Prevalence of hospital malnutrition in Latin America:: The multicenter ELAN study

doi:10.1016/S0899-9007(03)00168-0

Nutrition

Volume 19, Issue 10, October 2003, Pages 823-825

https://doi.org/10.1016/S0899-9007(03)00168-0 Get rights and content

Abstract

Objective

We determined the nutrition status and prevalence of malnutrition as determined by the Subjective Global Assessment in Latin America, investigated the awareness of the health team with regard to nutrition status, evaluated the use of nutritional therapy, and assessed the governmental policies regulating the practice of nutritional therapy in each country.

Methods

This cross-sectional, multicenter epidemiologic study enrolled 9348 hospitalized patients older than 18 y in Latin America. Student's t test and chi-square tests were used to analyze univariate analysis and multiple logistic regression analysis, respectively.

Results

Malnutrition was present in 50.2% of the patients studied. Severe malnutrition was present in 11.2% of the entire group. Malnutrition correlated with age (>60 y), presence of cancer and infection, and longer length of hospital stay (P < 0.05). Fewer than 23% of the patients' records contained information on nutrition-related issues. Nutritional therapy was used in 8.8% of patients (6.3% enteral nutrition and 2.5% parenteral nutrition). Governmental policies ruling the practice of nutritional therapy exist only in Brazil and Costa Rica.

Conclusions

Hospital malnutrition in Latin America is highly prevalent. Despite this prevalence, physicians' awareness of malnutrition is weak, nutritional therapy is not used routinely, and governmental policies for nutritional therapy are scarce.

Introduction

Hospital malnutrition has been a worldwide reality and challenge. Its prevalence has been reported to be in the range of 30% to 50%. A recent study in Latin America indicated that 48.1% of hospitalized patients are malnourished, with severe malnutrition being present in 12.6% of the entire group.1 There are several risk factors associated with the development of this carential syndrome, of which low socioeconomic status, disease per se, older age, and depression can be mentioned.1, 2 Malnutrition has a negative impact on the patients' outcome by increasing morbidity, mortality, length of hospital stay, and costs.3, 4, 5, 6, 7, 8, 9 Despite its high prevalence, malnutrition is seldom recognized and identified by medical teams.1, 10, 11 As a consequence, nutritional therapy is under-prescribed, thus increasing the problem.

In Latin America, a continent characterized by contrasts, where huge populations live in poverty, there are scarce resources dedicated to health issues and, as a consequence, there is a lack of hospital beds. Therefore, it is extremely important to optimize the use of available beds. Adequate nutritional treatment in an attempt to prevent malnutrition-related morbidity and mortality may be an option to decrease hospital length of stay and costs. By decreasing hospitalization time, more hospital beds likely would become available to increase the number of patients receiving health care. However, the prevalence of hospital malnutrition has been addressed in only a few countries. Further, nutritional therapy is not included in governmental health care policies in most countries. Therefore, the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) carried out a multicenter study, the ELAN Project, to assess the nutrition status of hospitalized patients in Latin America. ELAN means Latin American Nutrition Study in Portuguese and Spanish.

Section snippets

Methods

This was a multicenter trial, designed and carried out by members of FELANPE in 13 countries: Argentina, Brazil, Chile, Costa Rica, Cuba, Dominican Republic, Mexico, Panama, Paraguay, Peru, Puerto Rico, Venezuela, and Uruguay. The protocol of the previous Brazilian study (Ibranutri) was thoroughly followed.1, 12 In each country, a national coordinator was named, and this person with other participants were trained by one of the authors (M.I.T.D.C.). Nutrition assessment was performed with the

Results

There were 9348 patients enrolled whose mean age was 52.2 ± 18.4 y, and 51% were men. The distribution according to the country is presented in Table I. Malnutrition was diagnosed in 50.2% of patients, with severe malnutrition in 11.2% of the entire sample. The prevalence of malnutrition in each country can be seen in Table II. Despite the high prevalence of malnutrition, reference to the nutrition status of the patients was registered in only 23.1% of the medical records. The usual weight was

Discussion

Malnutrition is still highly prevalent among hospitalized patients in Latin America in the beginning of the new millennium. Whereas the Brazilian study1, 12 that encompassed 4000 patients was carried out in 1996, the other surveys showing identical overall rates of malnutrition were carried out between 1998 and 2000. These results are similar to others reported in the literature, in a different period.11, 14, 15, 16, 17

Nutrition assessment was performed with the SGA instead of the classic

Acknowledgements

The authors acknowledge the investigation leaders (country national coordinators) of the ELAN Collaborative Study: Adriana Crivelli, MD (Argentina), Alfredo Matos, MD (Panama), Gabriela Parallada, MD (Uruguay), Gertrudis Baptista, RD (Venezuela), Horácio Massotto, MD (Costa Rica), Jesús Barreto, MD (Cuba), Juan Kehr, MD (Chile), Rafael Figueredo, MD (Paraguay), Sergio Echenique, MD (Peru), Victor Sánchez, MD (Mexico), Victoria Soñé, MD (Dominican Republic), Zulma Gonzalez, MD (Puerto Rico), and

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Applied nutritional investigationPrevalence of hospital malnutrition in Latin America:: The multicenter ELAN study

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Nutrition

Aliment Pharmacol Ther

Nutrition

Am J Clin Nutr

Existence, causes and consequences of disease-related malnutrition in the hospital and the community, and clinical and financial benefits of nutritional intervention

Clin Nutr

Impaired wound healing in surgical patients with varying degrees of malnutrition

JPEN

Effects of nutrition on the immune system

Nutrition

Differences in immune status between well-nourished head and neck cancer patients

Clin Nutr

Impact of nutritional status on DRG length of stay

JPEN

Applied nutritional investigation
Prevalence of hospital malnutrition in Latin America:: The multicenter ELAN study