Incidence and criteria used in the diagnosis of hospital-acquired malnutrition in adults: a systematic review and pooled incidence analysis

Self-Determination, Optimism, Social Support, Knowledge, and Skills Have a Positive Influence on the Oral Intake of Long-Stay Acute Patients: A Qualitative Study

BACKGROUND

Although previous research has attempted to understand the barriers and enablers of oral intake in hospitalized patients, these studies have mainly focused on short-stay inpatients and lacked a theory-driven examination of the determinants that influence dietary behavior in the hospital.

OBJECTIVE

To explore and compare the factors influencing adequate and poor oral intake in long-stay acute patients (admitted >14 days).

DESIGN

A qualitative descriptive study with semistructured interviews.

PARTICIPANTS/SETTING

Twenty-one adult inpatients (13 men, 8 women) admitted to 2 medical and 2 surgical wards at a tertiary hospital in Brisbane, Australia, during 2022, stratified by the Subjective Global Assessment. Analysis performed Transcripts were initially deductively analyzed against the Theoretical Domains Framework, and a reflexive thematic approach was used to create overall themes.

RESULTS

Of the 21 included patients (median age = 68.0 years, IQR 34 years), 11 had adequate/improved intake and 10 poor/decreased intake. Six themes were identified to have influenced oral intake in long-stay patients: self-determination to eat; nutrition impact symptoms; foodservice characteristics and processes; nutrition-related knowledge and skills; social support; and optimism, emotions, and emotion regulation. Patients with adequate/improved oral intake were characterized by an autonomous motivation to eat. They had increased awareness about their nutritional status, knowledge, and skills about food for recovery, were more optimistic, and social support was an important enabler to eating. In contrast, patients with poor/decreased oral intake perceived nutrition impact symptoms and dislike of meals as the main barriers to eating in the hospital; however, they also expressed more negative emotions, reduced coping strategies, and decreased knowledge, skills, intrinsic motivation, and capabilities to eat. Social support was present but did not enable oral intake in this patient group.

CONCLUSIONS

This study provides novel insights into the factors that influenced oral intake in long-stay acute patients, highlighting the importance of patient-centered nutrition care, encompassing motivational interviewing techniques and collaboration from the multidisciplinary team to create a supportive environment that fosters autonomy and empowers patients to actively participate in their own nutrition and recovery.

Comparison of Readmission, Discharge Location and Mortality over Three Years Post-Discharge Between Patients Diagnosed with Hospital-Acquired Malnutrition and Those Malnourished on Admission-A Retrospective Matched Case-Control Study in Five Facilities

Background/Objectives: Increased mortality and poor post-discharge outcomes are common in malnourished inpatients. It is unknown whether post-discharge outcomes differ between patients with hospital-acquired malnutrition (HAM) or malnutrition present on admission (MPOA), which could impact nutrition processes within healthcare systems and hospital-acquired-complication policy. This retrospective matched case-control study compared mortality, discharge location and readmission at 3-, 12- and 36-months post-discharge between HAM and MPOA patients. Methods: The eligible patients were ≥18 years, malnourished and stayed in hospital for >14 days between 2015 and 2019. HAM patients were 1:1 matched with MPOA patients for age (±3 years), sex, facility and year of admission and further categorised by age group (18 < 65, ≥65 years). The data were obtained from medical records included demographics, mortality, discharge location and readmissions. Statistical tests were used to compare the groups. Results: There were 350 eligible patients (n = 175 HAM, 65 ± 18 years, 37%F, 88% moderately malnourished, 71% from hospitals with >500 beds). HAM and MPOA patients had similar post-discharge mortality (n = 51/175 (29%) vs. n = 64/175 (37%), p > 0.172) and discharge locations (n = 101/111 (81%) vs. n = 91/124 (82%) resided at home, p = 1.00) at 36 months. Of those readmitted to hospital (n= 268/350, 77%), days hospitalised post-discharge (HAM:17(6-40) vs. MPOA:19(8-39)) and number of readmissions (HAM:2(1-4) vs. MPOA:2(1-5)) were similar at 36 months (p > 0.05). However, older MPOA patients were more likely to readmit within 30 days (p = 0.007). Conclusions: Mortality was high but similar between MPOA and HAM patients up to 36 months post-discharge. Discharge location and readmissions were also similar between the groups, except that older MPOA patients were more likely to readmit to hospital within 30 days than older HAM patients. Mechanisms, such as nutrition policies and procedures, implementation of post-discharge nutrition interventions or allocation of post-discharge resources, should be explored further and should consider all long-stay malnourished patients, particularly those aged ≥ 65 years, to reduce preventable patient harm associated with malnutrition.

Machine Learning-based Prediction of Mortality Among Malnourished Patients Hospitalized With Inflammatory Bowel Disease

BACKGROUND

Malnourished patients hospitalized with inflammatory bowel disease (IBD) have a high risk of morbidity and mortality. Risk stratification can help identify patients who are most in need of medical and nutritional intervention.

GOAL

This study aimed to develop a machine-learning model that accurately predicts mortality in hospitalized IBD patients with protein-calorie malnutrition (PCM).

