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Open AccessArticle

Differential Impact of Malnutrition on Health Outcomes Among Indigenous and Non-Indigenous Adults Admitted to Hospital in Regional Australia—A Prospective Cohort Study

1
Monash University, Department of Epidemiology and Preventive Medicine; Baker Heart and Diabetes Institute; Melbourne 3004, Australia
2
The University of Melbourne, Department of Nursing, Melbourne 3052, Australia
3
The Queen Elizabeth Hospital, Cardiology Unit, Adelaide 5112, Australia
4
CSIRO Health and Biosecurity, Adelaide 5000, Australia
5
Western Health, General Internal Medicine, Melbourne 3001, Australia
*
Authors to whom correspondence should be addressed.
Nutrients 2018, 10(5), 644; https://doi.org/10.3390/nu10050644
Received: 26 April 2018 / Revised: 5 May 2018 / Accepted: 15 May 2018 / Published: 19 May 2018
The burden of malnutrition in Indigenous people is a major health priority and this study’s aims are to understand health outcomes among Indigenous and non-Indigenous patients. This cohort study includes 608 medical inpatients in three regional hospitals. Participants were screened for malnutrition using the Subjective Global Assessment tool. Hospital length of stay, discharge destination, 30-day and six-month hospital readmission and survival were measured. Although no significant difference was observed between Indigenous participants who were malnourished or nourished (p = 0.120), malnourished Indigenous participants were more likely to be readmitted back into hospital within 30 days (Relative Risk (RR) 1.53, 95% CI 1.19–1.97, p = 0.002) and six months (RR 1.40, 95% Confidence Interval (CI) 1.05–1.88, p = 0.018), and less likely to be alive at six months (RR 1.63, 95% CI 1.20–2.21, p = 0.015) than non-Indigenous participants. Malnutrition was associated with higher mortality (Hazards Ratio (HR) 3.32, 95% CI 1.87–5.89, p < 0.001) for all participants, and independent predictors for six-month mortality included being malnourished (HR 2.10, 95% CI 1.16–3.79, p = 0.014), advanced age (HR 1.04, 95% CI 1.02–1.06, p = 0.001), increased acute disease severity (Acute Physiology and Chronic Health Evaluation score, HR 1.03, 95% CI 1.01–1.05, p = 0.002) and higher chronic disease index (Charlson Comorbidity Index, HR 1.36, 95% CI 1.16–3.79, p = 0.014). Malnutrition in regional Australia is associated with increased healthcare utilization and decreased survival. New approaches to malnutrition-risk screening, increased dietetic resourcing and nutrition programs to proactively identify and address malnutrition in this context are urgently required. View Full-Text
Keywords: malnutrition; Indigenous Australians; subjective global assessment; Australia; survival malnutrition; Indigenous Australians; subjective global assessment; Australia; survival
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Morris, N.; Stewart, S.; Riley, M.; Maguire, G. Differential Impact of Malnutrition on Health Outcomes Among Indigenous and Non-Indigenous Adults Admitted to Hospital in Regional Australia—A Prospective Cohort Study. Nutrients 2018, 10, 644.

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