Risk factors for malnutrition among hospitalized gastroenterological patients
Abstract
Background/Aim. Risk factors for malnutrition of patients during hospitalization have not been precisely determined. The aim of the study was to determine these factors in hospitalized gastroenterological patients. Methods. Nutritional status (NS) of 650 gastroenterological patients was assessed at the hospital admission and at discharge by the six parameters: unintentional weight loss, lymphocyte count, serum albumin concentration, body mass index, triceps skinfold thickness, and mid-upper arm muscle circumference. The influence on NS at discharge was tested for ten factors: gender, age, affected organ, the nature, severity, and complications of the disease, the length of hospitalization, mobility worsening during hospitalization, Karnofsky score, and NS on admission. Primary and secondary risk factors were defined among the factors significantly influencing malnutrition. Results. Seven factors were found to be the independent predictors for malnutrition in hospitalized gastroenterological patients. NS at admission was considered as a primary risk factor (Forward: Wald multivariate logistic regression analysis, p < 0.001 for five applied assessment parameters). The other six factors, obtained in the evaluation according to 1-3 assessment parameters, were considered as secondary risk factors: severe disease activity, malignancy, the existence of complications, male gender, hospitalization > 14 days, and mobility worsening during the hospitalization (Forward: Wald multivariate logistic regression analysis, p from 0.001 to 0.027). Conclusion. There are seven risk factors for malnutrition among gastroenterological patients during hospitalization. Timely nutritional support in these patients can prevent the development of intrahospital malnutrition and its negative influence on the clinical outcome.
References
Marinho R, Pessoa A, Lopes M, Rosinhas J, Pinho J, Silveira J, et al. High prevalence of malnutrition in Internal Medicine wards - a multicentre ANUMEDI study. Eur J Intern Med 2020; 76: 82‒8.
Kang MC, Kim JH, Ryu SW, Moon JY, Park JH, Park JK, et al. Prevalence of Malnutrition in Hospitalized Patients: a Multi-center Cross-sectional Study. J Korean Med Sci 2018; 33(2): e10.
Zhu M, Wei J, Chen W, Yang X, Cui H, Zhu S. Nutritional Risk and Nutritional Status at Admission and Discharge among Chinese Hospitalized Patients: A Prospective, Nationwide, Multicenter Study. J Am Coll Nutr. 2017; 36(5): 357‒63.
Seretis C, Kaisari P, Wanigasooriya K, Shariff U, Youssef H. Mal-nutrition is associated with adverse postoperative outcome in patients undergoing elective colorectal cancer resections. J BUON 2018; 23(1): 36‒41.
Maruyama K , Nakagawa N , Koyama S, Maruyama IJ, Hasebe N. Malnutrition Increases the Incidence of Death, Cardio-vascular Events, and Infections in Patients With Stroke After Rehabilitation. Cerebrovasc Dis J Stroke 2018; 27(3): 716‒23.
Gomes F, Baumgartner A , Lisa Bounoure L, Bally M , Deutz EN , Greenwald LJ, et al. Association of nutritional support with clinical outcomes among medical inpatients who are mal-nourished or at nutritional risk: an updated systematic review and meta-analysis. JAMA Netw Open 2019; 2(11): e1915138.
Blaauw R, Achar E, Dolman RC Harbron J, Moens M, Munyi F et al. The Problem of Hospital Malnutrition in the African Con-tinent. Nutrients 2019; 11(9): E2028.
Bhirommuang N, Komindr S, Jayanama K. Impact of nutritional status on length of stay and hospital costs among patients ad-mitted to a tertiary care hospital in Thailand. Asia Pac J Clin Nutr 2019; 28(2): 252‒9.
Rinninella E, Cintoni M, De Lorenzo A, Anselmi G, Gagliardi L, Addolorato G et al. May nutritional status worsen during hospital stay? A sub-group analysis from a cross-sectional study. Intern Emerg Med 2019; 14(1): 51‒7.
Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Decline in nutritional status is associat-ed with prolonged length of stay in hospitalized patients ad-mitted for 7 days or more: A prospective cohort study. Clin Nutr 2016; 35(1): 144‒52.
Rinninella E, Cintoni M, De Lorenzo A, Addolorato G, Vassallo G, Moroni R et al. Risk, Prevalence, and Impact of Hospital Malnutrition in a Tertiary Care Referral University Hospital: A Cross-Sectional Study. Intern Emerg Med 2018; 13(5): 689‒97.
Cao Q Huang YH, Jiang M, Dai C. The prevalence and risk fac-tors of psychological disorders, malnutrition and quality of life in IBD patients. Scand J Gastroenterol 2019; 54(12): 1458‒66.
Allard JP, Keller H, Teterina A, Jeejeebhoy KN, Laporte M, Duerksen DR et al. Factors associated with nutritional de-cline in hospitalised medical and surgical patients admitted for 7 d or more: a prospective cohort study. Br J Nutr 2015; 114(10): 1612‒22.
Cui HY, Zhu MW, Wei JM, Chen W, Yang X, Zhu SN et al. Changes in nutritional status of patients with different diseas-es during hospitalization. Zhonghua Wai Ke Za Zhi 2017; 55(4): 297‒302. (Chinese)
Powell-Tuck J, Hennessy EM. A comparison of mid upper arm circumference, body mass index and weight loss as indices of undernutrition in acutely hospitalized patients. Clin Nutr 2003; 22(3): 307‒12.
Hammond KA. Dietary and clinical assessment. In: Kathleen ML, Raymond JL, Escott-Stump S, editors. Krause,s Food, nu-trition & diet therapy. 10 th ed. Philadelphia: WB Saunders; 2000. p. 353‒79.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. Educational and Clinical Practice Committee, European Society of Paren-teral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22(4): 415‒21.
Nthani D, Makasa J, Audain K. Establishing malnutrition prev-alence in adult in-patients in female and male medical wards at university teaching hospital: a case study of lusaka province. Acta Sci Nutr Health 2020; 4(1): 47‒55.
Zhang L, LuY, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br J Nutr 2014; 111(7): 1239‒44.
Young MA , Mudge MA , Banks DM , Rogers L, Demedio K, Isenring E. Improving Nutritional Discharge Planning and Follow Up in Older Medical Inpatiens: Hospital to Home Outreach for Malnourished Elders. Nutr Diet 2018; 75 (3): 283‒90.
Planas M, Hernández AJ, Sanz LM, Pérez CS, Araujo K, García de Lorenzo A et al. Prevalence of Hospital Malnutrition in Cancer Patients: A Sub-Analysis of the PREDyCES® Study. Support Care Cancer 2016; 24(1): 429‒35.
Leandro-Merhi VA, Costa CL, Saragiotto L, Aquino JLB. Nutri-tional indicators of malnutrition in hospitalized patients. Arq Gastroenterol 2019; 56(4): 447‒50.
Chang KD, Song AG. Understanding Nutritional Support in Digestive Diseases. Korean J Gastroenterol 2015; 65(6): 333‒5. (Korean)
Konturek PC, Herrmann HJ, Schink K, Neurath MF, Zopf Y. Mal-nutrition in Hospitals: It Was, Is Now, and Must Not Remain a Problem! Med Sci Monit 2015; 21: 2969‒75.
Jeejeebhoy NK, Duerksen RD. Malnutrition in Gastrointestinal Disorders: Detection and Nutritional Assessment. Gastroen-terol Clin North Am 2018; 47(1): 1‒22.
Tostado CM, Guevara CG, Alvarado LES , Cervantes-Pérez CG, Camacho BJF, Clotilde FO, et al. Comparison of Nutrition-al Screening Tools to Assess Nutritional Risk and Predict Clinical Outcomes in Mexican Patients With Digestive Dis-eases. BMC Gastroenterol 2020; 20(1): 79.
