Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Setting
2.2. Participants and Recruitment
2.3. Data Collection and Variables
2.4. Baseline Characteristics
2.5. Screening for Malnutrition and Risk of Malnutrition
2.6. Diagnostic Criteria for Malnutrition
2.7. Risk Factors for Malnutrition
2.8. Sample Size and Statistics
3. Results
3.1. Participants
3.2. Participant Characteristics
3.3. Prevalence of Malnutrition and Risk of Malnutrition and Agreement between Screening Tools
3.4. Transitional Aggrement within and between Screnning Tools
3.5. Risk Factors for Malnutrition
4. Discussion
4.1. Prevalence of Malnutrition and Risk of Malnutrition and Agreement between Screening Tools
4.2. Diagnostic Criteria for Malnutrition
4.3. Transitional Aggrement within and between Screnning Tools and Change in Body Weight
4.4. Risk Factors for Malnutrtion
4.5. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All Participants | ||
---|---|---|
Variable | n | |
Age, years, median (IQR) | 127 | 77.6 (72.3; 85.2) |
Sex, male, n (%) | 127 | 56 (44) |
Smoking, n (%) | 127 | 19 (15) |
Education | ||
1–14 years of school, n (%) | 125 | 46 (36.8) |
Skilled worker, n (%) | 125 | 60 (48) |
High School +, n (%) | 125 | 19 (15.2) |
Living alone, n (%) | 127 | 84 (66.1) |
Body weight (kg), mean (SD) | 127 | 75.9 (19.4) |
Height (cm) mean (SD) | 127 | 169.7 (9.9) |
Body mass index (kg/m2), mean (SD) | 127 | 26.2 (5.5) |
Quality of life (EQ-5D-5L index), median (IQR) | 125 | 0.702 (0.493; 0.786) |
Charlson comorbidity index, median (IQR) | 122 | 1 (0; 2) |
C-Reactive protein (mg/L), mean (SD) | 127 | 22 (5,3; 70) |
Maximal hand grip strength (kg), mean (SD) | 124 | 23.2 (10.4) |
Functional recovery score, median (IQR) | 119 | 88 (80; 99) |
Physically inactive, n (%) | 126 | 53 (42.1) |
Fallen within previous year, n (%) | 127 | 65 (51.2) |
Baseline, n (%) * | Follow-Up, n (%) * | Development from Baseline to Follow-Up | |
---|---|---|---|
MNA-SF score ≤ 11 | 85 (68) | 63 (69) | |
Maintained a score ≤ 11 | 49 (57) | ||
Recovered, by gaining a score > 11 | 10 (12) | ||
MNA-SF score > 11 | 40 (32) | 29 (32) | |
Maintained a score > 11 | 19 (48) | ||
Acquired a score ≤ 11 | 14 (35) | ||
NRS-2002 score ≥ 3 | 71 (59) | 26 (30) | |
Maintained a score ≥ 3 | 24 (27) | ||
Recovered, by gaining a score < 3 | 21 (30) | ||
NRS-2002 score < 3 | 50 (41) | 62 (71) | |
Maintained a score < 3 | 37 (74) | ||
Acquired a score ≥ 3 | 2 (4) | ||
EVS score ≥ 1 | 122 (98) | 78 (85) | |
Maintained a score ≥ 1 | 77 (63) | ||
Recovered, by gaining a score < 1 | 12 (10) | ||
EVS score < 1 | 3 (2) | 14 (15) | |
Maintained a score < 1 | 2 (67) | ||
Acquired a score ≥ 1 | 0 (0) |
MNA-SF at Follow-Up | NRS-2002 at Follow-Up | EVS At Follow-Up | ||||
---|---|---|---|---|---|---|
MNA-SF at Baseline | p-Value | p-Value | p-Value | |||
n | 92 | 88 | 92 | |||
Kappa (95% CI) | 0.42 (0.22–0.61) | 0.861 | 0.33 (0.19–0.47) | 0.339 | 0.17 (−0.02–0.36) | <0.001 |
PPV | 83% | 44% | 90% | |||
NPV | 58% | 97% | 25% | |||
Sensitivity | 78% | 96% | 69% | |||
Specificity | 66% | 48% | 57% | |||
Agreement | 74% | 63% | 67% | |||
NRS-2002 at baseline | ||||||
n | 88 | 84 | 88 | |||
Kappa (95% CI) | 0.42 (0.23–0.60) | 0.875 | 0.47 (0.30–0.63) | 0.432 | 0.15 (−0.01–0.30) | <0.001 |
PPV | 87% | 53% | 92% | |||
NPV | 54% | 95% | 23% | |||
Sensitivity | 68% | 92% | 59% | |||
Specificity | 79% | 64% | 69% | |||
Agreement | 72% | 73% | 54% | |||
EVS at baseline | ||||||
n | 91 | 87 | 91 | |||
Kappa (95% CI) | 0.03 (−0.08–0.13) | <0.001 | 0.02 (−0.01–0.05) | <0.001 | 0.22 (−0.04–0.48) | 0.200 |
