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

Background: Undernutrition/nutritional risk were evaluated longitudinally in 531 hospitalized elderly by four validated methods to appraise the most feasible for routine use. Design: 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. Results: Significant changes from admission to discharge in risk/ undernutrition prevalence, were not shown by BMI (≈17% vs 22%), ≥5%weight loss (≈53% vs ≈56%) or MNA 83% vs ≈81%; at admission, 93% patients were MUST high risk declining to ≈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 ≥l0%weight loss vs medicine, p<0.01. Only admission ≥5%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 ≥5%weight loss, MNA risk/undemutrition, and MUST high risk, p<0.005. Overall, mean energy requirements/diet were not significantly different between admission/discharge: requirements ≈1400kcal were always lower than on offer ≈2128kcal, p=0.0001. Conclusions: 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.