Shuja A, Malespin M, Scolapio J. Nutritional Considerations in Liver Disease. Gastroenterol Clin North Am 2018; 47(1): 243‒52.
Ciocîrlan Ma , Ciocîrlan Mi , Iacob R, Tanțău A, Gheorghe L , Gheorghe C, et al. Malnutrition Prevalence in Newly Diag-nosed Patients With Inflammatory Bowel Disease - Data From the National Romanian Database. J Gastrointestin Liver Dis 2019; 28: 163‒8.
Gheorghe C, Pascu O, Iacob R, Vadan R, Iacob S, Goldis A, et al. Nutritional Risk Screening and Prevalence of Malnutrition on Admission to Gastroenterology Departments: A Multicentric Study. Chirurgia (Bucur) 2013; 108(4): 535‒41.
Lewis RS, Schofield-Robinson JO, Alderson P, Smith FA. Enteral Versus Parenteral Nutrition and Enteral Versus a Combina-tion of Enteral and Parenteral Nutrition for Adults in the In-tensive Care Unit. Cochrane Database Syst Rev 2018; 6(6): CD012276.
Rogobete FA, Grintescu MI, Bratu T, Bedreag HO, Papurica M, Petrisor Z, et al. Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Pa-tients: From Molecular to Clinical Outcomes. Diagnostics (Basel) 2019; 9(4): 171.
Maev VI , Kucheryavyi AYu , Andreev ND, Bideeva VT. Nutri-tional Status in PatientsWith Chronic Pancreatitis. Ter Arkh 2016; 88(2): 81‒9. (Russian)
Caporali R, Caccialanza R, Bonino C, Klersy C, Cereda E, Xoxi B et al. Disease-related malnutrition in outpatients with systemic sclerosis. Clin Nutr 2012; 31(5): 666‒71.
Ryan MA, Power GD, Daly L , Cushen JS, Bhuachalla NE, Prado MC. Cancer associated Malnutrition, Cachexia and Sarcopenia: The Skeleton in the Hospital Closet 40 Years Lat-er. Proc Nutr Soc 2016; 75(2): 199‒211.
Lach K, Peterson JS. Nutrition Support for Critically Ill Patients With Cancer.Nutr Clin Pract 2017; 32(5): 578‒86.
Baccaro F, Sanchez A. Body mass index is a poor predictor of malnutrition in hospitalized patients. Niger J Med 2015; 24(4): 310‒4.
de Pinho NB, Martucci RB, Rodrigues VD, D'Almeida CA, Thuler LCS, Saunders C, et al. Malnutrition associated with nutrition impact symptoms and localization of the disease: Results of a multicentric research on oncological nutrition. Clin Nutr 2019; 38(3): 1274‒9.
Pirlich M , Schütz T, Norman K, Gastell S, Lübke JH, Bischoff CS, et al. The German Hospital Malnutrition Study. Clin Nutr 2006; 25(4): 563‒72.
Zhu WM , Wei MJ, Chen W, Yang X, Cui YH, S N Zhu NS, et al. Dynamic Investigation of Nutritional Risk in Patients With Malignant Tumor During Hospitalization. Zhonghua Yi Xue Za Zhi 2018; 98(14): 1093‒8. (Chinese)
Pañella L, Jara M, Cornejo M, Lastra X, Contreras GM, Alfaro K, et al. Nutritional Status and Postoperative Complications in Patients With Digestive Cancer]. Rev Med Chil 2014; 142(11): 1398-406. (Spanish)
De Waele E , Malbrain M, Spapen H. Nutrition in Sepsis: A Bench-to-Bedside Review. Nutrients 2020; 12(2): 395.
Laaban JP. Nutrition and Chronic Respiratory Failure. Ann Med Interne (Paris) 2000; 151(7): 542‒8. (French)
Gu A, MalahiasAM, StrigelliV, Nocon AA, Sculco PT, Sculco KP. Preoperative Malnutrition Negatively Correlates With Post-operative Wound Complications and Infection After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34(5): 1013‒24.
