Prevalência de factores de risco de desnutrição em pacientes hospitalizados na América Latina: uma análise nutritionDay 2016-2020

Hospital malnutrition is a complex international health issue described to be associated with worse patient outcomes and increased healthcare costs(1). A large proportion of patients is already found malnourished at the time of hospital admission, others develop malnutrition while in hospital, often as a complication associated with the disease. Malnutrition screening is crucial for identifying vulnerable patients who are nutritionally at risk already on admission, presenting well-known risk factors such as poor appetite, low food intake, history of unintentional weight loss or low body mass index (BMI).La desnutrición hospitalaria es un problema de salud complejo a nivel internacional, el cual, según se ha descrito, se asocia con peores desenlaces para los pacientes y costos más elevados para los sistemas de salud(1). Es grande la proporción de pacientes que llegan desnutridos al momento de su ingreso al hospital; otros desarrollan desnutrición durante su estancia hospitalaria como una complicación asociada con su patología. El tamizaje para desnutrición es crucial para identificar a aquellos pacientes con riesgo nutricional al momento de su ingreso, y los factores de riesgo bien conocidos son la falta de apetito, baja ingesta de alimento, historia de pérdida de peso no intencional o bajo índice de masa corporal (IMC)

A negative impact of recent weight loss on in-hospital mortality is not modified by overweight and obesity

BACKGROUND: Obesity [Body Mass Index (BMI) > 30 kg/m2] is a risk factor for disease conditions enhancing hospitalization and mortality risks, but higher BMI was paradoxically reported to reduce mortality in several acute and chronic diseases. Unintentional weight loss (WL) is conversely associated with disease development and may worsen patient outcome, but the impact of weight loss and its interaction with obesity in modulating risk of death in hospitalized patients remain undefined. METHODS: We investigated the ESPEN nutritionDay database of non-critically ill hospitalized patients to assess the impact of self-reported 3-month WL (WL1:2.5-6.6%; WL2: 6.6-12.6%, WL3: >12.6%) and its interaction with BMI in modulating 30-day in-hospital mortality. Multivariate Cox regression was used to estimate hazard ratios (HR), with stable weight (WL0) as reference category. RESULTS: In 110835 nDay patients, 30-day mortality increased with increasing WL. Male gender, increasing disease severity index PANDORA score (age, nutrient intake, mobility, fluid status, cancer and main patient group) and not having had surgery also predicted 30-day mortality. HR for 30-day mortality remained significantly higher compared to WL0 for WL2 and WL3 after multiple adjustment. Adjusted HR and its increments through increasing weight loss categories were comparable in lean (BMI30 kg/m2). Impact of gender, PANDORA score and surgery on 30-day mortality were conversely comparable in the three BMI groups. CONCLUSIONS: These results indicate that self-reported WL could represent a relevant prognostic factor in every hospitalized patient. Overweight and obesity per se have no protective impact against WL-associated mortality

Hospital Malnutrition, a Call for Political Action: A Public Health and NutritionDay Perspective

Disease-related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analysed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical, surgical, long-term care and other patients (n = 153,470). In 59,126 medical patients included between 2006 and 2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. A similar pattern is found in all four patient groups. Nutrition care processes increase slightly with the presence of risk factors but are never done in more than 50% of the patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM

Importância do diagnóstico precoce e o acesso ao rastreamento do câncer de mama por mulheres da zona rural da região nordeste do Brasil/ Importance of early diagnosis and access to breast cancer tracking by women in the rural area of the northeast region of Brazil

Introdução: O câncer de mama é uma neoplasia com alta incidência e prevalência no Brasil e no mundo, sendo a principal causa de morte de mulheres no Brasil, com exceção aos cânceres não melanomas. O acesso ao rastreamento do câncer de mama como forma de prevenção e diagnóstico precoce é essencial, com o propósito de instituir políticas para se obter uma diminuição da morbidade e mortalidade por essa neoplasia na região Nordeste. Objetivos: Demonstrar a importância do diagnóstico precoce do Câncer de Mama por meio da realização dos exames de rastreamento, e evidenciar as causas que afastam mulheres do mesmo de modo a modificar essa problemática. Metodologia: Para realização deste trabalho foi utilizado um estudo ecológico de uma população específica: mulheres da zona rural da região nordeste do Brasil. Foram coletados dados de estimativa de câncer de mama para 2020; distribuição percentual da população residente, por Grandes Regiões, a partir dos 40 anos; distribuição da população por sexo a partir dos 40 anos na região Nordeste; os fatores relacionados a não realização de exames de rastreio para câncer de mama por mulheres; taxa de analfabetismo para as Grandes Regiões; taxa de analfabetismo para mulheres com 15 ou mais, segundo o sexo, na região Nordeste, e renda per capita no municípios nordestinos. Resultados: Foi encontrado um risco estimado para câncer de mama de 44,29 por 100 mil habitantes na região Nordeste; na região Nordeste 23% de indivíduos com 40 anos ou mais, e 13,4% com 60 anos ou mais; distribuição da população por sexo, segundo os grupos de idade na região Nordeste, homens e mulheres, respectivamente, a partir dos 40 anos, 7.453.510/8.618.118. Fatores associados à não realização de exames de rastreamento: (1) acesso ao sistema de saúde; (2) desigualdades relacionadas ao gênero e trabalho; (3) grandes distâncias entre as residências e os serviços de saúde; (4) idade avançada; (5) nível de escolaridade. Para taxa de analfabetismo, foi encontrado 16,2% em 2015, sendo que 14,5% das mulheres de 15 anos ou mais de idade eram analfabetas. Conclusão: Diante dos fatos encontrados, vários fatores distanciam essa população do acesso aos exames de rastreamento. Devido a estes fatores se observa a importância da ampliação dos serviços de saúde como forma de modificar as suas condições, garantindo assim que as dificuldades de acesso ao exame de rastreamento possam ser superadas, fazendo-se valer os princípios de integralidade, equidade e universalidade do Sistema Único de Saúde

