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Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study.
Int J Nurs Stud. 2018 Jun; 82:40-48.IJ

Abstract

BACKGROUND

Decreased food intake is a risk factor for relevant complications (e.g. infections, pressure ulcers), longer hospital stays, higher readmission rates, greater health care costs and increased patient mortality, particularly in frail hospitalized older adults who are malnourished or at risk of malnutrition. Nurses are called to improve this criticality, starting from accurately identifying malnourished patients at hospital admission and effectively monitoring their food intake.

OBJECTIVES

The primary aim was to identify reliable predictive indicators of reduced food intake at hospital admission. The secondary aims were to assess the adequacy of daily energy and protein intake and the impact of nutrient intake on patient outcomes.

DESIGN

Prospective observational longitudinal study.

SETTING

Internal Medicine Ward of an Academic Teaching University Hospital.

PARTICIPANTS

Acute older adults who were malnourished or at risk of malnutrition (Nutritional Risk Score-2002 ≥ 3, middle-upper arm circumference <23.5 cm or impaired self-feeding ability) at admission.

METHODS

The effective energy and protein intake was monitored during the first 5 days of hospital stay by a photographic method and compared to the daily energy and protein requirement calculated by specific equations. Data on anthropometry, inflammation/malnutrition laboratory data and body composition (phase angle calculated using bioelectrical impedance analysis) were collected.

RESULTS

Eighty-one subjects (age 81.5 ± 11.5 years) were enrolled. Mean energy intake was 669.0 ± 573.9 kcal/day, and mean protein intake was 30.7 ± 25.8 g/day. Over 60% of patients ingested ≤50% of their calculated energy and protein requirements: these patients were older (p = 0.026), had a lower middle-upper arm circumference (p = 0.022) and total arm area (p = 0.038), a higher C-reactive protein/albumin ratio and Instant Nutritional Assessment score (p < 0.01), and experienced longer hospital stays (p ≤ 0.04) and higher in-hospital and 30-day post-discharge mortality (p < 0.001). In the multivariate analysis, lower middle-upper arm circumference, higher C-reactive protein/albumin ratio, and impaired self-feeding at admission were independently associated with critically reduced energy and protein intake.

CONCLUSIONS

Middle-upper arm circumference, C-reactive protein/albumin ratio, and impaired self-feeding are easily obtainable indicators of impaired energy and protein intake and poor clinical outcomes. Such parameters should be adopted as screening criteria to assess the risk for critically reduced energy/protein intake in hospitalized older adults. These findings are relevant to improve clinical practice through the implementation of multidisciplinary strategies, given the adverse clinical outcomes related to hospital malnutrition.

Authors+Show Affiliations

School of Nursing, Dept. of Medical Science, University of Trieste, piazzale Valmaura 9, 34148, Trieste, Italy. Electronic address: gsanson@units.it.School of Nursing, Dept. of Medical Science, University of Trieste, piazzale Valmaura 9, 34148, Trieste, Italy. Electronic address: luca.berto89@gmail.com.School of Nursing, Dept. of Medical Science, University of Trieste, piazzale Valmaura 9, 34148, Trieste, Italy. Electronic address: eugeniadalbo@gmail.com.Nutrition Team, Trieste University Hospital, Strada di Fiume 447, 34149, Trieste, Italy. Electronic address: luisa.dipasquale@asuits.sanita.fvg.it.School of Nursing, Dept. of Medical Science, University of Trieste, piazzale Valmaura 9, 34148, Trieste, Italy; Nutrition Team, Trieste University Hospital, Strada di Fiume 447, 34149, Trieste, Italy. Electronic address: zanetti@units.it.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29579571

