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ABSTRACT
Malnutrition may occur before or after admission
Longer length of stay
High financial cost
Poor wound healing
Increased potential for new wounds
Increased risk of mortality
Need exists for further studies of
Early intervention
Screening protocols
Post-discharge care planning tools

WHAT DOES RESEARCH SHOW?

What do we know?
Up to 50% of hospitalized patients are malnourished

Post-discharge care planning is lacking

Nutritional care in US hospitals needs improvement

WHAT DOES RESEARCH SHOW?

Collect the evidence
Current practitioners
Collect data
Outcomes

Clinical trials

Multidisciplinary teams Inpatient & post-discharge

Caregivers
Registered dietitians
Hospitalists
Nurses
Primary Care Physicians
Care Coordinators

WHAT DOES RESEARCH SHOW?

Primary vs. Secondary Malnutrition
Primary

Poor dietary intake

Before or after admission

Secondary

Medications affecting intake/absorption/appetite

Diseased state
Post-surgery
Poor dentition
Dysphagia
Proper care during hospitalization
Prevention
of secondary malnutrition

WHAT DOES RESEARCH SHOW?

Early screening , early intervention
Morbidity risk (Chima et al., 1999)
High risk for malnutrition
Higher length of stay
Higher financial cost
Inpatient and home health care

Mortality risk (Stratton et al., 2005)

MUST: Malnutrition Universal Screening Tool
High and medium nutritional risk
Higher mortality 3-6 months post-discharge
Longer length of stay

WHAT DOES RESEARCH SHOW?

Higher mortality
Mortality risk and PEM (Sullivan and Walls, 1998)
Six year follow-up
First 4.5 years of study, 74% died
PEM highest associated variable risk
Mortality risk and PEM (Sullivan et al., 1991)
One year follow-up

Within one year 30% died

10% prior to discharge, 20% post-discharge

Weight loss in year prior to admission highest associated

variable

MALNUTRITION & RISK OF IN

SPECIFIC POPULATIONS
90
80
70
60
50
40
30
20
10
0

High End %
Low End %

WHAT DOES RESEARCH SHOW?

At risk populations and higher mortality
Populations with or at risk for malnutrition (Mahan, 2012)
40-60% of hospitalized older adults (with/at risk)

40-85% nursing home residents (malnourished)

20-60% home health patients (malnourished)
Mortality risk and PEM (Liu et al., 2002)
One year follow-up
13% of the participants died
BMI <20 / >10% loss UBW in year PTA / <85% UBW highest risks
Being undernourished at time of discharge independent risk factor

WHAT DOES RESEARCH SHOW?

Interventions
Supplementation (Burnham, Moss, and Ziegler, 2005)
Despite nutrition intervention, critically ill patients
Increase in nitrogen loss through urine

Protein catabolism
Muscle wasting

Glutamine
Nonessential amino acid

Stimulates protein anabolism

Inhibits protein catabolism
Higher survival rates with TPN and ICU patients

Shorter length of stay for surgical patients

TO BE CONTINUED
More studies are needed
Glutamine and other amino acid supplementation

Multidisciplinary team approach

Collection of data, further evidence to support best practice
Earlier interventions
How to best support malnourished patients postdischarge
Studies continue to mention the lack and the need
Post-discharge care planning and follow up
Working closer with care coordinators
Communication with caregivers and primary care
physicians

STEPS WE CAN TAKE

High calorie supplements at med-pass
Care Coordinators schedule appointments or send referrals for

follow ups based on nutrition status

Make PCP or specialist aware
Care Plan Meetings
Malnutrition Protocol
Meet with charge nurses email updates
Coupons, samples (supplement Reps)
Education, encouragement supplements
Signage similar to fluid restriction, or NPO
Volunteers come in at meal times
Add supplements to med list
Nutrition Reps???

PROTOCOL

EDUCATION

EDUCATION

Any questions?

Thank you!

REFERENCES

Brown, J. (2011). Nutrition through the life cycle (4th ed.). Belmont, CA: Wadsworth, CENGAGE Learning.
Burnham, E. L., Moss, M., & Ziegler, T. R. (2005). Myopathies in critical illness: Characterization and nutritional aspects. The Journal
of nutrition, 135(7), 1818S-1823S.
Chima, C. S., Barco, K., Dewitt, M. L., Maeda, M., Teran, J. C., & Mullen, K. D. (1997). Relationship of nutritional status to length of
stay, hospital costs, and discharge status of patients hospitalized in the medicine service. Journal of the American
Dietetic Association, 97(9), 975-978.
Liu, L., Bopp, M. M., Roberson, P. K., & Sullivan, D. H. (2002). Undernutrition and risk of mortality in elderly patients within 1 year
of hospital discharge. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(11), M741- M746.
Mahan, L. (2012). Krause's food & the nutrition care process (13th ed.). St. Louis, Mo.: Elsevier/Saunders.
Nutrition and the hospitalized patient. (2006). Journal of Hospital Medicine, 1: 79. doi: 10.1002/jhm.53
Stratton, R. J., King, C. L., Stroud, M. A., Jackson, A. A., & Elia, M. (2006). Malnutrition Universal Screening Tool predicts
mortality and length of hospital stay in acutely ill elderly. British journal of nutrition, 95(02), 325-330.

Sullivan, D. H., Walls, R. C., & Lipschitz, D. A. (1991). Protein-energy undernutrition and the risk of mortality within 1 y of hospital
discharge in a select population of geriatric rehabilitation patients. The American journal of clinical nutrition, 53(3),

599-605.

Sullivan, D. H., & Walls, R. C. (1998). Protein-energy undernutrition and the risk of mortality within six years of hospital
discharge. Journal of the American College of Nutrition, 17(6), 571-578.
Tappenden, K. A., Quatrara, B., Parkhurst, M. L., Malone, A. M., Fanjiang, G., & Ziegler, T. R. (2013). Critical role of nutrition in
improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. Journal of the
Nutrition and Dietetics, 113(9), 1219-1237.
Whitney, E., & Rolfes, S. (2011). Understanding nutrition (12th ed.). Australia: Wadsworth, Cengage Learning.

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