Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

How important is malnutrition? A prospective study in internal medicine

European Journal of Clinical Nutrition volume 63, pages 430–436 (2009)Cite this article

Abstract

Background/Objective:

Data about the prevalence of malnutrition on hospital admission vary and follow-up data are scarce. We assessed the nutritional status of unselected patients on admission and discharge.

Subjects/Methods:

A total of 430 consecutively admitted patients were assessed and 168 patients hospitalized ⩾6 days were reassessed on discharge. Assessment was carried out by the Mini Nutritional Assessment (MNA), weight and anthropometric measurements, bioelectrical impedance analysis, biochemical markers and a subjective clinical assessment by the physicians in charge.

Results:

On admission, 47% of all patients were overweight (body mass index, BMI >25 kg m−2) and 8% underweight (BMI<18.5 kg m−2). In terms of the MNA 70% were adequately nourished, 20% were at risk for malnutrition and 10% were malnourished. By clinical judgment alone 18 (4.3%) malnourished patients according to MNA were missed. The 44 malnourished patients according to the MNA had significantly lower values for BMI, fat-free mass, fat mass, waist circumference, triceps skinfold thickness, hemoglobin, albumin, prealbumin, total cholesterol but higher values for C-reactive protein. Of the 168 patients staying ⩾6 days in hospital, 57% lost and 39% gained weight. Only 1.9% of all patients (8 of 430) were malnourished and lost further weight during hospitalization.

Conclusions:

We found a low prevalence (10%) of malnourished patients on admission. Clinical judgment and to some extent anthropometrical measurement were helpful for assessing the nutritional status, laboratory values were not.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  • Bauer JM, Vogl T, Wicklein S, Trogner J, Muhlberg W, Sieber CC (2005). Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriatr 38, 322–327.

    Article  CAS  Google Scholar 

  • Beattie AH, Prach AT, Baxter JP, Pennington CR (2000). A randomized controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients. Gut 46, 813–818.

    Article  CAS  Google Scholar 

  • Bishop CW, Bowen PE, Ritchey SJ (1981). Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr 34, 2530–2539.

    Article  CAS  Google Scholar 

  • Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J (1976). Prevalence of malnutrition in general medical patients. JAMA 253, 1567–1570.

    Article  Google Scholar 

  • Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V (2002). Nutritional approach in malnourished surgical patients: a prospective study. Arch Surg 137, 174–180.

    Article  Google Scholar 

  • Burr ML, Phillips KM (1984). Anthropometric norms in the elderly. Br J Nutr 51, 165–169.

    Article  CAS  Google Scholar 

  • Corish CA, Flood P, Kennedy NP (2004). Comparison of nutritional risk screening tools in patients on admission to hospital. J Hum Nutr Diet 17, 133–139.

    Article  CAS  Google Scholar 

  • Corish CA, Flood P, Mulligan S, Kennedy NP (2000). Apparent low frequency of undernutrition in Dublin hospital in-patients: should we review the anthropometric thresholds for clinical practice? Br J Nutr 84, 325–335.

    CAS  PubMed  Google Scholar 

  • Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA et al. (1987). What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11, 8–13.

    Article  CAS  Google Scholar 

  • Durnin JV, Womersley J (1974). Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 32, 77–97.

    Article  CAS  Google Scholar 

  • Edington J, Boorman J, Durrant ER, Perkins A, Giffin CV, James R et al. (2000). Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group. Clin Nutr 19, 191–195.

    Article  CAS  Google Scholar 

  • Elia M, Stratton RJ (2005). Geographical inequalities in nutrient status and risk of malnutrition among English people aged 65 y and older. Nutrition 21, 1100–1106.

    Article  Google Scholar 

  • Gallagher-Allred CR, Voss AC, Finn SC, McCamish MA (1996). Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc 96, 361–366,369.

    Article  CAS  Google Scholar 

  • Giner M, Laviano A, Meguid MM, Gleason JR (1996). In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition 12, 23–29.

    Article  CAS  Google Scholar 

  • Guigoz Y (2006). The Mini Nutritional Assessment (MNA) review of the literature—what does it tell us? J Nutr Health Aging 10, 466–485.

    CAS  Google Scholar 

  • Guigoz Y, Vellas B (1999). The Mini Nutritional Assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Programme 1, 3–11;discussion 11–12.

    Article  CAS  Google Scholar 

  • Jolliet P, Pichard C, Biolo G, Chiolero R, Grimble G, Leverve X et al. (1999). Enteral nutrition in intensive care patients: a practical approach. Clin Nutr 18, 47–56.

    Article  CAS  Google Scholar 

  • Jones JM (2002). The methodology of nutritional screening and assessment tools. J Hum Nutr Diet 15, 59–71.

