Prevalence and consequences of hospital malnutrition associated outcomes at a teaching hospital in Ghana
Nyatefe, Dzifa Esi
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Background At admission, malnutrition in hospitalised adults is a highly prevalent problem and has been associated with adverse clinical outcomes. Therefore, nutritional risk screening has been recommended as a quick and easy way to improve the detection and treatment of malnutrition in this population. By the time of discharge, malnutrition prevalence has been shown to increase. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends the Nutritional Risk Screening Tool-2002 (NRS-2002) for the identification of patients at risk of malnutrition in all hospital settings. Amidst the high rates of malnutrition documented worldwide and its associated consequences, little is known on this topic in the Ghanaian hospital setting. The aim of this study was to determine the prevalence of adult hospital malnutrition on admission and discharge, the association between nutritional risk and patient outcomes, as well as the identification of at-risk patients by hospital staff for immediate referral for nutritional support. Methods Over a five-month study period, adult patients newly admitted to the Korle Bu Teaching Hospital (KBTH) (≥18 years) with a minimum length of stay of 24 hours were recruited. Patients were screened according to the NRS-2002 within 48 hours of admission. Nutritional risk was defined as an NRS-2002 score ≥3. Length of stay in hospital (LOS) was captured for every patient. For patients that stayed longer than seven days, other clinical outcomes (complications and mortality) were recorded until discharge or compulsory date of discharge, day 28 for patients. A subsequent follow-up was done via telephone call to a subsample one month after discharge to assess the impact of malnutrition after discharge. The additional outcome of readmissions was included at this stage. Results and discussion A total of 402 patients, predominantly female (56.5%), were included. The mean age was 47.1 ± 15.9 years and mean LOS was 8.6 ± 0.3 days. Nutritional risk defined as a function of the NRS-2002 was very high (71.4%) ranging from 62.5% in the cardiothoracic unit to 81.2% in the department of general medicine. Nutritional risk was associated with a significantly prolonged LOS (9.70 days versus 5.95 days, p<0.001, d=0.74) and adverse clinical outcomes during hospitalisation and one month after discharge.’ The incidence of complications (7.8%) and mortality (7.2%) occurred only in those that were at nutritional risk during hospitalisation (p=0.002 each). Additionally, deaths occurred only in the at-risk group (8.1%, p=0.002) one month after discharge. The rates of complications were greater in the group that was not at nutritional risk compared with the at-risk group although the difference was not statistically significant (10% versus 2.7%, p=0.625). Readmission rates were significantly greater in the group that was not at nutritional risk, but this occurred in only one out of the 10 patients that were not at nutritional risk compared to 10 out of the 123 patients that were at nutritional risk (p=0.012). The prevalence of nutritional risk did not change at discharge (n=172). More than 93% of the nutritionally at-risk patients were undetected for nutritional risk by attending physicians and hence were not referred for nutritional support. Conclusion and recommendations: There was a high prevalence of nutritional risk in this study population, all of whom should have been referred for immediate dietetic assessment and possible nutritional support. NRS-2002 was predictive of LOS, which is a surrogate measure of patient recovery in at-risk patients. In general, the incidence of adverse clinical outcomes was associated with being at nutritional risk. Considering the alarming high prevalence of nutritional risk, education of hospital staff on the identification and prompt referral of nutritionally at-risk patients is warranted. Local and national hospital policies should make the practice of nutritional screening mandatory and the dietetic department should be supported to deal with optimising patients’ nutritional status.
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