• Nutrition

Disease-Related Malnutrition

Malnutrition is common across varying patient populations, particularly older adults, and sarcopenia prevalence increases with advancing age. Both disease-related malnutrition and sarcopenia are associated with substantial adverse outcomes affecting both the patient and the healthcare system, including increased morbidity, mortality, rehospitalization rates, and healthcare costs. Healthcare professionals may assess patients for either malnutrition or sarcopenia; however, both conditions are clinically present in many patients. Clinicians are urged to screen, assess and treat these conditions currently so as to adequately address the full spectrum of patients’ nutritional issues.

Malnutrition is a global, clinical and public health issue. Malnutrition is common, under-recognized, and under-treated. 1 Unfortunately, few improvements have been made in preventing and treating malnutrition since the problem was first highlighted in the medical literature in the 1974 article by Dr. Charles E. Butterworth ‘The Skeleton in the Hospital Closet’. This landmark article addressed the often overlooked issue of malnutrition in US hospitals.2

A recent committee comprised of experts involved with the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and European Society of Clinical Nutrition and Metabolism (ESPEN) proposed new nomenclature for nutrition diagnosis in adult patients in the clinical setting.3 These definitions included “starvation-related malnutrition”, when there is chronic starvation without inflammation, “chronic disease-related malnutrition”, when inflammation is chronic and of mild to moderate degree, and “acute disease or injury-related malnutrition”, when inflammation is acute and of severe degree.3

The prevalence of malnutrition ranges by healthcare setting and patient population, however, malnutrition is common in certain populations. These populations include the elderly, surgical patients, patients with certain chronic medical conditions such as cancer, as well as patients who are ill in the hospital, long-term care facilities, as well as in the community.

Malnutrition is common among older adult patients. Studies have found high rates of malnutrition both upon admission and discharge from the hospital. A study in 2011 from Johns Hopkins Hospital found that approximately 50% of patients were malnourished upon hospital admission.4 In addition, nutritional status tends to decline with length of stay.5

This decline in nutritional status over the course of the hospital stay occurs due to many factors including patients’ decreased appetite and oral intake, decreased food choice, availability and quality, and numerous disruptions in diet order due to medical procedures. The prevalence of malnutrition in Long-term Care (LTC) and care homes is higher than in hospitals, particularly due to the higher population of elderly in these facilities. In the US, 35 – 85% of LTC residents were malnourished.6

However, there are still many populations, especially the older adults, that are malnourished or at risk for malnutrition living in the community setting. For older adults living in the community, 41-48% are at moderate to high risk of malnutrition8. Therefore, almost half of older adults living at home are at high malnutrition risk.7

The older adults are at high risk for malnutrition due to multiple and confounding factors including decreased appetite and food intake as well as multiple acute and chronic medical conditions. Research has shown that older patients have the highest prevalence of malnutrition.

Up to 85% of patients with cancer will experience malnutrition and weight loss.8-9 Disease-related malnutrition may contribute to loss of lean body mass. Poor nutritional status and loss of LBM affect clinical outcomes for patients with cancer.

References

  1. Elia M, Zellipour L, Stratton RJ. Clin Nutr. 2005;24;867-84.
  2. Butterworth CE. Nutr Today. 1974:94-8.
  3. Jensen GL, Mirtallo J, Compher C, et al. JPEN J Parenter Enteral Nutr. 2010;34:156-59.
  4. Somanchi M, Tao X, Mullin GE. JPEN J Parenter Enteral Nutr. 2011;35:209-16.
  5. Corish CA, Kennedy NP. Bri J Nutr. 2000;83:575-91.
  6. Burger SG, Kayser-Jones J, Bell JP. National Citizens' Coalition for Nursing Home Reform, editor. 2000. The Commonwealth Fund.
  7. deGroot LCPGM, Beck AM, Schroll M, van Staveren WA. EurJ Clin Nutr. 1998;52:877-83.
  8. Dewys WD, et al. Am J Med. 1980;69(4):491-97.
  9. Laviano A, et al. Nutrition. 1996;12:358-71.