Johane P Allard1, Heather Keller2, Khursheed N Jeejeebhoy3, Manon Laporte4, Don R Duerksen5, Leah Gramlich6, Helene Payette7, Paule Bernier8, Elisabeth Vesnaver9, Bridget Davidson10, Anastasia Teterina11, Wendy Lou12. 1. Department of Medicine, University Health Network, University of Toronto, Ontario, Canada johane.allard@uhn.on.ca. 2. Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. 3. Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 4. Clinical Nutrition Department, Réseau de Santé Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada. 5. Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. 6. Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada. 7. Facultée de la Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada. 8. Jewish General Hospital, McGill University, Montréal, Québec, Canada. 9. Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada. 10. Canadian Nutrition Society, Toronto, Ontario, Canada. 11. University Health Network, Toronto, Ontario, Canada. 12. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS. MATERIALS AND METHODS: This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization. RESULTS: One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%-48%) were malnourished, and based on BMI, 32% (95% CI, 29%-35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1-117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62-0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor. CONCLUSION: Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors.
BACKGROUND: In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS. MATERIALS AND METHODS: This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization. RESULTS: One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%-48%) were malnourished, and based on BMI, 32% (95% CI, 29%-35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1-117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62-0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor. CONCLUSION: Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors.
Authors: Julie Shlisky; David E Bloom; Amy R Beaudreault; Katherine L Tucker; Heather H Keller; Yvonne Freund-Levi; Roger A Fielding; Feon W Cheng; Gordon L Jensen; Dayong Wu; Simin N Meydani Journal: Adv Nutr Date: 2017-01-17 Impact factor: 8.701
Authors: David M Golombos; Padraic O'Malley; Patrick Lewicki; Daniel P Nguyen; Benjamin V Stone; Bashir Al Hussein Al Awamlh; Douglas S Scherr Journal: World J Urol Date: 2016-11-19 Impact factor: 4.226
Authors: H Keller; M Laporte; H Payette; J Allard; P Bernier; D Duerksen; L Gramlich; K Jeejeebhoy Journal: Eur J Clin Nutr Date: 2017-02-22 Impact factor: 4.016