A longitudinal study of hospital undernutrition in the elderly: Comparison of four validated methods

Undernutrition/nutritional risk were evaluated longitudinally in 531 hospitalized elderly by four validated methods to appraise the most feasible for routine use. Within 48hrs of admission&24hrs before discharge: the following data were collected: clinical data, nutritional status (BMI, %weight loss) & risk (MNA, MUST), energy requirements (Owen et al), diet. Significant changes from admission to discharge in risk/undernutrition prevalence, were not shown by BMI (a parts per thousand 17% vs 22%), a parts per thousand yen5% weight loss (a parts per thousand 53% vs a parts per thousand 56%) or MNA 83% vs a parts per thousand 81%; at admission, 93% patients were MUST high risk declining to a parts per thousand 47% (p=0.001) at discharge, alongside eating resumption. By multivariate analysis comparing all methods&differences between patient groups during hospitalization, only %weight loss clarified nutritional progression: more surgical patients had a parts per thousand yen10% weight loss vs medicine, p < 0.01. Only admission a parts per thousand yen5% weight loss was predictive of longer hospitalizations (OR:1.57; 95% CI 1.02-2.40; p < 0.003), though MNA&MUST undernourished/high risk had significantly longer stays. MNA and MUST were the most concordant methods, p < 0.001. Eating compromising symptoms were prevalent in surgery/medicine with a parts per thousand yen5% weight loss, MNA risk/undernutrition, and MUST high risk, p < 0.005. Overall, mean energy requirements/diet were not significantly different between admission/discharge: requirements a parts per thousand 1400kcal were always lower than on offer a parts per thousand 2128kcal, p=0.0001. Rigid diets create costly waste which do not counteract nutritional deterioration. Different nutritional risk/status prevalences were unveiled at admission&discharge: > 50% patients were at risk/undernourished by significant weight loss, MNA or MUST, all associated with longer stays. Recent weight loss is unarguably essential, comprehensive MNA & MUST similarly reliable; in this study dynamic MUST seemed easier to practise. Quality nutritional care before/during/after hospitalization is mandatory in the elderly.