STUDY

Hospitalized adults with IBD and PCM were identified in the 2016 to 2019 National Inpatient Sample (NIS). Random Forest Classifier (RFC) and Extreme Gradient Boosting (XGB) models were constructed using a 70% randomly sampled training set from the years 2016 to 2018, tested using the remaining 30% of 2016 to 2018 data, and externally validated using 2019 data. Patient characteristics were evaluated using weighted estimates that accounted for the complex sampling design of the NIS.

RESULTS

Among 879,730 malnourished patients hospitalized for IBD, 1930 (0.2%) died. Compared with malnourished patients who survived, those who died were generally older, White, had ulcerative colitis with multiple comorbidities, and admitted on the weekend. The accuracy, precision, sensitivity, and specificity for both models were 0.99, 0.98, 0.99, and 0.99, respectively. The area under the receiver operating characteristic curve was 0.91 for both models.

CONCLUSION

Machine learning models can accurately predict mortality in malnourished patients hospitalized with IBD, while solely relying on readily available clinical data. Further integration of these tools into clinical practice could improve risk stratification of IBD patients with PCM and potentially reduce mortality in this high-risk population by prompting earlier intervention.

Research and exploration of quality control indicators for nutritional therapy in critically ill patients-a multicenter before-and-after controlled study

Objective

To evaluate and explore the feasibility of using quality control indicators for nutritional therapy in critically ill patients as quality evaluation criteria.

Methods

This study focused on intensive care unit (ICU) critically ill patients and conducted a cross-sectional investigation of nutritional therapy quality control indicators (the proportion of patients with application of enteral nutrition pump, nutritional risk assessment rate, the proportion of patients start enteral nutrition within 48 hours, and caloric and protein target achievement rate on 7th day) in 13 hospitals in Jilin Province. After training according to the critical patients nutrition related guidelines and the latest literatures, a second cross-sectional investigation was conducted. Then, analyze the improvement of quality control indicators of the nutritional therapy before and after the training, thus evaluating the feasibility of using these quality control indicators as nutritional therapy quality evaluation criteria in critical patients.

Results

(1) A total of 631 patients were included before and after training, with a data acquisition rate of 97.3% for enteral nutrition pumps usage and complete data collection for the remaining nutritional risk assessment rate, start enteral nutrition proportion of patients within 48 h, and caloric and protein target achievement rate on 7th day. (2) The nutritional risk assessment rate before and after training was 88.2% vs. 94.8%, with a P-value of 0.003. The proportion of patients start enteral nutrition within 48 h before and after training was 65.1% vs. 75.4%, with a P-value of 0.039; and protein target achievement rate on 7th day before and after training was 64.6% vs. 79.6%, with a p-value of 0.015. These five indicators as quality evaluation criteria are relevant to the current developments in nutritional therapy and consistent with the national conditions of China. The proportion of patients with application of enteral nutrition pump before and after training was 70.1% vs. 79.4%, with a p-value of 0.065, and the caloric target achievement rate on 7th day before and after training was 73.4% vs. 83.9%, with a p-value of 0.062, and there was no statistical difference between the two groups.

Conclusion

The five quality control indicators for nutritional therapy in critically ill patients are clinically feasible and can be used as quality evaluation criteria for nutritional therapy in critically ill patients.

Incidence and outcomes of in-hospital nutritional decline: A prospective observational cohort study in adult patients

BACKGROUND AND AIMS

Hospital malnutrition is associated with higher healthcare costs and worse outcomes. Only a few prospective studies have evaluated trends in nutritional status during an acute stay, but these studies were limited by the short timeframe between nutrition assessments. The aim of this study was to investigate changes in nutritional status, incidence of hospital-acquired malnutrition (HAM), and the associated risk factors and outcomes in acute adult patients admitted for >14 days.

METHODS

A prospective observational cohort study was conducted in two medical and two surgical wards in a tertiary hospital in Brisbane, Australia. Nutrition assessments were performed using the Subjective Global Assessment at baseline (day eight) and weekly until discharge. Nutritional decline was defined as a change from well-nourished to moderate/severe malnutrition (HAM) or from moderate to severe malnutrition (further decline) >14 days after admission.

RESULTS

One hundred and thirty patients were included in this study (58.5% male; median age 67.0 years (IQR 24.4), median length of stay 23.5 days (IQR 14)). At baseline, 70.8% (92/130) of patients were well-nourished. Nutritional decline occurred in 23.8% (31/130), with 28.3% (26/92) experiencing HAM. Of the patients with moderate malnutrition on admission (n = 30), 16% (5/30) continued to decline to severe malnutrition. Improvement in nutritional status from moderate and severe malnutrition to well-nourished was 18.4% (7/38). Not being prescribed the correct nutrition care plan within the first week of admission was an independent predictor of in-hospital nutritional decline or remaining malnourished (OR 2.3 (95% CI 1.0-5.1), p = 0.039). In-hospital nutritional decline was significantly associated with other hospital-acquired complications (OR 3.07 (95% CI 1.1-8.9), p = 0.04) and longer length of stay (HR 0.63 (95% CI 0.4-0.9), p = 0.044).

CONCLUSION

This study found a high rate of nutritional decline in acute patients, highlighting the importance of repeated nutrition screening and assessments during hospital admission and proactive interdisciplinary nutrition care to treat or prevent further nutritional decline.