
  1. 1.Clinical Nutrition Unit, Gastroenterology and Oncology AreaFondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro CuoreRomaItaly
  2. 2.Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
  3. 3.Internal Medicine and Gastroenterology Unit, Gastroenterology and Oncology AreaFondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro CuoreRomaItaly
  4. 4.Institute of Neurology, Neuroscience AreaFondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro CuoreRomeItaly

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