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Institutional factors associated with the nutritional status of residents from 10 german nursing homes (ernstes study)



In nursing homes malnutrition among residents is widespread. Because residents place part of their personal freedom of choice into institutional hands, institution-specific factors may influence nutritional status of residents.


Multi-centre cross-sectional study.


10 nation-wide German nursing homes.


714 exclusively orally fed residents (aged 65 years and older, not in final weeks of life).


Participants’ characteristics (e. g. gender, age, level of care, dementia diagnosis), body mass index (BMI), mini nutritional assessment (MNA), energy intake (3-day dietary record, BLS II.3), and selected institution-specific factors (size of institution, daily rate for food supply, number of residents per care staff member). Metric data are given as median (P25, P75).


11 % of residents (81 % female, 85 (81, 91) years) had a BMI <20 kg/m2 (n=658). According to MNA, 10 % of the residents were malnourished (n=650). Capacity of institutions was 116 (56, 139) beds, care staff ratio was 4.1 (3.5, 4.2) residents per care person (mean over all care levels), and daily food budget was 4.45 (4.10, 4.71) Euro/d. Low daily food budget was associated with a higher risk for a BMI <20 kg/m2 (OR 3.30 [95 %CI 1.70–6.42]). Higher food budget also decreased malnutrition risk (OR 0.66 [0.46–0.95]) according to MNA. Residents’ mean energy intake was 6.1 (5.2, 7.1; n=565) MJ/day in women and 7.1 (6.2, 8.2; n=132) MJ/day in men. Intake was higher with small facility size, higher food budget, and lower care staff ratio (P <0.05).


The institutional environment affects the nutritional status of nursing home residents as an independent risk factor. The results suggest promotion of small facilities and the provision of more care staff and more financial resources for food in the structural design of residential homes.

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beta coefficient


Bundesanstalt für Landwirtschaft und Ernährung




body mass index


calf circumference


coefficient of variation


‘Ernährung in stationären Einrichtungen für Senioren und Seniorinnen’




medical services of the German statutory health insurance


mini nutritional assessment


nursing home


not significant


odds ratio




level of significance


25th percentile


75th percentile


standard error


Statistical Package for the Social Sciences


upper arm circumference


95 % confidence interval of the OR


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Correspondence to Stephanie Lesser.

Additional information

Part of the data has been presented as: Strathmann S, Bai J, Lesser S, Overzier S, Paker-Eichelkraut HS, Stehle P, Heseker H (2009): Einfluss einrichtungsspezifischer Faktoren auf den Ernährungsstatus von Altenheimbewohnern in Deutschland. 46th Scientific Congress of the German Nutrition Society (DGE), 2009-03-12/13, Gießen. Proc Germ Nutr Soc 13: 40, PI-21.

The ErnSTES study was financially supported by the Federal Ministry of Food, Agriculture and Consumer Protection via Bundesanstalt für Landwirtschaft und Ernährung (BLE; 05HS017/1-2).

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Strathmann, S., Lesser, S., Bai-Habelski, J. et al. Institutional factors associated with the nutritional status of residents from 10 german nursing homes (ernstes study). J Nutr Health Aging 17, 271–276 (2013).

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Key words

  • Nursing home resident
  • elderly
  • energy intake
  • BMI
  • MNA