Original article
Disease-related malnutrition in hospitalized chronic patients with
complex needs
Q7
Q6
R. Burgos
a, *
, C. Joaquín
b
, C. Blay
c
, C. Vaqu
e
d
a
Nutritional Support Unit, University Hospital Vall d’Hebron, Barcelona, Spain
b
Nutrition Unit, Endocrinology and Nutrition Service, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
c
Central Catalonia Chronicity Research Group (C3RG), Faculty of Medicine, Universitat de Vic-Universitat, Central de Catalunya, Spain
d
Research Group on Methodology, Methods, Models and Outcome of Health and Social Sciences (M3O), Health Science Faculty, Universitat de
Vic-Universitat Central de Catalunya, Spain Q1
article info
Article history:
Received 12 December 2018
Accepted 7 June 2019
Keywords:
Disease-related malnutrition
Nutritional screening
Chronic disease
Clinical complexity
Complex needs
Mini-nutritional assessment (MNA)
Nutritional risk screening 2012 (NRS-2002) Q2
summary
Background and aims: Disease-related malnutrition is a prevalent condition that can be associated with
multimorbidity. The purposes of this study were to assess the prevalence of disease-related malnutrition
in a cohort of chronic patients with complex needs (CPCN) admitted to two University hospitals, and to
evaluate the impact of malnutrition in their hospitalization outcomes.
Methods: All CPCN admitted on a previously agreed day in non-critical services of two University hos-
pitals in Catalonia were included. Nutritional risk was evaluated with Mini-Nutritional Assessment Tool
and Nutritional Risk Screening 2002. Hospitalization outcome data were evaluated, including length of
the hospital stay, mortality during admission and placement when discharged. After five months, a new
evaluation was performed to assess mortality and readmissions.
Results: A total of 101 patients were included, 83% of which were at nutritional risk when screened with
NRS-2002; when using MNA, 86% of them were found to be either at nutritional risk or malnourished.
Malnourished patients had a greater need for home care/intermediate care hospital at discharge (41.8%
vs 22.9%, p < 0.01), and a higher mortality rate during admission (16.7% vs 1.6%, p < 0.01). Mortality at 5
months was also higher in the malnourished group (30.5% vs 9.8%, p < 0.01). Factors associated with
malnutrition were BMI and gender (malnutrition was more prevalent in women). In our cohort,
malnutrition was the sole independent predictor of mortality at 5 months.
Conclusions: The prevalence of both malnutrition and risk of malnutrition is very high in hospital-
admitted CPCN, and has a profound impact on placement at discharge and mortality. This high preva-
lence is not explained by the multimorbidity pattern. Other factors need to be evaluated in this group of
high-need, high-cost patients.
© 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
1. Introduction
Disease-related malnutrition (DRM) is a prevalent condition
amongst older people as well as in patients of all healthcare settings
around the world [1e3]. DRM is associated with the presence of
chronic morbidity, higher hospital admission and readmission
rates, increased needs for social resources (home care facilities,
teleassistance devices) and even a high mortality [4,5].
Taking into account the strong relationship between nutritional
status and chronicity, the European Society for Clinical Nutrition
and Metabolism (ESPEN) has recently published a Guideline to
address nutritional support in polymorbid patients [6], underlying
the need to consider the co-occurrence of at least two chronic
health conditions in the same person and the need to move away
from the current single-disease healthcare approach. Within the
group of polymorbid patients, a special interest is focused on pa-
tients with high needs of care.
Chronic patients with complex needs (CPCN) are those with
chronic conditions that involve multiple health requirements,
entangled social support needs or both [7]. CPCN are a group of
patients with a higher risk of disability, hospital admissions
(frequently due to the exacerbation of the main chronic pathology)
and use of primary care or home-care services, and they are * Corresponding author. Passeig Vall d’Hebron 119-129, 08830, Barcelona, Spain.
E-mail address: rburgos@vhebron.net (R. Burgos).
Contents lists available at ScienceDirect
Clinical Nutrition
journal homepage: http://www.elsevier.com/locate/clnu
https://doi.org/10.1016/j.clnu.2019.06.006
0261-5614/© 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Clinical Nutrition xxx (xxxx) xxx
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Please cite this article as: Burgos R et al., Disease-related malnutrition in hospitalized chronic patients with complex needs, Clinical Nutrition,
https://doi.org/10.1016/j.clnu.2019.06.006