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Recognition and Prevention of Nosocomial Malnutrition: A Review and A Call to Action!

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Nosocomial malnutrition in hospitalized adults is a morbid, costly, and potentially preventable and treatable problem. Although recognized as contributing to many serious complications of hospitalization, malnutrition is often missed when present on admission and rarely diagnosed if it occurs during hospital stay. Many routine clinical practices such as holding nutrition for testing or failing to address poor intake, when added to acute inflammatory disease states, cause rapid deterioration in nutritional status in up to 70% of inpatients. Malnutrition during hospitalization is associated with increased mortality for years after discharge. In addition, unrecognized (and under-coded) malnutrition is associated with potential lost revenues for hospital systems. Low-cost interventions of recognizing at-risk patients and providing adequate nutrition have the potential to improve patient outcomes and reduce health care costs. Physicians must champion implementation of these interventions, using guidance from national organizations.

Introduction

Malnutrition in hospitalized adults contributes to poor health outcomes and increased health care costs.12 Many patients present with malnutrition upon admission.3456 Additionally, 38% of normally nourished inpatients and 69% of malnourished inpatients either develop malnutrition or experience worsening nutritional status during the course of a hospital stay.789 Malnutrition at discharge increases mortality risks for years.410 While nosocomial malnutrition may be both preventable and treatable, it must first be recognized. Unfortunately, poor or declining nutritional status often goes unrecognized by providers.1112 Perhaps most disturbing is that this is not a new phenomenon; “physician-induced malnutrition” was described as “one of the most serious nutritional problems of our time” in 1974!13

In this review, we will discuss the scope of the problem of nosocomial malnutrition for adult inpatients, review the outcomes associated with malnutrition, and describe the impact of nutritional support during hospitalization. Areas of quality improvement and future research will also be described.

Methods

For this nonsystematic clinical review, the terms “nosocomial malnutrition,” “hospital acquired malnutrition,” “inpatient malnutrition,” and “malnutrition in hospitalized patients” were used as starting points, with further searches for specific references as indicated, using PubMed, Ovid, and Google Scholar. Nutrition industry-supported publications were avoided wherever possible. The author received no funding from any sources, and had no conflict of interest to declare.

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- Lisa L. Kirkland, MD, Erin Shaughnessy, MD, MSHCM

This article originally appeared in the December 2017 issue of The American Journal of Medicine.

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