Original articleMalnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010☆
Introduction
The Australasian Nutrition Care Day Survey (ANCDS) is the largest multicentre study in the Australasian region, reporting the prevalence of malnutrition and poor food intake in 3122 patients across 56 Australian and New Zealand hospitals.1 With one-in-three patients malnourished; and two-in-three patients not consuming all of the offered hospital food, it was evident that malnutrition and poor food intake are a common occurrence in Australian and New Zealand hospitals.1
Numerous studies have suggested that in comparison to well-nourished patients, malnourished patients experience worse outcomes such as prolonged length of stay (LOS) in hospital, increased readmissions, and mortality.2, 3, 4, 5, 6 There is documented evidence to suggest that malnourished patients incur greater hospitalisation costs,7 related to longer LOS, readmissions, and greater utilisation of hospital resources.2, 5
The ANCDS found that one-in-three malnourished patients (n = 305, 30%), and one-in-five well-nourished patients (n = 371, 18%) consumed nothing or up to 25% of the food offered during the 24-h data collection period.1 Since continued sub-optimal food intake can eventually lead to deterioration of nutritional status, it is important to evaluate the effect of poor food intake on health-related outcomes. Two studies have reported the link between poor food intake during hospitalisation and mortality,6, 8 however, there is no published evidence regarding the association between poor food intake and readmissions and/or LOS.
Although previous studies have investigated associations between malnutrition and patient outcomes, issues such as heterogeneity in patient populations; study design; methods of evaluating nutritional status, food intake and/or outcomes; prevent the results from these studies being generalised throughout the acute care population. Factors such as type and severity of disease are major causes of malnutrition,9 poor food intake,10 and patient outcomes, and yet they have rarely been controlled for. Without accounting for the confounding effect of disease type and severity most studies fail to distinguish the association between the effect of disease, nutritional issues, and other factors (such as age, gender), and patient outcomes. Therefore, there is a risk of underestimating the independent effects of disease, and overestimating the independent effects of nutritional issues. The aim of this study was to take into account disease type and severity and explore associations between: (1) nutritional status; (2) food intake; and health-related outcomes (LOS, mortality, and readmissions) in participants from the ANCDS.
Section snippets
Methods
The ANCDS was conducted in two phases. Participants were recruited in Phase 1 of the study and the episode of admission was referred to as “index hospitalisation”.
In Phase 1 data were collected by dietitians from participating hospitals.1 Data included demographic, nutritional status, and 24-h food intake information for each participant.1 Participants' Body Mass Index (BMI) were calculated based on their recorded weight and height.1 To evaluate nutritional status, each participant was screened
Results
Outcomes data were available for 3017 of the total 3122 participants (97%). After data cleaning (as previously outlined), data analyses for LOS and mortality included 2982 participants (95%), and readmissions data were analysed for 2942 participants (94%).
Table 1 depicts admission-related characteristics of the participants. Malnutrition was significantly associated with age ≥ 65 years, emergency admissions, admissions other than surgical or medical, certain MDCs, severe/catastrophic PCCL
Discussion
The ANCDS is the first multicentre study in acute care hospitals across Australia and New Zealand to report the association between patients' nutritional status, food intake and health-related outcomes. The study found that patients who were malnourished or consumed ≤ 25% of the hospital offered food had significantly longer LOS and higher in-hospital mortality rates. Malnourished patients also had significantly higher readmissions rates than well-nourished patients.
Considering there are
Authors' contributions to manuscript
EA designed and coordinated the study; acquired, analysed and interpreted the data; and wrote the manuscript. MF, MB and EI provided significant advice on the study design. MBatterham provided statistical advice. All authors participated in editing and final revisions of the manuscript. All authors have read and approved the final manuscript.
Conflict of Interest
EA, MBatterham, JB, and SC have no conflict of interest to declare. MF, MB and EI are employed by Queensland Health, Australia.
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 EA 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
References (31)
- et al.
Nutritional status and dietary intake of acute care patients: results from the Nutrition Care Day Survey 2010
Clin Nutr
(2012) - et al.
Predicting early non-elective hospital readmission in nutritionally compromised older adults
Am J Clin Nutr
(1997) - et al.
Nutritional status among adult patients admitted to an university-affiliated hospital in Spain at the time of genoma
Clin Nutr
(2004) - et al.
Malnutrition and its impact on cost of hospitalisation, length of stay, readmission, and 3-year mortality
Clin Nutr
(2012) - et al.
Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay Survey 2006
Clin Nutr
(2009) - et al.
The costs arising from pressure ulcers attributable to malnutrition
Clin Nutr
(2010) - et al.
Prognostic impact of disease-related malnutrition
Clin Nutr
(2008) Nutrition, hospital food and in-hospital mortality
Clin Nutr
(2009)- et al.
Development of a valid and reliable malnutrition screening tool for adult acute hospital patients
Nutrition
(1999) - et al.
The German hospital malnutrition study
Clin Nutr
(2006)
Visual plate waste in hospitalized patients: length of stay and diet order
J Am Diet Assoc
Food intake in 1707 hospitalised patients: a prospective comprehensive hospital survey
Clin Nutr
Common comorbidity scales were similar in their ability to predict healthcare costs and mortality
J Clin Epidemiol
The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through multivariate model analysis
Clin Nutr
Protein-energy undernutrition among elderly hospitalized patients: a prospective study
J Am Med Assoc
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Conference Presentation: This paper was presented at the 34th ESPEN Congress on Clinical Nutrition and Metabolism in Barcelona, Spain (8–11 September 2012).