Hospital Malnutrition, Nutritional Risk Factors, and Elements of Nutritional Care in Europe: Comparison of Polish Results with All European Countries Participating in the nDay Survey

NutritionDay (nDay) is a project established by the Medical University of Vienna and the European Society for Clinical Nutrition and Metabolism (ESPEN) to audit the nutritional status of hospitalized patients and nursing home residents. This study aimed to evaluate nDay data describing the prevalence of hospital malnutrition, nutritional risk factors, and elements of the nutritional care process implemented in hospital wards in 25 European countries and to compare the data derived from Poland with the data collected in all the European countries participating in the study. In total, 10,863 patients (European reference group: 10,863 participants including Poland: 498 participants) were involved in the study. The prevalence of malnutrition was identified on the basis of the ESPEN diagnostic criteria established in 2015, while the prevalence of nutritional risk factors was assessed by analyzing the following parameters: body mass index (BMI), score of Malnutrition Screening Tool (MST), recent weight loss, insufficient food intake, decreased appetite, increased number of drugs intake, reduced mobility, and poor self-reported health status. Malnutrition prevalence was 12.9% in patients from the European reference group and 9.4% in patients from Polish hospital wards (p < 0.05). However, the prevalence of some nutritional risk factors, i.e., recent weight loss, history of decreased food intake, and low actual food intake, were approximately four times more prevalent than diagnosed malnutrition (referring to approximately 40–50% of all participants). In comparison to the European reference group, the significant differences observed in Polish hospital wards concerned mainly dietitian’s involvement in the process of treating malnutrition (16% vs. 57.2%; p < 0.001); supply of special diets (8% vs. 16.1%; p < 0.0001); provision of oral nutritional support (ONS) (3.8% vs. 12.2%; p < 0.0001); prescription of enteral/parenteral nutrition therapy to hospitalized patients (8.2% vs. 11.7%; p < 0.001); as well as recording patient weight performed at hospital admission (100% vs. 72.9%; p < 0.0001), weekly (20% vs. 41.4%; p < 0.05), and occasionally (0% vs. 9.2%). These results indicate that the prevalence of malnutrition and malnutrition risk factors in hospitalized patients in Poland was slightly lower than in the European reference group. However, some elements of the nutritional care process in Polish hospitals were found insufficient and demand more attention

Hospital Malnutrition, Nutritional Risk Factors, and Elements of Nutritional Care in Europe: Comparison of Polish Results with All European Countries Participating in the nDay Survey

NutritionDay (nDay) is a project established by the Medical University of Vienna and the European Society for Clinical Nutrition and Metabolism (ESPEN) to audit the nutritional status of hospitalized patients and nursing home residents. This study aimed to evaluate nDay data describing the prevalence of hospital malnutrition, nutritional risk factors, and elements of the nutritional care process implemented in hospital wards in 25 European countries and to compare the data derived from Poland with the data collected in all the European countries participating in the study. In total, 10,863 patients (European reference group: 10,863 participants including Poland: 498 participants) were involved in the study. The prevalence of malnutrition was identified on the basis of the ESPEN diagnostic criteria established in 2015, while the prevalence of nutritional risk factors was assessed by analyzing the following parameters: body mass index (BMI), score of Malnutrition Screening Tool (MST), recent weight loss, insufficient food intake, decreased appetite, increased number of drugs intake, reduced mobility, and poor self-reported health status. Malnutrition prevalence was 12.9% in patients from the European reference group and 9.4% in patients from Polish hospital wards (p p p p p p p < 0.05), and occasionally (0% vs. 9.2%). These results indicate that the prevalence of malnutrition and malnutrition risk factors in hospitalized patients in Poland was slightly lower than in the European reference group. However, some elements of the nutritional care process in Polish hospitals were found insufficient and demand more attention