    Article  Google Scholar 

  • Kelly IE, Tessier S, Cahill A, Morris SE, Crumley A, McLaughlin D et al. (2000). Still hungry in hospital: identifying malnutrition in acute hospital admissions. Q J med 93, 93–98.

    Article  CAS  Google Scholar 

  • Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (2003a). Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN Guidelines for Nutritional Screening 2002. Clin Nutr 22, 415–421.

    Article  CAS  Google Scholar 

  • Kondrup J, Johansen N, Plum LM, Bak L, Larsen IH, Martinsen A et al. (2002). Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 21, 461–468.

    Article  CAS  Google Scholar 

  • Kondrup J, Rasmussen HH, Hamber O, Stanga Z (2003b). Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22, 321–336.

    Article  Google Scholar 

  • Koretz RL, Avenell A, Lipman TO, Braunschweig CL, Milne AC (2007). Does enteral nutrition affect clinical outcome? A systemic review of the randomized trials. Am J Gastroenterol 102, 412–429.

    Article  Google Scholar 

  • Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gomez JM et al. (2004a). Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr 23, 1226–1243.

    Article  Google Scholar 

  • Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gomez J et al. (2004b). Bioelectrical impedance analysis—part II: utilization in clinical practice. Clin Nutr 23, 1430–1453.

    Article  Google Scholar 

  • Kyle UG, Morabia A, Slosman DO, Mensi N, Unger P, Pichard C (2001). Contribution of body composition to nutritional assessment at hospital admission in 995 patients: a controlled population study. Br J Nutr 86, 725–731.

    Article  CAS  Google Scholar 

  • Kyle UG, Pirlich M, Schuetz T, Luebke HJ, Lochs H, Pichard C (2003). Prevalence of malnutrition in 1760 patients at hospital admission: a controlled population study of body composition. Clin Nutr 22, 473–481.

    Article  CAS  Google Scholar 

  • Kyle UG, Pirlich M, Schuetz T, Pichard C (2004c). Is nutritional depletion by Nutritional Risk Index associated with increased length of hospital stay? A population-based study. JPEN J Parenter Enteral Nutr 28, 99–104.

    Article  Google Scholar 

  • McWhirter JP, Pennington CR (1994). Incidence and recognition of malnutrition in hospital. Brit Med J 308, 945–948.

    Article  CAS  Google Scholar 

  • Naber TH, de Bree A, Schermer TR, Bakkeren J, Bar B, de Wild G et al. (1997). Specificity of indexes of malnutrition when applied to apparently healthy people: the effect of age. Am J Clin Nutr 65, 1721–1725.

    Article  CAS  Google Scholar 

  • Suter PM, Schutz Y (2005). Overweight and obesity in adults. In: Eichholzer M, Camenzind-Frey E, Matzke A, Amadò R, Ballmer PE, Beer M et al. (eds). Fünfter Schweizerischer Ernährungsbericht. Bundesamt für Gesundheit: Bern, 471–492. (article in German).

    Google Scholar 

  • Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y et al. (2006). Overview of the MNA—its history and challenges. J Nutr Health Aging 10, 456–463.

    CAS  PubMed  Google Scholar 

  • World Health Organization (1998). Report of a WHO consultation on obesity. Obesity: Preventing and Managing the Global Epidemic. World Health Organization: Geneva.

Download references

Acknowledgements

We thank Valentin Rousson, Department of Biostatistics University of Zürich, for statistical support; Subrata Ghosh, professor of gastroenterology, Hammersmith Hospital London and Alan Shand, consultant gastroenterologist, Western General Hospital Edinburgh for valuable discussions. The study was supported by the Bonizzi-Theler Foundation, Switzerland (an industry-independent nonprofit organization).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Kantonsspital Graubünden, Chur, Switzerland

    R M Venzin, N Kamber, W C F Keller & W H Reinhart

  2. Medical Policlinic, University Hospital, Zürich, Switzerland

    P M Suter

Authors
  1. R M Venzin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N Kamber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W C F Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P M Suter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W H Reinhart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W H Reinhart.

Additional information

Contributors: RMV did the study design, data acquisition, analysis and wrote the manuscript, NK was involved in the study design, partially in the data acquisition and analysis, WCFK contributed to the interpretation of the results and the manuscript preparation, PMS was involved in the study concept and the manuscript preparation and WHR had the idea for the study and contributed to the data analysis and manuscript preparation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Venzin, R., Kamber, N., Keller, W. et al. How important is malnutrition? A prospective study in internal medicine. Eur J Clin Nutr 63, 430–436 (2009). https://doi.org/10.1038/sj.ejcn.1602948

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602948

Keywords

This article is cited by

Search

Advanced search

Quick links