Prevalence of Malnutrition in Hospitalized Patients
Original articles
In patients hospitalized upon admission to the Colombia University Clinic
Prevalence of malnutrition among patients upon admission to the Clínica Universitaria Colombia in 2010
Cristina Posada Álvarez, ND,1 Milciades Ibáñez Pinilla, 2 Yeny Cuéllar, ND,3 Adriana Cadena, ND,4 Sandra Arias, ND4
Diana Posso, ND,4 María del Pilar Morales, ND,4 Diana Osorio, ND,4 Teresa Jiménez, ND .5
Clínica Universitaria Colombia
Summary
Hospital malnutrition is a health problem in the world.Various studies report a prevalence between 30%
and 60%.
Objective: estimate the prevalence of malnutrition upon admission and associated factors in adult patients hospitalized at the Colombia University Clinic in 2010.
Materials and methods: a cross-sectional study of agreement between two nutritional screening scales, Nutritional Risk Screening 2002 (NRS 2002) and Malnutrition Screening Tool (MST) was carried out with 1,142 patients, from January to August. of 2010.
Results: a nutritional risk was found by NRS 2002 of 13.7% and by MST of 13.3%;no significant differences were found by gender (p = 0.736);the prevalence of malnutrition in EPS patients was significantly higher at 11.5% (p < 0.001);Significant differences were found by age groups, being higher in those >75 years of age (p < 0.001), by specialty it was higher in hematology and general surgery.The correlation between scales was direct, significant and moderate (r = 0.46, p < 0.001, Spearman coefficient).Agreement was significant and moderate (kappa = 0.525, p < 0.001) with observed agreement of 88.9%.In this cohort of patients, agreement was found between scales and a relationship between nutritional risk, age group, specialty and affiliation entity.
Keywords: Prevalence;screening;malnutrition (MeSH source).
Abstract
Hospital malnutrition is a health problem around the world.Many studies report prevalence rates ranging from 30% to 60% of patients.
Objective: The objective of this study was to estimate the prevalence of malnutrition and associated factors among patients upon admission to the Clínica Universitaria Colombia during 2010.
Materials and Methods: Between January and August 2010 we conducted a cross-sectional study using two nutritional screening scales, Nutritional Risk Screening 2002 (NRS 2002) and Malnutrition Screening Tool (MST), to cross check nutritional risks among 1,142 patients.
Results: 13.7% of the patients studied were found to be at nutritional risk with NRS 2002, while MST found that 13.3% of patients were at risk.We found no significant differences by gender (p = 0.736).The prevalence of malnutrition among EPS (Colombian equivalent of HMOs in the USA) patients was 11.5% higher than among other patients (p<0.001).Nutritional risk levels were significantly higher among patients who were 75 years of age and older (p <0.001), and were also higher among hematology patients and those undergoing general surgery.The correlation between scales was direct, significant and moderate (r=0.46, p<0.001, Spearman coefficient).Agreement was significant and moderate (kappa=0.525, p <0.001).Observed agreement was 88.9%.Within this cohort of patients, correlations between scales and relationships between nutritional risk, age group, specialty, and institution affiliation were found.
Key words: Prevalence;screening;malnutrition.
Introduction
Hospital malnutrition is a major health problem in the world .Establish the probability of malnutrition at admission using the Malnutrition Screening Tool (MST) and Nutritional Risk Screening 2002 (NRS 2002) scales.
.Determine the relationship between demographic, anthropometric, diagnosis and specialty variables, and malnutrition at admission.
.Evaluate the agreement between the scales to establish their use in the institution.
Methodology
Type of study and design general
A cross-sectional study of agreement between the two scales was carried out with patients admitted for hospitalization at the Colombia University Clinic in 2010 and the prevalence of malnutrition upon admission was established. To the clinical and associated factors, the patients were taken consecutively or sequentially during the study period.Clinical nutritionists evaluated all patients who met the inclusion criteria during the first 24 hours of admission to the clinic in the room.
Target population, white or target
Adult patients hospitalized in all services of the Colombia University Clinic 2010;The time of previous hospitalization in other institutions was not taken into account.
Inclusion criteria
-
- First, Patients hospitalized at the Colombia University Clinic
- Second, Patients over 18 years of age
- Third, Patients who wanted to participate in voluntarily.
Exclusion criteria
- First, Pregnant or postpartum women up to the 6th month
- Second, Edema patients
- Third, Amputee patients
- Fourth, Patients unable to stand
- Fifth, Patients in the medical intensive care unit
- Sixth, Patients with altered state of consciousness or interdicts
- Seventh, Patients with eating disorders (anorexia and/or bulimia).
Sample size
The final sample size was 1,142 patients.
The expected prevalence of malnutrition was estimated at 50%,(2) with a confidence level of 95%. , design effect 1, absolute precision of 3% and an adjustment for losses of 7%.
Study variables
The variables of the study are shown in table 1.
Table 1.Definition and operationalization of the study variables.
Measuring instruments
- Scale: Tanita spring-loaded personal scale .
- Tape measure: non-extendable, graduated in centimeters.
- Malnutrition Screening Tool (MST)
- Nutritional Screening Risk 2002 (NRS 2002).
Methods for data control and quality
Calibration of all the clinic scales was carried out, through the metrology laboratory of the organization, to avoid variation in weight data.A workshop was held to standardize anthropometric measurements (weight and height).
Systematization of information
Digitization: it was built the structure of the database and was entered in Excel, version 2003.
Debugging: the transcription of the data from the instruments to the database was evaluated, with descriptive statistics using frequencies and crosses between variables, with SPSS version 15.00.
Ethical considerations
.Patients who were identified early at risk of malnutrition benefited because nutritional intervention was performed.