Phase Angle Is a Stronger Predictor of Hospital Outcome than Subjective Global Assessment—Results from the Prospective Dessau Hospital Malnutrition Study

This prospective cohort study of 16,943 consecutive patients compared phase angle (PhA, foot-to-hand at 50 kHz) and subjective global assessment (SGA) to predict outcomes length of hospital stay (LOS) and in-hospital mortality in patients at risk of malnutrition (NRS-2002 ≥ 3). In 1505 patients, the independent effects on LOS were determined by competing risk analysis and on mortality by logistic regression. In model I, including influence factors age, sex, BMI, and diagnoses, malnourished (SGA B and C) patients had a lower chance for a regular discharge (HR 0.74; 95%CI 0.69–0.79) and an increased risk of mortality (OR 2.87; 95%CI 1.38–5.94). The association of SGA and outcomes regular discharge and mortality was completely abrogated when PhA was added (model II). Low PhA reduced the chance of a regular discharge by 53% in patients with a PhA ≤ 3° (HR 0.47; 95%CI 0.39–0.56) as compared to PhA > 5°. Mortality was reduced by 56% for each 1° of PhA (OR 0.44; 95%CI 0.32–0.61). Even when CRP was added in model III, PhA ≤ 3° was associated with a 41% lower chance for a regular discharge (HR 0.59; 95%CI 0.48–0.72). In patients at risk of malnutrition, the objective measure PhA was a stronger predictor of LOS and mortality than SGA

Predicting Hospital Length of Stay at Admission Using Global and Country-Specific Competing Risk Analysis of Structural, Patient, and Nutrition-Related Data from nutritionDay 2007&ndash;2015

Hospital length of stay (LOS) is an important clinical and economic outcome and knowing its predictors could lead to better planning of resources needed during hospitalization. This analysis sought to identify structure, patient, and nutrition-related predictors of LOS available at the time of admission in the global nutritionDay dataset and to analyze variations by country for countries with n &gt; 750. Data from 2006&ndash;2015 (n = 155,524) was utilized for descriptive and multivariable cause-specific Cox proportional hazards competing-risks analyses of total LOS from admission. Time to event analysis on 90,480 complete cases included: discharged (n = 65,509), transferred (n = 11,553), or in-hospital death (n = 3199). The median LOS was 6 days (25th and 75th percentile: 4&ndash;12). There is robust evidence that LOS is predicted by patient characteristics such as age, affected organs, and comorbidities in all three outcomes. Having lost weight in the last three months led to a longer time to discharge (Hazard Ratio (HR) 0.89; 99.9% Confidence Interval (CI) 0.85&ndash;0.93), shorter time to transfer (HR 1.40; 99.9% CI 1.24&ndash;1.57) or death (HR 2.34; 99.9% CI 1.86&ndash;2.94). The impact of having a dietician and screening patients at admission varied by country. Despite country variability in outcomes and LOS, the factors that predict LOS at admission are consistent globally

The determinants of reduced dietary intake in hospitalised colorectal cancer patients

Purpose: Patients with colorectal cancer (CRC) often experience malnutrition and weight loss, largely resulting from reduced dietary intake. The aim of this study was to identify determinants of reduced dietary intake in order to facilitate early recognition of malnutrition and optimise nutritional treatment. Methods: Data from nutritionDay, an international 1-day survey investigating patient, disease and food profiles, were used. To identify determinants of dietary intake, defined as normal vs. reduced in the last week, univariate and multivariate logistic regressions were performed. Results: Of 1131 hospitalised CRC patients, 54% reported reduced dietary intake. Patient- and disease-related characteristics significantly associated with reduced dietary intake were female gender (odds ratio (OR) 1.38), cancer stage III (OR 1.52) or IV (OR 1.70) vs. I, performance status 2 (OR 1.56), 3 (OR 2.37) or 4 (OR 4.15) vs. 0, duration since hospital admission of ≥ 4 days (OR 4–7 days, 1.91; 8–21 days, 1.97; > 21 days, 1.92) vs. < 4 days, and unintentional weight loss (OR 2.56). Additionally, higher symptom scores of pain, weakness, depression, tiredness and lack of appetite were associated with reduced intake. Conclusions: Patient- and disease-related determinants for reduced dietary intake were being female, higher cancer stage, worse performance status, duration since hospital admission ≥ 4 days and unintentional weight loss. Furthermore, multiple symptoms were associated with a reduced dietary intake. Future trials should assess whether early recognition of patients at risk of malnutrition and the combination of treating symptoms and dietary advice result in improved intake and treatment-related outcomes

Predictors of incident malnutrition—a nutritionDay analysis in 11,923 nursing home residents

Background/Objectives: Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods: NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) < 20 at FU) was analyzed in univariate generalized estimated equation (GEE) models. Significant (p < 0.1) variables were selected for multivariate GEE-analyses. Effect estimates are presented as odds ratios and their respective 99.5%-confidence intervals. Results: Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion: 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age