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PubMed2006

Malnutrition in acute care patients: a narrative review.

OBJECTIVES: This narrative review assesses the current prevalence of malnutrition, the methods for detection of malnutrition, the factors associated with malnutrition, and the effects of malnutrition in the acute care patients. DESIGN: A narrative review methodology was employed. DATA SOURCES: CINAHL, Pub Med, and MEDLINE electronic databases were searched from 1996 to 2005, for English language articles. Search terms of malnutrition, acute care patients, nutrition assessment, and nutrition screening were used. REVIEW METHOD: The titles and abstracts of 857 articles were examined. Full text of the articles were obtained only when abstracts described undernutrition, malnutrition, protein-energy malnutrition, nutrition assessment, nutrition screening, factors contributing to malnutrition, or resultant outcomes of malnutrition in adult acute care patients. Additionally, a hand search through reference lists of retrieved articles was done. The articles reviewed included empirical reports (110), reviews (25), commentaries (4), and reports from professional associations (10). RESULTS: Currently, malnutrition ranges from 13-78% among acute care patients. Different methods of detecting malnutrition make it difficult to determine the prevalence among acute care patients. Additionally, many nutrition-screening tools used to detect malnutrition have not undergone rigorous testing for validity, reliability, sensitivity, and specificity. Numerous personal and organizational factors affect the nutritional status of acute care patients. Diminished nutritional status contributes to increased use of hospital resources and increased hospital costs. CONCLUSION: Malnutrition continues to be a significant problem among acute care patients. The Subjective Global Assessment tool has the most diagnostic value for acute care patients. Simple measures, like documenting height and weight on admission, and assessing patient's nutritional intake, weight status, and medications that alter nutritional intake could assist in early detection of malnutrition in the acute care patient.

Acute Disease↗
PubMed1994

A methodology for estimating the contribution of malnutrition to child mortality in developing countries.

According to conventional methods of classifying cause of death, approximately 70% of child deaths (0-4 y) worldwide are due to a small number of priority infectious diseases which, in turn, receive the vast majority of donor and national resources in the health sector. Despite the long-recognized synergism between malnutrition and infection in the causation of child mortality, malnutrition does not appear as a major cause of death in health statistics from developing countries. Part of the reason for this has been the difficulty of estimating the percent of deaths due to malnutrition, because the conventional methods of classifying cause of death do not recognize the potentiating effect of malnutrition on the disease. The purpose of this paper is to develop and test a simple methodology to estimate the percent of child deaths in a given country or community that is due to malnutrition's potentiating effects on prevailing infectious diseases. The cornerstone of the methodology is knowledge of the strength of the association between malnutrition and mortality in developing countries, as measured in eight prospective studies. These studies reveal remarkable consistency in relative risk across different grades of malnutrition. The mean and SE of relative risk for severe malnutrition is 8.4 +/- 2.1, for moderate malnutrition it is 4.6 +/- 0.9, and for mild malnutrition it is 2.5 +/- 0.3. When applied to survey data from Ethiopia, Malawi, Guatemala and India for illustrative purposes, this methodology indicates that 42-57% of all child deaths in these samples (6-59 mo) are due to malnutrition's potentiating effects on infectious disease, of which 76-89% is attributable to mild-to-moderate malnutrition. This methodology is recommended for use in a variety of policy and planning applications.

Child, Preschool↗
PubMed2004

Malnutrition screening in hospitalised patients and its implication on reimbursement.

BACKGROUND: Several studies have cited the incidence of malnutrition in hospitals, which is correlated to negative clinical outcomes, to be up to 60%. Data in Singapore, however, are scarce. Its impact on casemix funding is not known. AIMS: The aims of the present study were to determine the prevalence of malnutrition, the predisposing risk factors and the impact of documentation and coding of malnutrition on casemix funding in a local population in Singapore. METHODS: Patients admitted to selected wards over a 1-month period were screened for malnutrition. Those at risk were further assessed using subjective global assessment. Logistic regression was used to ascertain the impact of identified factors on malnutrition. Financial impact analysis of coding of malnutrition as a comorbidity was carried out and tested with Wilcoxon signed rank tests. RESULTS: Six hundred and fifty-eight patients were eligible for screening. The overall prevalence of malnutrition in the selected wards was 14.7% (95% confidence interval (CI): 12.0-17.4%). Old age, the occurrence of cancer and the admitting unit were statistically significant in explaining the occurrence of malnutrition. Coding of malnutrition was found to significantly increase the complexity of 24 of 105 episodes (22.9%) of patient care as measured by expected cost weights (P < 0.001) and expected lengths of stay (P < 0.001). As a result, the expected financing for these 24 patients increased by 59.7%. CONCLUSIONS: Malnutrition is prevalent in hospitalised medical and surgical patients. Certain clinical factors should heighten awareness and prompt detection for malnutrition. Coding for malnutrition impacts favourably on casemix funding for a subset of malnourished patients.

Adolescent↗