Prevalence of Risk of Malnutrition in Hospitalised Adult Patients in a Tertiary Hospital Setting in South Africa

[摘要] ENGLISH SUMMARY : Introduction: Hospital malnutrition was first identified by Charles Butterworth in 1974, referring to malnutrition often being overlooked, underdiagnosed and consequently undertreated. This is still a current problem, with worldwide prevalence of malnutrition ranging from 15–76% among adults. Hospital malnutrition is associated with increased cost of care, complications, increased length of stay, mortality and poor quality of life compared to well-nourished patients. South Africa's hospitalised population is at an increased risk of malnutrition, due to high poverty levels and the quadruple burden of disease. The aim of this study was to determine the prevalence of risk of malnutrition in hospitalised patients in a South African Hospital setting. Methods: Patients that were admitted (≤48 hours) and (≥18 years old) were eligible for inclusion. The prevalence of risk of malnutrition was assessed using three different screening tools (NRS-2002, SGA and AMDT) on admission and discharge (if hospitalised ≥7days). The prevalence of risk of malnutrition, related outcomes and the number of referrals for nutritional support were documented. The included wards were assessed for availability of nutrition protocols and resources needed to implement nutrition intervention using an observational checklist.Results: On admission, a total of 403 patients were included (males 52.9%). The mean age was 45.5 years ±16.6SD. There was an even distribution between patients from surgical (n=192) and medical wards (n=190), with gynaecology (n=21) contributing a small number of patients. The prevalence of risk of malnutrition on admission ranged depending on the screening tool used: NRS-2002 (59.1%; n=237), AMDT (62.9%; n=252) and SGA (56.6%; n=228). The mean length of stay was 6.9 days ±5.9SD, with a significant difference (p<0.01) in length of stay between malnourished patients (mean 7.4 days ±6.1SD) and well-nourished patients (5.2 days ±4.8SD). On discharge, 92 patients were included (males 52.8%). Most patients (64%; n=59) endured a complication, with significantly more complications (p=0.048) among the malnourished (mean 1.7 ±1.6SD) when compared to the well-nourished (mean 0.8±1.3SD).Patients 'at risk' were diagnosed with infectious and gastrointestinal diseases, cancer, or had abdominal surgery, making these high-risk disease categories for malnutrition. The prevalence of risk of malnutrition was higher within the discharge sample, regardless of which tool was used: NRS-2002 (73.8%; n=62), SGA (65.2%; n=60) and AMDT (79.3%;n=73). Despite the high prevalence of malnutrition, the nutrition referrals were poor, with only 1.3% (n=5) being referred on admission, and 9.8% (n=9) on discharge. The AMDT was the only tool that had good validity (sensitivity 83.9%, specificity 80.2%) and interrater agreement (k=0.62) when using the SGA as reference. Similarly, the NRS-2002 had fair validity (sensitivity 73.8% and specificity 51.8%) but poor inter-rater agreement (k=0.24). Lastly, the hospital setting had a poor nutrition-care environment as none of the wards (n=28) had nutrition protocols, nor screening tools available at ward level. Scales were available (96.4%; n=27), but 22.2% (n=6) were not in working condition. Stadiometers were not readily available (42.9%; n=12). The mean number of patients per ward was 43 ±17.7SD, with only an average of 11 ±2.5SD nurses on duty per ward, indicating a shortage of nurses for adequate patient care.Conclusion: The prevalence of nutritional risk and malnutrition is very high in the hospital setting, regardless of screening tool used, and is associated with unfavourable patient outcomes.

[发布机构] Stellenbosch University