PPV | 70% | 31% | 87% | |||
NPV | 50% | 100% | 100% | |||
Sensitivity | 98% | 100% | 100% | |||
Specificity | 4% | 3% | 14% | |||
Agreement | 69% | 32% | 87% |
Risk Factor of Malnutrition | Baseline | Follow-Up | PPV, % | ||
---|---|---|---|---|---|
n | n (%) | n | n (%) | ||
Polypharmacy | 127 | 86 (68) | |||
Risk of dysphagia (EAT10 ≥ 3) | 125 | 34 (27) | 92 | 15 (16) | 33 |
Risk of depression (GDS ≥ 2) | 123 | 27 (22) | 91 | 24 (26) | 63 |
Activities of daily living | |||||
Needs help cooking | 125 | 29 (23) | 90 | 24 (27) | 84 |
Needs help eating | 126 | 1 (0.8) | 92 | 3 (3) | 100 |
Needs help grocery shopping | 126 | 25 (20) | 92 | 21 (23) | 82 |
Low muscle strength in lower extremities | |||||
STS-test < 5, or STS-test > 5 or ≤ 8 + GS ≤ 0.6 m/s | 82 | 43 (52) | 76 | 25 (33) | 67 |
Eating Symptom questionnaire, problems with: | |||||
Chewing | 124 | 21 (17) | 93 | 16 (17) | 50 |
Diarrhea | 125 | 34 (27) | 93 | 19 (20) | 46 |
Xerostomia | 125 | 77 (62) | 92 | 47 (51) | 70 |
Constipation | 125 | 37 (30) | 93 | 24 (26) | 63 |
Nausea | 125 | 50 (40) | 93 | 24 (26) | 47 |
Pain in mouth | 124 | 23 (19) | 92 | 12 (13) | 36 |
Vomiting | 125 | 25 (20) | 93 | 12 (13) | 33 |
Impaired cognition | |||||
Moderately impaired (OMC 7–10) Severely impaired (OMC > 10) | 124 | 68 (55) 28 (23) | 90 90 | 63 (70) 12 (13) | 80 27 |
At Risk of Malnutrition or with Malnutrition at Baseline According to: | |||
---|---|---|---|
MNA-SF Score ≤ 11 | NRS-2002 Score ≥ 3 | EVS Score ≥ 1 | |
n = 85 | n = 71 | n = 122 | |
Risk factor for malnutrition | Probability of having the risk factor, n(%) | Probability of having the risk factor, n(%) | Probability of having the risk factor, n(%) |
Polypharmacy | 61 (72) | 52 (73) | 83 (68) |
Risk of dysphagia, EAT10 ≥ 3 a | 27 (32) | 26 (37) | 34 (28) |
Risk of depression, GDS ≥ 2 | 24 (29) | 18 (26) | 27 (23) |
Activities of daily living | |||
Needs help cooking a | 26 (31) | 22 (31) | 29 (24) |
Needs help eating a | 1 (1) | 1 (1) | 1 (1) |
Needs help grocery shopping | 23 (27) | 21 (30) | 24 (20) |
Low muscle strength in lower extremities: | |||
STS-test < 5, or STS-test >5 or ≤ 8 + GS ≤ 0.6 m/s | 34 (69) * | 31 (72) ** | 42 (53) *** |
Eating Symptom questionnaire, problems with: | |||
Chewing a | 15 (18) | 15 (21) | 21 (18) |
Diarrhea | 28 (33) | 25 (35) | 34 (28) |
Xerostomia | 54 (64) | 48 (67) | 75 (62) |
Constipation | 26 (31) | 26 (37) | 36 (30) |
Nausea | 38 (45) | 38 (54) | 50 (41) |
Pain in moutha | 19 (22) | 16 (23) | 23 (19) |
Vomiting | 21 (25) | 19 (27) | 25 (21) |
Cognitive Impairment | |||
Moderately impaired (OMC = 7–10) | 41 (49) | 35 (50) | 67 (56) |
Severely impaired (OMC > 10) | 25 (30) | 21 (30) | 28 (23) |
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Andersen, A.L.; Nielsen, R.L.; Houlind, M.B.; Tavenier, J.; Rasmussen, L.J.H.; Jørgensen, L.M.; Treldal, C.; Beck, A.M.; Pedersen, M.M.; Andersen, O.; et al. Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study. Nutrients 2021, 13, 2757. https://doi.org/10.3390/nu13082757
Andersen AL, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, et al. Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study. Nutrients. 2021; 13(8):2757. https://doi.org/10.3390/nu13082757
Chicago/Turabian StyleAndersen, Aino Leegaard, Rikke Lundsgaard Nielsen, Morten Baltzer Houlind, Juliette Tavenier, Line J. H. Rasmussen, Lillian Mørch Jørgensen, Charlotte Treldal, Anne Marie Beck, Mette Merete Pedersen, Ove Andersen, and et al. 2021. "Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study" Nutrients 13, no. 8: 2757. https://doi.org/10.3390/nu13082757