Risk of malnutrition linked to higher mortalitiy and re-admission to the hospital

17 May 2021

One in five people admitted to the hospital run a risk of malnutrition. A good nutritional follow-up of these patients is important, because they have a higher risk of mortality during their admission or within the first month after their admission and they have to be readmitted more often. These are the results of a large-scale UZ Leuven trial in collaboration with five other Belgian hospitals. The Leuven clinical nutrition specialists raise the alarm and ask more attention to nutrition, both in- and outside the hospital. 

More than one in five admitted patients run the risk of malnutrition, which can have big consequences. (Picture: Shutterstock)

UZ Leuven researchers wanted to check the nutritional condition of patients at the time of hospital admission and what the consequences of malnutrition could be. They set up a large scale retrospective trial based on the data of more than 73,000 adult patients admitted to six Belgian hospitals in 2018. It is the first Belgian trial that examines nutritional risk on such a large scale and in several centres. 

Prof. Ann Meulemans, clinical nutrition coordinator at UZ Leuven: “Nearly all patients receive a nutritional screening within 24 hours of admission, as is required for all Belgian hospitals. The screening includes a short questionnaire that assess BMI and unwanted weight loss or decreased appetite. This showed that 22 per cent, i.e. more than one in five patients, has an increased risk of malnutrition. For the group of patients living alone, this went up to one in four, and for all patients residing in a care home, even one in three had a risk of malnutrition at admission.”

Especially oncological patients

Nutritional risk occurred in all age groups and a little more frequent in women than in men. The frequency was mainly dependent on the reason for admission: oncological patietns ran the highest risk of malnutrition (38,3% of the patients), while it is a lot more rare for people admitted for plastic or reconstructive surgery (5,2%). Which was to be expecetd, as the last group of patients is physically a lot less ill. 

Matching of patients with and without risk

The researchers also examined whether there was a connection between the nutritional status of a patient and the risk of mortality (during admission or within 30 days after admission), the total length of stay and the chance of re-admission within four months. 

Researcher Luk Bruyneel: “To exclude influencing factors such as reason for admission, other disorders, age and gender as much as possible, we used a special statistical matching technique. Every patient with a nutritional risk was compared to another patient in the same hospital with very similiar characteristics but with no risk of malnutrition.”

Higher risk of mortality

Prof. Ann Meulemans: “We discovered that the mortality probability during admission or within month after admission, was well over 1.5 time higher in patients with a nutritional risk. They also required re-admission more often after four months of the first admission. By working with a corrected admission duration in combination with our statistical method, we saw that, in comparison to other trials, there was no significant increase in admission duration for patients with a risk.”

The importance of a healthy diet seems evident, but isn't.
Prof. Ann Meulemans - clinical nutrition coordinator at UZ Leuven

Need for nutritional follow-up

The results De resultaten wijzen op het belang van nutritionele opvolging voor patiënten met risico op ondervoeding. Uit de studie blijkt dat slechts 62 procent van de risicopatiënten een diëtist zagen tijdens hun opname, met grote verschillen tussen de ziekenhuizen en medische afdelingen.

“There are simply not enough hospital dieticians to assist all patients and an individual nutritional programme is very intense. Also, the follow-up after admission and any food supplements are not re-imbursed.” 

Besides which, the hospital is not the best context to improve someone's nutritional status: it usually requires an intervention of several months, whereas a hospital stay is a lot shorter on average. The follow-up afterwards is also important. 

“What would be even better is to have attention for a healthy nutritional status long before people get ill and end up in hospital”, prof. Ann Meulemans stresses. “The importance of a healthy diet seems evident, but isn't.”

Last edit: 17 May 2021