Original ArticlePrevalence of undernutrition on admission to Swiss hospitals
Introduction
Undernutrition continues to be a common finding in hospitalized patients. In general, the term malnutrition is a broad description of different nutritional conditions such as overweight, underweight, but deficiencies in specific nutrients, e.g. protein or vitamins, are also classified as malnutrition. In the present study, we use the term “undernutrition” for patients with protein-energy-malnutrition. According to the literature, between 20 and 60% of patients are undernourished at the time of hospital admission.1, 2, 3, 4, 5, 6 The prevalence of undernutrition (UN) varies according to the population or type of institution studied and the diagnostic criteria used.7
In a recent study we found a prevalence of UN of 28% in hospitalized general medical patients, and, according to subjective global assessment, every tenth patient was classified as severely undernourished.8 UN is known to predispose to complications and co-morbidity, adversely affect patients' outcome, and has detrimental effects on physical and psychological health.9, 10, 11 UN is also associated with increased mortality. Elderly individuals who lost at least 5% of their body weight within one month, have formerly been shown to have a five- to tenfold increase of the risk of death.12, 13
In Switzerland, there is a general lack of data on the prevalence of UN in hospitalized patients. The use of a simple screening procedure to detect UN is of paramount significance for improvement of nutritional management of hospital patients. The aim of the present study was to investigate the prevalence of UN in medical patients and possible overall regional differences in hospitals of the German speaking part of Switzerland using the simple nutritional risk-screening tool NRS-2002.14 Furthermore, we aimed to sensitize the participating hospital staffs to nutritional issues, and, in particular, to the need of nutritional interventions. In addition the study aimed to show the burden of this problem to hospital managers, insurances and politicians.
Section snippets
Patients
All consecutive adult patients admitted to the general medical departments of 7 Swiss hospitals were eligible for inclusion. Patients admitted to intensive care or day care units were excluded from the study. Recruitment was started in May 2003 and closed in April 2006. All completed NRS-2002 forms were sent to one center (Kantonsspital Winterthur), and the data were entered in a database. Data collection was performed by a single independent person which screened all NRS-2002 scores. She
Results
5978 (18.2%) of 32 837 patients had a score of 3 or more and were classified as severely undernourished or “at risk” for developing UN (Fig. 1). The age-dependent distribution of the NRS-2002 is shown in Fig. 2.
A nutritional intervention was made in 4175 patients (12.7% of the totally screened patients). Thus, 70% (4175/5978) of the patients with an apparent indication for nutrition therapy happened to get such an intervention. The proportion of nutritional interventions increased from 63% in
Discussion
In a very large cohort of 32 837 patients of seven Swiss hospitals, we found a high prevalence of severe UN of 18.2% on admission to hospital. The proportion of one in five patients was constant over the whole observation period of three years. In patients with an obvious indication for nutrition therapy, i.e. an NRS-2002 score of 3 or more, 70% patients on average were treated accordingly.
Since UN is common in hospital patients and chronically under-recognized and under-treated,15 the routine
Conflict of interest statement
All authors of the paper have no conflict of interest.
Acknowledgements
We thank Patricia Imoberdorf for controlling all NRS-2002 forms and entering all the data into the computer database, and the Stiftung Diakoniewerk Neumünster-Schweizerische Pflegerinnenschule for generous financial support.
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