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A Clinically Relevant Relationship

Raffaele Antonelli Incalzi, MD; Antonella Gemma, MD; Oliviero Capparella, MD; Luca Cipriani, MD; Francesco Landi, MD; PierUgo Carbonin, MD

Arch Intern Med. 1996;156(4):425-429.

Abstract
Background
Malnutrition is a common finding in the acute-care hospital.

Objectives
To assess the adequacy of nutritional intake to individual needs and the effects of the hospitalization on nutritional status, and to identify the reasons for inadequate energy intake.

Methods
A total of 286 patients with a mean (±SD) age of 79±6 years (range, 70 to 99 years), consecutively admitted to the geriatrics and internal medicine wards of an acute-care university hospital, underwent multidisciplinary assessment on admission and at discharge and daily dietary data collection. The needed, prescribed, and actual daily energy intake for each individual was measured. Nutritional depletion was diagnosed if midarm circumference decreased by 3.6% or more from admission to discharge.

Results
Nutritional depletion occurred in 27% of the patients and correlated with anorexia (86.4% vs 65.5% and 40% in patients whose midarm circumference was unchanged and increased, respectively; P<.001), Mini— Mental State Examination score (21.6±8.3 vs 23±6.9 and 26.5±3.6; P<.05), simplified premorbid Activities of Daily Living score (4.4±2.2 vs 5.1 ±1.8 and 5.0±1.8; P<.03), lymphocyte count (1.32 ±0.63 x 10⁹/L vs 1.62±0.88x10⁹/L and 1.47±0.50x10⁹/L; P<.03), serum albumin level (38±5 g/L vs 40±4 g/L and 39±8 g/L; P<.002), ratio of actual to needed energy intake (56.9%±22.1% vs 69.3%±30.4% and 60.0%±14.1%; P<.01), ratio of actual to prescribed energy intake (50.5%±16.9% vs 60.5%±20.5% and 65.5%±15.7%; P<.001). Patients who consumed less than 40% of the prescribed food complained of anorexia and masticatory inefficiency and were unsatisfied with quality and timing of meals compared with the other patients.

Conclusions
In-hospital starvation affects mainly patients with baseline nutritional, functional, and cognitive deficits and is strongly related to the inadequate energy intake.

(Arch Intern Med. 1996;156:425-429)

Author Affiliations
From the Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy (Drs Antonelli Incalzi, Cipriani, Landi, and Carbonin), and Teaching Nursing Home Cittadella della Carità, Taranto, Italy (Drs Gemma and Capparella).

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