Elsevier

Clinical Nutrition

Volume 31, Issue 1, February 2012, Pages 41-47
Clinical Nutrition

Original article
Nutritional status and dietary intake of acute care patients: Results from the Nutrition Care Day Survey 2010

https://doi.org/10.1016/j.clnu.2011.08.002Get rights and content

Summary

Background & aims

One aim of the Australasian Nutrition Care Day Survey was to determine the nutritional status and dietary intake of acute care hospital patients.

Methods

Dietitians from 56 hospitals in Australia and New Zealand completed a 24-h survey of nutritional status and dietary intake of adult hospitalised patients. Nutritional risk was evaluated using the Malnutrition Screening Tool. Participants ‘at risk’ underwent nutritional assessment using Subjective Global Assessment. Based on the International Classification of Diseases (Australian modification), participants were also deemed malnourished if their body mass index was <18.5 kg/m2. Dietitians recorded participants’ dietary intake at each main meal and snacks as 0%, 25%, 50%, 75%, or 100% of that offered.

Results

3122 patients (mean age: 64.6 ± 18 years) participated in the study. Forty-one percent of the participants were “at risk” of malnutrition. Overall malnutrition prevalence was 32%. Fifty-five percent of malnourished participants and 35% of well-nourished participants consumed ≤50% of the food during the 24-h audit. “Not hungry” was the most common reason for not consuming everything offered during the audit.

Conclusion

Malnutrition and sub-optimal food intake is prevalent in acute care patients across hospitals in Australia and New Zealand and warrants appropriate interventions.

Introduction

In recent published literature, several international studies report hospital malnutrition prevalence ranging from 20 to 50%.1 A weighted mean of studies from Europe and USA indicated that 31% of hospital patients are either malnourished or at nutritional risk.2 In the last decade results from malnutrition prevalence studies emerging from four Australian and one New Zealand hospital report malnutrition prevalence ranging from 11 to 47%.2, 3, 4, 5, 6 Variation in sample size and the use of a variety of techniques to evaluate nutritional status (including anthropometric measurements, nutritional screening and assessment tools) are factors that prevent generalisation of the prevalence of malnutrition in the Australian and New Zealand acute care setting. The largest multicentre malnutrition study conducted by Banks et al. (n = >2200) reported 30% malnutrition prevalence in the acute care setting, however its results were limited to public hospitals in the state of Queensland only.2

One of the many factors implicated in the aetiology of malnutrition is sub-optimal food intake during hospitalisation.7, 8, 9, 10 Although optimal nutritional intake forms an essential part of therapeutic treatment of malnutrition, only two Australian studies were identified describing the food intake trends of acute care patients. One study audited the nutritional intake at main meals of acute care patients and reported that on average, the energy consumption of over one-third of their participants was less than 50% of that provided in a standard hospital diet.11 However, this study did not capture information on the nutritional status of the participants. In a recent study, Bauer et al. (2011) found on average nearly 50% of patients reported eating half or less of their meal and these patients were found to be up to four times more likely to be malnourished compared to those who ate more than half of their meal.12 The European NutritionDay Study captured information on the body mass index of acute care patients and audited their one-day food intake.8 The study found that fewer than half the participants finished the meals offered during the one-day audit.8 The strength of the European NutritionDay Study was its large sample size of 16000 participants (from 256 hospitals across Europe) and the involvement of a variety of people (such as doctors, nurses, catering and food service staff, administrative staff, patients themselves and/or their family members and friends) to assist with data collection.8 The striking results provided the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) an impetus to conduct a similar study in Australian and New Zealand hospitals. Senior staff within hospitals in this region felt that perhaps only dietitians could be enthused to assist with data collection and there was also a strong desire to conduct nutritional assessment of participants using a validated tool. With these factors in mind and to improve nutrition care practices in Australasian hospitals, the Australasian Nutrition Care Day Survey (ANCDS) was designed. The aim of this paper is to:

  • provide point prevalence data for malnutrition;

  • determine food consumption of acute care patients; and

  • evaluate the differences in food intake of well-nourished and malnourished patients in hospitals across Australia and New Zealand.

Section snippets

Materials and methods

The ANCDS was a multisite cross-sectional study. In an effort to solicit participation from as many acute care hospitals across Australia and New Zealand, members of the Australasian Society of Australia and New Zealand (AuSPEN), and Dietitians Association of Australia (DAA) Interest Groups were invited to a webinar in March 2010 where details of the study aims, methodology, and sample size requirements were provided.

Ethical approval was provided by the Medical Research Ethics Committee of The

Demographics

A total of 3122 participants from 370 acute care wards from 56 hospitals across Australia (n = 42) and New Zealand (n = 14) participated in the study. Eight main specialities (Medical, Surgical, Oncology, Neurology, Orthopaedics, Renal/Urology, Gastroenterology, and Cardiology/Respiratory) were represented. Ward size ranged from 7 to 54 beds. A total of 300 dietitians were involved in data collection.

Participant characteristics are provided in Table 1. There was no significant difference

Discussion

The ANCDS is the first multicentre study to determine the prevalence of malnutrition and food intake in the acute care setting in hospitals across Australia and New Zealand. With almost one-third of all participants malnourished these results are comparable to malnutrition prevalence reports from Europe and USA and the study by Banks et al., thereby confirming that malnutrition is an ongoing issue in the acute hospital setting in this region.1, 2

The finding that heights and weights were

Conclusion

The ANCDS found that one-third of acute care patients in Australia and New Zealand hospitals are malnourished. A significant proportion (40%) of patients eat less than half the food offered and are at least twice more likely to be malnourished than those who consume more than half the food offered. Being the first large multicentre study in Australia and New Zealand, this study provides hospitals with a fresh insight into the ongoing existence of malnutrition and sub-optimal food intake and

Statement of authorship

The project was done as part of the PhD study by EA and was supervised by EI, MF, and MB. The project was planned and designed by EI, MB, MF, and EA. The project was coordinated; data was acquired, analysed and interpreted by EA. The original manuscript was written by EA, and then all authors participated in editing and final revisions. All authors have read and approved the final manuscript.

Conflict of interest

None of the authors have a conflict of interest to declare.

Acknowledgements

The authors would like to thank (1) Participating sites for their time and effort in collecting the data for this study; (2) AuSPEN for its support in organising the webinars for training dietitians involved with data collection; and the small research grant awarded to Ekta Agarwal in 2010; (3) Members of the AuSPEN Steering Committee for their valuable feedback on the project plan in the initial stages of the project; (4) Queensland Health for funding Queensland hospitals to recruit additional

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