Cheung Vivien Hui In, Wan Ching Shan
Independent Researcher, Wollongong, NSW 2500, Australia.
Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia.
Nutrients. 2025 Sep 16;17(18):2970. doi: 10.3390/nu17182970.
Preventing nutritional decline during hospitalisation is imperative in reducing the development of complications such as malnutrition and pressure injuries. However, existing malnutrition screening and assessment tools employ a reactive rather than proactive approach, using predictors to identify inpatients who are already malnourished instead of those at risk of developing hospital-acquired malnutrition. Therefore, this review aimed to identify key contextual and individual factors contributing to nutritional deterioration and their interrelatedness, and to inform strategies for preventing hospital-acquired malnutrition.
A scoping review of five databases (Medline, CINAHL, Embase, All EBM Reviews and PsycINFO) up to June 2024 was conducted to include English-language studies that reported statistically significant risk factors for changes in nutritional status during hospitalisation. A directed acyclic graphing method was used to visualise the interlinkage between contextual and individual risk factors identified. PRISMA Extension for Scoping Reviews was followed in reporting.
Of 8215 retrieved abstracts, 51 studies were included. Four contextual (ward type; food service satisfaction; medical-related mealtime interruption; nutrition care collaboration) and four individual factors (nutritional status prior admission; hospital length of stay; multimorbidity; disease acuity) were found to significantly predict nutritional decline during hospitalisation and were closely interrelated.
More contextual risk factors are modifiable, suggesting a need for organisational strategies to optimise collaborative nutrition care and improve patient satisfaction with hospital food services to promote early nutritional intervention, particularly within the first three days of admission and for inpatients with multimorbidity, high disease acuity, or pre-existing malnourishment.
预防住院期间的营养状况下降对于减少诸如营养不良和压疮等并发症的发生至关重要。然而，现有的营养不良筛查和评估工具采用的是反应性而非前瞻性方法，利用预测指标来识别已经营养不良的住院患者，而非那些有发生医院获得性营养不良风险的患者。因此，本综述旨在确定导致营养状况恶化的关键背景因素和个体因素及其相互关系，并为预防医院获得性营养不良的策略提供依据。
对截至2024年6月的五个数据库（Medline、CINAHL、Embase、All EBM Reviews和PsycINFO）进行了范围综述，纳入了报告住院期间营养状况变化的具有统计学意义的风险因素的英文研究。采用有向无环图方法来可视化所确定的背景风险因素和个体风险因素之间的相互联系。报告遵循《系统综述和荟萃分析扩展版的首选报告项目》（PRISMA）。
在检索到的8215篇摘要中，纳入了51项研究。发现四个背景因素（病房类型；餐饮服务满意度；与医疗相关的用餐时间中断；营养护理协作）和四个个体因素（入院前营养状况；住院时间；多种疾病并存；疾病严重程度）可显著预测住院期间的营养状况下降，且它们之间密切相关。
更多的背景风险因素是可以改变的，这表明需要制定组织策略来优化协作性营养护理，并提高患者对医院餐饮服务的满意度，以促进早期营养干预，特别是在入院后的头三天内，以及针对患有多种疾病、疾病严重程度高或已有营养不良的住院患者。
