Elsevier

Clinical Nutrition

Volume 29, Issue 1, February 2010, Pages 38-41
Clinical Nutrition

Original Article
Prevalence of undernutrition on admission to Swiss hospitals

https://doi.org/10.1016/j.clnu.2009.06.005Get rights and content

Summary

Background & aims

According to the literature, undernutrition is prevalent in 20–60% of patients on hospital admission. The differences in the rate of undernutrition arise from different diagnostic tools used in the studies. We aimed to investigate the prevalence of undernutrition in Swiss hospitals using a standardized screening tool.

Methods

All patients admitted to the departments of internal medicine of 7 Swiss hospitals were screened at entry for nutritional status using the Nutrition Risk Screening 2002 score. Patients with a score of 3 or more, which denotes severe undernutrition or patient “at risk” for undernutrition were analyzed.

Results

Between May 2003 and April 2006 32 837 patients were included in the study. 5978 (18.2%) had a score of 3 or more and were classified as severely undernourished or at high risk for undernutrition (age < 45 y: 8%; 45–64 y: 11%; 65–84 y: 22%; >85 y: 28%). A nutritional intervention was made in 4175 patients (12.7%).

Conclusions

Nearly one in five patients was severely undernourished or “at risk” for undernutrition. Undernutrition was directly related to age. Patients with a clear indication for nutrition therapy, as suggested by the formal screening procedure, obtained nutritional intervention in 70%.

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.

References (21)

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