.The elderly population is included in the research group due to its vulnerability to malnutrition due to comorbidities and social factors.
Statistical analysis
The description of the qualitative variables was carried out with distributions of absolute and relative frequencies expressed in percentage and in the quantitative variables, with measures of central tendency, with average and median and dispersion, the range and the standard deviation.
The point prevalences of malnutrition by the NRS 2002 and MST scales, crude and adjusted, were expressed as a percentage.The differences between the prevalence of malnutrition of the scales with gender, age groups and specialty were evaluated with the chi-square test of difference of Pearson proportions or exact likelihood ratio (expected values < 5).
{0001)}
Nutritional risk was measured with the prevalence ratio and in variables with more than two categories, an unconditional logistic regression was used, with contrast for indicator or dummy variables.The variables that together were associated with nutrition risk were evaluated with an unconditional logistic regression.
The agreement in the dichotomous categories of nutrition risk was measured with the Kappa test, its standard error and their respective significance, the observed agreement was also taken into account;The correlation between the scales was performed with Spearman’s non-parametric correlation coefficient.
The tests were evaluated at a significance level of 5% (p < 0.05).
Results
Demographic characteristics
The study group They made up 1,142 patients hospitalized at the Colombia University Clinic;The distribution was very similar by gender and the most common age group was between 60 and 74 years old.
The most common specialties were internal medicine, general surgery and cardiology.Affiliation with the social security system was very similar between Health Promotion Entities (EPS) and prepaid medicine (table 2).
Table 2.General characteristics of patients hospitalized in
the Colombia University Clinic 2010.
Prevalence of malnutrition
The risk of malnutrition by the NRS 2002 scale showed a prevalence of 13.7% of patients and by MST of 13.3% (adjusted 7.3%).
With the NRS 2002 and MST scales, no significant differences were found by gender;Significant differences were observed in the NRS 2002 malnutrition scale, with the nutritional risk being greater in the group between 75 and 89 years old and those aged 90 and over (p < 0.001);No differences were observed on the MST scale.The two scales showed significant differences by specialty, being higher in hematology, general surgery and gastroenterology patients.The prevalence of malnutrition among patients affiliated with EPS was significantly higher than in those with prepaid medicine, in both scales (p < 0.001) (table 3).
Table 3. Factors associated with nutritional risk, with the NRS 2002 and MST scales.
In the analysis multivariate with logistic regression, a higher risk of malnutrition was found with the NRS 2002 scale, in those over 75 years of age, hematology, general surgery and gastroenterology patients and with affiliation to EPS.The agreement was greater for those classified as normal than for those at risk of malnutrition (table 4).
Table 4.Agreement between the NRS 2002 and MST.
Discussion
The prevalence of malnutrition in the two scales used in this study was very similar to the study carried out in Mexico(25) in which a risk of malnutrition of 13% was found.
The result is not comparable with other studies carried out in the world, in which the risk of malnutrition is: in Sweden between 22% and 34%(26) in Portugal between 28.5% and 47.3%(4), in Spain between 40, 2% and 59.9%,(6.27) in China between 20.8% and 38.8%,(5) in Sarajevo 55%,(28) in Ireland from 40% to 46%,(25) in Singapore it was 29%(29) and in Latin America it was 50.2%(2) probably because in order to compare the two scales all patients had to be able to stand upright to take their weight and height, which could generate the exclusion of high-risk patients who did not meet this condition;Additionally, different tools were used in all countries to identify the risk of malnutrition.
However, in this cohort of patients, as in the ELAN(2) and other studies,(3, 30-32) age was found as a risk variable;in others (2) a greater risk was found in internal medicine patients, and this study identified a greater risk in hematology and general surgery patients.
Only in the ELAN study (2) is it mentioned as a variable the socioeconomic stratum;In this cohort of patients, a significant difference was found according to the affiliation entity to the general social security system, with the risk being higher in EPS patients than in prepaid medicine patients, but this risk is probably associated with the accessibility of the services. services more than to the socioeconomic stratum.
Conclusions
.The prevalence of malnutrition in adult patients hospitalized in the services of the Colombia University Clinic, in 2010, with the NRS 2002 scale is 13.7% and with the MST 13.3%.
.In adult patients hospitalized in the clinic services, there is a greater risk of malnutrition in patients over 75 years of age, hematology, general surgery and gastroenterology patients and with affiliation to an EPS.
.In hospitalized adult patients, a direct, significant and moderate agreement was found between the NRS 2002 and MST nutritional screening scales.
Conflict of interest
The authors declare no conflict of interest.
Funding
This study was financed with resources from the Sanitas International Organization.
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Authors
- 1 Cristina Posada Álvarez, ND.Nutritionist-Dietitian, Specialist in Clinical Biochemistry, Nutrition Department Coordinator of the Colombia University Clinic.
- 2Milciades Ibáñez Pinilla.Mathematical statistician with specialty and master in epidemiology, expert in epidemiology
- 3 Yeny Cuéllar, ND.Nutritionist-Dietitian, Specialist in Clinical Biochemistry, Clinical Nutritionist Colombia
- 4 Adriana Cadena, ND-Diana Posso, ND,-María del Pilar Morales, ND,.Nutritionist-Dietitian-Sandra Arias, ND, Diana Osorio, ND.Clinical Nutritionist Colombia
- 5 Teresa Jiménez, ND.Nutritionist-Dietitian, Clinical Nutrition Specialist, Colombia Clinical Nutritionist, Clinic
Universitaria Colombia, Bogotá, Colombia Correspondence: cposada@colsanitas.com
Received: April 2011
Accepted for publication: May 2011
RMNC 2011;2(1): 13-19.
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