Elsevier

Clinical Nutrition

Volume 25, Issue 4, August 2006, Pages 563-572
Clinical Nutrition

ORGINAL ARTICLE
The German hospital malnutrition study

https://doi.org/10.1016/j.clnu.2006.03.005Get rights and content

Summary

Background & aims

Malnutrition is frequently observed in chronic and severe diseases and associated with impaired outcome. In Germany general data on prevalence and impact of hospital malnutrition are missing.

Methods

Nutritional state was assessed by subjective global assessment (SGA) and by anthropometric measurements in 1886 consecutively admitted patients in 13 hospitals (n=1073, university hospitals; n=813, community or teaching hospitals). Risk factors for malnutrition and the impact of nutritional status on length of hospital stay were analyzed.

Results

Malnutrition was diagnosed in 27.4% of patients according to SGA. A low arm muscle area and arm fat area were observed in 11.3% and 17.1%, respectively. Forty-three % of patients ⩾70 years old were malnourished compared to only 7.8% of patients <30 years. The highest prevalence of malnutrition was observed in geriatric (56.2%), oncology (37.6%), and gastroenterology (32.6%) departments. Multivariate analysis revealed three independent risk factors: higher age, polypharmacy, and malignant disease (all P<0.01). Malnutrition was associated with an 43% increase of hospital stay (P<0.001).

Conclusions

In German hospitals every fourth patient is malnourished. Malnutrition is associated with increased length of hospital stay. Higher age, malignant disease and major comorbidity were found to be the main contributors to malnutrition. Adequate nutritional support should be initiated in order to optimize the clinical outcome of these patients.

Introduction

Clinically overt malnutrition affects about 20–50% of all medical and surgical patients admitted to hospitals depending on hospital setting, population, and the different definitions and criteria used for the diagnosis of malnutrition.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 Malnutrition has a high clinical and economic impact reflected by an increased morbidity,2, 4 prolonged hospital stay at substantial extra cost of health care,7, 9, 11, 12, 13, 14 and by increased mortality particularly in elderly patients.3, 5, 15, 16 The association between malnutrition and poor survival has been established for a number of different diseases and in particular for malignant disorders and chronic organ failure.7, 16, 17 The cause of malnutrition is usually multifactorial including both metabolic effects of underlying disease and reduced nutritional intake. There is evidence that additional factors such as higher age,7, 18 polypharmacy4 and educational level of the patient or living situation might increase the general risk of developing nutritional deficits. The prevalence of malnutrition also appears to be dependent on the health care system and the economic situation of the country where the study was performed.6, 7

Surprisingly, there is a general lack of data on the prevalence of hospital malnutrition in Germany, despite of its large population and the economic pressure on its health care system. Therefore, the primary objective of this study was to assess the prevalence and severity of disease-related malnutrition in German hospitals.

Moreover, we attempted to assess the impact of different factors such as disease parameters, age, gender as well as the hospital setting (university hospital vs. community hospital) on the nutritional status of hospitalised patients in order to identify subgroups with particular risk for nutritional depletion. The study was performed in 12 hospitals with different settings and specialities in Germany and in one university hospital in Austria.

Section snippets

Patients

The nutritional state of 1886 consecutively admitted patients was prospectively studied in 13 different hospitals participating in this study: 1073 patients were included in 7 university hospitals, and 813 patients were included in 6 community or teaching hospitals. Among the latter 306 patients were recruited from hospitals specialized in geriatric medicine. Other participating specialities were: surgery (n=512), gastroenterology (n=273), other medical (n=205), cardiology (n=201), urology (n=

Prevalence of malnutrition

According to the definitions used different frequencies of malnutrition have been found. Nutritional assessment by the SGA demonstrated that 27.4% of all patients were malnourished. Malnutrition was classified as moderate in 17.6% (SGA B) and as severe in 9.8% (SGA C).

The clinical classification of malnutrition according to SGA was also reflected by a significantly lower BMI, a higher percentage of patients with relevant unintended weight loss, and a significantly higher percentage of patients

Discussion

In this study, we prospectively evaluated the nutritional state of 1886 consecutively admitted hospital patients with a wide variety of diseases. Malnutrition was diagnosed in 27% according to the SGA on admission to hospital. This prevalence rate is within the range of hospital malnutrition reported during the last 15 years using the same score.4, 5, 16, 20 Since the study started before the Nutritional Risk Screening was introduced and recommended by ESPEN24 we used the SGA as the primary

Acknowledgements

The statistical analysis of this study was possible due to a grant given by the Deutsche Gesellschaft für Ernährungsmedizin (DGEM). The authors would like to thank the heads and the staff of the different departments for their kind support in the different hospitals participating in the study. We are particularly grateful to a number of physicians, nurses, dieticians, and nutritional scientists for data collection and preparation:

  • Berlin: Charité Universitätsmedizin Berlin: Medizinische Kliniken

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