School of Human Movement and Nutrition Science, The University of Queensland, Brisbane, QLD, Australia.
Department of Nutrition and Dietetics, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Eur J Clin Nutr. 2023 Jan;77(1):23-35. doi: 10.1038/s41430-022-01141-2. Epub 2022 May 2.
Despite advances in identifying malnutrition at hospital admission, decline in nutritional status of well-nourished patients can be overlooked. The aim of this systematic review was to investigate the incidence of hospital-acquired malnutrition (HAM), diagnostic criteria and health-related outcomes. PubMed, CINAHL, Embase and Cochrane Library were searched up to July 2021. Studies were included if changes in nutritional status was assessed with a validated nutrition assessment tool in acute and subacute adult (≥18 yrs) hospitalised patients. A random-effects method was used to pool the incidence proportion of HAM in prospective studies. The certainty of evidence was appraised using the Grading of Recommendation Assessment, Development and Evaluation system. We identified 12 observational cohort studies (10 prospective and 2 retrospective), involving 35,324 participants from acute (9 studies) and subacute settings (3 studies). Retrospective studies reported a lower incidence of HAM (<1.4%) than prospective studies (acute: 9-38%; subacute: 0-7%). The pooled incidence of HAM in acute care was 25.9% (95% confidence interval (CI): 17.3-34.6). Diagnostic criteria varied, with use of different nutrition assessment tools and timeframes for assessment (retrospective studies: >14 days; prospective studies: ≥7 days). Nutritional decline is probably associated with longer length of stay and higher 6-month readmission (moderate certainty of evidence) and may be association with higher complications and infections (low certainty of evidence). The higher incidence of HAM in the acute setting, where nutritional assessments are conducted prospectively, highlights the need for consensus regarding diagnostic criteria and further studies to understand the impact of HAM.
尽管在入院时识别营养不良方面取得了进展，但营养良好的患者的营养状况下降可能会被忽视。本系统评价的目的是调查医院获得性营养不良（HAM）的发生率、诊断标准和与健康相关的结局。检索了 PubMed、CINAHL、Embase 和 Cochrane Library，截至 2021 年 7 月。如果使用经过验证的营养评估工具评估急性和亚急性成人（≥18 岁）住院患者的营养状况变化，则纳入研究。使用随机效应方法对前瞻性研究中 HAM 的发生率进行汇总。使用推荐评估、制定和评估系统（Grading of Recommendation Assessment, Development and Evaluation system）评估证据的确定性。我们确定了 12 项观察性队列研究（10 项前瞻性和 2 项回顾性），涉及来自急性（9 项研究）和亚急性环境（3 项研究）的 35324 名参与者。回顾性研究报告 HAM 的发生率较低（<1.4%），而前瞻性研究报告的发生率较高（急性：9-38%；亚急性：0-7%）。急性护理中 HAM 的总发生率为 25.9%（95%置信区间[CI]：17.3-34.6）。诊断标准不同，使用不同的营养评估工具和评估时间框架（回顾性研究：>14 天；前瞻性研究：≥7 天）。营养下降可能与住院时间延长和 6 个月再入院率升高有关（证据确定性为中等），并且可能与更高的并发症和感染率有关（证据确定性为低）。在急性环境中，即前瞻性进行营养评估的环境中，HAM 的发生率较高，这突出表明需要就诊断标准达成共识，并开展进一步的研究，以了解 HAM 的影响。