Cardi M, Sibio S, Di Marzo F, Lefoche F, d'Agostino C, Fonsi BG, et al. Prognostic Factors Influencing Infectious Compli-cations After Cytoreductive Surgery and HIPEC: Results From a Tertiary Referral Center. Gastroenterol Res Pract 2019; 2019: 2824073.
Carlsson M, Håglin L, Rosendahl E, Gustafson Y. Poor Nutri-tional Status Is Associated With Urinary Tract Infection Among Older People Living in Residential Care Facilities. J Nutr Health Aging 2013; 17(2): 186‒91.
Pinchcofsky DG, Kaminski VM Jr. Increasing Malnutrition Dur-ing Hospitalization: Documentation by a Nutritional Screen-ing Program. J Am Coll Nutr 1985; 4(4): 471‒9.
Kinyoki KD, Berkley AJ, Moloney MG, Kandala BN, Noor MA. Predictors of the Risk of Malnutrition Among Children Under the Age of 5 Years in Somalia. Public Health Nutr 2015; 18(17): 3125‒33.
Correia MI, Caiaffa TW, da Silva LA, Waitzberg LD. Risk Factors for Malnutrition in Patients Undergoing Gastroenter-ological and Hernia Surgery: An Analysis of 374 Patients. Nutr Hosp 2001; 16(2): 59‒64.
Mosselman MJ, Kruitwagen CL, Schuurmans MJ, Hafsteinsdóttir TB. Malnutrition and Risk of Malnutrition in Patients With Stroke: Prevalence During Hospital Stay. J Neurosci Nurs 2013; 45(4): 194‒204.
Lin JS, Hwang JS, Liu YC, Lin RH. The Relationship Between Nutritional Status and Physical Function, Admission Fre-quency, Length of Hospital Stay, and Mortality in Old People Living in Long-Term Care Facilities. J Nurs Res 2012; 20(2): 110‒21.
Weinsier RL, Hunker EM, Krumdieck CL, Butterworth CE Jr. Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr 1979; 32(2): 418‒26.
Correia MA. Hospital Malnutrition in Latin America: Building a Culture of Nutrition Care: The feedM.E. Global Study Group Response to "A Quick Fix for Hospital-Acquired Mal-nutrition?" JPEN J Parenter Enteral Nutr 2016; 40(4): 458‒9.
O'Shea E, Trawley S, Manning E, Barrett A, Browne V, Timmons S. Malnutrition in Hospitalised Older Adults: A Multicentre Observational Study of Prevalence, Associations and Out-comes. J Nutr Health Aging 2017; 21(7): 830‒6.
Pérez-Cruz E, Camacho-Limas CP. Association of nutrition-al status and functional capacity in gastrointestinal cancer pa-tients. Gac Med Mex 2017; 153(5): 575‒80. (Spanish)
Li J, Wang C, Liu X, Liu Q, Lin H, Liu C, et al. Severe malnutrition evaluated by patient-generated subjective global assessment results in poor outcome among adult patients with acute leukemia: A retrospective cohort study. Medi-cine (Baltimore) 2018; 97(3): e9663.
Ziętarska M, Krawczyk-Lipiec J, Kraj L, Zaucha R, Małgorzewicz S. Nutritional status assessment in colorectal cancer patients qualified to systemic treatment. Contemp Oncol (Pozn) 2017; 21(2): 157‒61.
Kirkland LL, Shaughnessy E. Recognition and Prevention of Nosocomial Malnutrition: A Review and A Call to Action! Am J Med 2017; 130(12): 1345‒50.
McWhirter PJ, Pennington RC. Incidence and Recognition of Malnutrition in Hospital. BMJ 1994; 308(6934): 945‒8.
Rivera-Comparán EA, Ramírez-Cruz SI, Villasis-Keever MA, Zurita-Cruz JN. Factors Related to the Presence of Hospital Malnutrition in Patients Under Five Years Old in a Third Level Unit. Nutr Hosp 2019; 36(3): 563‒70. (Spanish)