Nutritional screening on hospital admission and one-year clinical outcomes in a prospective cohort of older patients

• Published in: Clinical nutrition ESPEN Vol. 64; pp. 221 - 228
• Main Authors: Isaia, Gianluca, Presta, Roberto, Brunetti, Enrico, Cacciatore, Clelia Maria, Carbonara, Francesca, Berardo, Eleonora, Villosio, Cristina, Cicerchia, Francesca, Mulatero, Paolo, Bo, Simona, Bo, Mario
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2024
• Subjects: Aged; Aged, 80 and over; clinical nutrition; cognition; cognitive disorders; Comprehensive geriatric assessment; Female; females; Frailty; Gastroenterology and Hepatology; Geriatric Assessment; Hospitalization; hospitals; Humans; Internal Medicine; Italy - epidemiology; Male; malnutrition; Malnutrition - epidemiology; Malnutrition risk; mortality; Nutrition Assessment; Nutritional screening; Nutritional Status; Older inpatients; prediction; Prevalence; Prognosis; Prospective Studies; Quality of Life; risk; Risk Factors; Italy; Comprehensive geriatric assessment; Frailty; Older inpatients; Nutritional screening; Malnutrition risk; frailty; older inpatients; comprehensive geriatric assessment; nutritional screening; malnutrition risk
• ISSN: 2405-4577; 2405-4577
• DOI: 10.1016/j.clnesp.2024.10.006

Malnutrition negatively affects the prognosis and quality of life of hospitalized patients. However, there are several gaps between evidence-based knowledge and current clinical practice. Our primary aim was to describe the prevalence of malnutrition risk in a cohort of in a cohort of older inpatients; secondly, we explored its predictors and its independent impact on 12-month survival. Prospective study focused on patients aged 65 years and older consecutively admitted for any reason to the acute geriatric and general medical units of an Italian university hospital. Comprehensive geriatric assessment data, including the short form of the Mini Nutritional Assessment (MNA-SF), were collected within 48 hours of admission. The prevalence of malnutrition and risk of malnutrition according to the MNA-SF represented the main outcome. Correlations among clinical variables, nutritional status, and one-year survival were analyzed using multivariable and Cox models. Among 594 patients (median age: 84 years, 49.5 % female), mostly living at home with moderate functional autonomy, 82.3 % were identified as probably malnourished or at risk of malnutrition according to MNA-SF (39.9 % and 42.4 %, respectively). Malnutrition and the risk of malnutrition were positively associated with living alone at home (OR 2.803, 95%CI 1.567–5.177, p < 0.001), and negatively associated with autonomy in IADL (OR 0.765, 95%CI 0.688–0.846, p < 0.001) and the best performance at HST (OR 0.901, 95%CI 0.865–0.936; p < 0.001). After 12 months, 31.8 % of patients was dead and mortality was positively correlated with malnutrition according to MNA-SF (OR 2.493, 95%CI 1.345–4.751, p = 0.004), institutionalization (OR 2.815, 95%CI 1.423–5.693, p = 0.003) and severe cognitive impairment (OR 1.701, 95%CI 1.031–2.803, p = 0.036). Malnutrition is common among older inpatients upon admission, primarily influenced by their functional and cognitive status, and it is linked to a worse prognosis. Early incorporation of thorough nutritional and functional assessments into clinical practice is crucial to improve prognosis prediction and enable timely, focused interventions targeting modifiable causal factors in a patient-centered approach.