Citation

Sanson, Gianfranco, et al. "Identifying Reliable Predictors of Protein-energy Malnutrition in Hospitalized Frail Older Adults: a Prospective Longitudinal Study." International Journal of Nursing Studies, vol. 82, 2018, pp. 40-48.
Sanson G, Bertocchi L, Dal Bo E, et al. Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. Int J Nurs Stud. 2018;82:40-48.
Sanson, G., Bertocchi, L., Dal Bo, E., Di Pasquale, C. L., & Zanetti, M. (2018). Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. International Journal of Nursing Studies, 82, 40-48. https://doi.org/10.1016/j.ijnurstu.2018.03.007
Sanson G, et al. Identifying Reliable Predictors of Protein-energy Malnutrition in Hospitalized Frail Older Adults: a Prospective Longitudinal Study. Int J Nurs Stud. 2018;82:40-48. PubMed PMID: 29579571.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. AU - Sanson,Gianfranco, AU - Bertocchi,Luca, AU - Dal Bo,Eugenia, AU - Di Pasquale,Carmen Luisa, AU - Zanetti,Michela, Y1 - 2018/03/07/ PY - 2017/07/10/received PY - 2018/03/04/revised PY - 2018/03/06/accepted PY - 2018/3/27/pubmed PY - 2018/11/10/medline PY - 2018/3/27/entrez KW - CRP-albumin ratio KW - Elderly KW - Feeding self-care KW - Hospital malnutrition KW - MUAC KW - Older adults KW - Reduced food intake SP - 40 EP - 48 JF - International journal of nursing studies JO - Int J Nurs Stud VL - 82 N2 - BACKGROUND: Decreased food intake is a risk factor for relevant complications (e.g. infections, pressure ulcers), longer hospital stays, higher readmission rates, greater health care costs and increased patient mortality, particularly in frail hospitalized older adults who are malnourished or at risk of malnutrition. Nurses are called to improve this criticality, starting from accurately identifying malnourished patients at hospital admission and effectively monitoring their food intake. OBJECTIVES: The primary aim was to identify reliable predictive indicators of reduced food intake at hospital admission. The secondary aims were to assess the adequacy of daily energy and protein intake and the impact of nutrient intake on patient outcomes. DESIGN: Prospective observational longitudinal study. SETTING: Internal Medicine Ward of an Academic Teaching University Hospital. PARTICIPANTS: Acute older adults who were malnourished or at risk of malnutrition (Nutritional Risk Score-2002 ≥ 3, middle-upper arm circumference <23.5 cm or impaired self-feeding ability) at admission. METHODS: The effective energy and protein intake was monitored during the first 5 days of hospital stay by a photographic method and compared to the daily energy and protein requirement calculated by specific equations. Data on anthropometry, inflammation/malnutrition laboratory data and body composition (phase angle calculated using bioelectrical impedance analysis) were collected. RESULTS: Eighty-one subjects (age 81.5 ± 11.5 years) were enrolled. Mean energy intake was 669.0 ± 573.9 kcal/day, and mean protein intake was 30.7 ± 25.8 g/day. Over 60% of patients ingested ≤50% of their calculated energy and protein requirements: these patients were older (p = 0.026), had a lower middle-upper arm circumference (p = 0.022) and total arm area (p = 0.038), a higher C-reactive protein/albumin ratio and Instant Nutritional Assessment score (p < 0.01), and experienced longer hospital stays (p ≤ 0.04) and higher in-hospital and 30-day post-discharge mortality (p < 0.001). In the multivariate analysis, lower middle-upper arm circumference, higher C-reactive protein/albumin ratio, and impaired self-feeding at admission were independently associated with critically reduced energy and protein intake. CONCLUSIONS: Middle-upper arm circumference, C-reactive protein/albumin ratio, and impaired self-feeding are easily obtainable indicators of impaired energy and protein intake and poor clinical outcomes. Such parameters should be adopted as screening criteria to assess the risk for critically reduced energy/protein intake in hospitalized older adults. These findings are relevant to improve clinical practice through the implementation of multidisciplinary strategies, given the adverse clinical outcomes related to hospital malnutrition. SN - 1873-491X UR - https://www.unboundmedicine.com/medline/citation/29579571/Identifying_reliable_predictors_of_protein_energy_malnutrition_in_hospitalized_frail_older_adults:_A_prospective_longitudinal_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-7489(18)30058-0 DB - PRIME DP - Unbound Medicine ER -