Department of Surgery, Universidade Federal de Minas Gerais Medical School, Belo Horizonte, Brazil.
Abbott Nutrition, Abbott Park, IL, USA.
Clin Nutr. 2021 Sep;40(9):5114-5121. doi: 10.1016/j.clnu.2021.07.023. Epub 2021 Jul 27.
BACKGROUND & AIMS: Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes.
On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay.
The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P < 0.001) for patients eating one-quarter of their meal (compared with those who ate the full meal), increasing to 6.6 (95% CI [5.02, 8.7]; P < 0.0001) for patients who ate none of the food offered.
Based on compilation of nDay surveys throughout Latin America, 2 of every 5 hospitalized patients were at risk for malnutrition. The associated risk for hospital mortality was up to 6-fold higher among patients who ate little or none of their meal on nDay. This high prevalence showed scant improvement over rates two decades ago-a compelling rationale for new focus on nutrition education and training of professionals in acute care settings.
在全球范围内，医院营养不良的患病率因所服务的人群和当地社会经济状况的不同而有很大差异。虽然营养不良被广泛认为会恶化患者的预后，并给医疗保健系统带来经济负担，但拉丁美洲最近关于医院营养不良的数据有限。我们的研究目的是：（1）量化拉丁美洲医院病房营养不良风险的流行率，（2）探讨营养风险状况、住院期间食物摄入与健康结果之间的关系。
在营养日（nDay），全球范围内的医院病房可以在每年的特定一天参与为期一天的横断面审计。我们分析了 2009 年至 2015 年在十个拉丁美洲国家收集的 nDay 数据，包括来自 582 个病房/单位的成年患者（≥18 岁）的人口统计学和营养相关发现。根据患者对与营养不良筛查工具相关的问题的报告回答，我们确定了营养不良风险的流行率（MST 评分≥2）。我们还总结了 nDay 当天患者报告的食物摄入量，并分析了 nDay 后 30 天收集的工作人员的结果数据。
在拉丁美洲 nDay 研究人群（N=14515）中，营养不良风险的患病率为 39.6%。超过 50%的研究患者只吃了一半或更少的医院餐，在 nDay 前一周吃得比平时少，或在过去三个月体重减轻。与吃完整餐的患者相比，每餐吃四分之一的患者的住院死亡率危险比为 3.63（95%CI[2.71, 4.88]；P<0.001），而不吃所提供食物的患者则增加到 6.6（95%CI[5.02, 8.7]；P<0.0001）。
根据拉丁美洲各地 nDay 调查的汇编，每 5 名住院患者中就有 2 名有营养不良风险。在 nDay 当天吃少量或不吃食物的患者，其住院死亡率的相关风险高达 6 倍。这一高患病率与二十年前的比率相比几乎没有改善，这强烈地说明了在急性护理环境中对营养教育和专业人员培训进行新的关注的理由。
