Vol.:(0123456789) 1 3 Internal and Emergency Medicine https://doi.org/10.1007/s11739-018-1884-0 IM - ORIGINAL Risk, prevalence, and impact of hospital malnutrition in a Tertiary Care Referral University Hospital: a cross‑sectional study Emanuele Rinninella 1  · Marco Cintoni 1,2  · Antonino De Lorenzo 2  · Giovanni Addolorato 3  · Gabriele Vassallo 3  · Rossana Moroni 4  · Giacinto Abele Donato Miggiano 1  · Antonio Gasbarrini 3  · Maria Cristina Mele 1 Received: 26 April 2018 / Accepted: 24 May 2018 © SIMI 2018 Abstract Hospital malnutrition is still underestimated among physicians, even in internal medicine settings. This is a cross-sectional study, aiming to estimate the risk, the prevalence and the impact of malnutrition in an Internal Medicine and Gastroenterol- ogy Department of a large Italian hospital (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome). Patients were evaluated within 72 h from admission according to Nutritional Risk Screening-2002 (NRS-2002) and European Society for Clinical Nutrition and Metabolism (ESPEN) Criteria. Anthropometric, laboratory tests and Bioelectrical Impedance Analysis (BIA) derived phase angle were also performed. Length of hospital stay (LOS) and in-hospital mortality were col- lected. Univariate and multivariate analyses were conducted to correlate nutritional status with LOS and hospital mortality. In 10 months, 300 patients were enrolled: male patients were 172 (57.3%); mean age was 63.7 (± 17.6). At admission, 157 (52.3%) patients were at risk of malnutrition; 116 (38.7%) were malnourished. Malnourished patients had a mean LOS of 11.5 (± 8.0) days, not-malnourished 9.4 (± 6.2) days (p < 0.05). In-hospital mortality did not signifcantly difer between the two groups. Multivariate analysis shows that both malnutrition (p = 0.04; 95% CI 0.03–3.41) and phase angle (p = 0.004; 95% CI − 1.92 to − 0.37) independently correlate with LOS. In an Internal Medicine and Gastroenterology Department, over half (52.3%) of the patients were found at risk of malnutrition, and over a third (38.7%) were malnourished at hospital admission. Malnutrition and BIA-derived phase angle are independently associated with LOS. ESPEN Criteria and phase angle could be performed at admission to identify patients deserving specifc nutritional support. Keywords Hospital malnutrition · NRS-2002 · ESPEN Criteria · Phase angle · Length of hospital stay · Hospital mortality · Personalized medicine Introduction Hospital malnutrition is defned as a condition of undernutri- tion during hospital stay, representing a detrimental variable for clinical outcomes such as length of stay (LOS), mor- bidity and hospital mortality, while also producing higher healthcare costs. It ranges from 11 to 69%, with considerable variability among geographical sites and clinical specialty wards [1, 2]. Notwithstanding its long-recognized role [3], it continues to be underestimated in clinical practice [1]. Several tools have been validated to investigate malnu- trition at hospital admission. There is no “gold standard” tool to defne malnutrition, even if Nutritional Risk Score- 2002 (NRS-2002) [4] has been largely accepted to identify patients at risk of malnutrition in a hospital context. This score takes into account the patient’s weight loss, Body Mass Index (BMI), reduced dietary intake and the gravity * Emanuele Rinninella emanuele.rinninella@unicatt.it 1 Clinical Nutrition Unit, Gastroenterology and Oncology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Roma, Italy 2 Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy 3 Internal Medicine and Gastroenterology Unit, Gastroenterology and Oncology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy 4 Institute of Neurology, Neuroscience Area, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy