Clinical Malnutrition May Be Hiding in Plain Sight
Hospital-acquired malnutrition is a debilitating and highly prevalent condition in acute clinical care settings. It can strike any patient at any time, and can afflict those who are unable to properly digest food as a result of surgery, illness, or other underlying conditions.
Approximately one-third of patients are malnourished prior to hospital admission, and another one-third become malnourished during their hospital stay.2 Though any patient can develop clinical malnutrition, the most vulnerable are those with long-term conditions who may be chronically underweight, patients who undergo surgery or are recovering from stroke, cancer, and digestive diseases, and older people who are more susceptible to illness and injury.
The Impact of Malnutrition
Often overlooked and underdiagnosed, clinical malnutrition may result in increased morbidities, mortality, complications and cost during both inpatient and outpatient care. Malnourished patients can suffer from a range of devastating health effects, including impaired immune responses and predispositions to infection, impaired wound healing and thermoregulation, reduced muscle strength and respiratory strength, and fatigue.7
In addition, patients who undergo surgery or experience injury in the hospital are more likely to develop malnutrition. 45% of patients who fall in the hospital are malnourished, and surgical patients with malnutrition have 3 times greater risk of developing post-operative complications and 4 times the risk of death compared to similar patients who are well nourished.2-3 Inpatient hospital stays that involved malnutrition resulted in 50% higher rates of readmission within 30 days.8
Not only does malnutrition take its toll on physical health, it also carries a major cost burden to society. Disease-associated malnutrition has been estimated to cost the U.S. healthcare system $15.5 billion in direct costs each year.1
The Importance of Nutritional Screening
Hospital acquired malnutrition is largely preventable, and treatable once it has been diagnosed. Nutritional screening has been highly recommended by healthcare organizations upon first patient contact. The results of these screenings can then be used to direct the level of management, treatment, and care for patients who may need simple dietary measures or more intensive nutritional support therapy.2,5
Additionally, a multidisciplinary team—including dieticians, nurses, pharmacists, and physicians should work together to ensure continuing education and training around nutritional care. The practice and process of detecting, diagnosing, and treating clinical malnutrition must remain top of mind as a best practice for better patient outcomes and cost-effective care.2,5
Supporting the Stats
Healthcare Nutrition Council
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Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition A Randomized Controlled Trial
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The New England Journal of Medicine Trial of the Route of Early Nutritional Support in Critically Ill Adults
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ClinicoEconomics and Outcomes Research Early Parenteral Nutrition in Critically Ill Patients With Short-Term Relative Contraindications to Early Enteral Nutrition: A Full Economic Analysis of a Multicenter Randomized Controlled Trial Basis on US Costs
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1 Goates, S. et al. PLOS ONE. 2016; published online 21 September, 2016.
2 Guenter P., et al. Addressing Disease-Related Malnutrition in Hospitalized Patients: A Call for a National Goal. The Joint Commission Journal on Quality and Patient Safety 2015. 41 (10) 469-473
3 The Unseen US Health Crisis of Malnutrition. Abbott Nutrition.
4 Blancato Bob, et. al.The Malnutrition Quality Collaborative. National Blueprint: Achieving Quality Malnutrition Care for Older Adults.Avalere and Defeat Malnutrition Today. March 2017. 45-46
5 Nutrition support in adults Oral nutrition support, enteral tube feeding and parenteral nutrition. National Collaborating Centre for Acute Care, February 2006
6 Fingar Kathryn, et. al. All-Cause Readmissions Following Hospital Stays for Patients With Malnutrition, 2013. Agency for Healthcare Research and Quality. 2016, 3
7 Singer Pierre, et al. ESPEN Guidelines on Parenteral Nutrition: Intensive care. ELSAVIER. 2009 387–400
8 A.S.P.E.N. Parenteral Nutrition Fact Sheet. American Society for Parenteral and Enteral Nutrition. April 2012