Abstract :
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 10%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/undernutrition, 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
Keywords :
Elderly , Hospital , food waste , Undernutrition , nutritional risk , Energy requirements , energy intake , MNA , MUST.
