title: Energy intake and in-hospital starvation. A clinically relevant relationship.
abstract: BACKGROUND
  Malnutrition is a common finding in the acute-care hospital.
  
  
  OBJECTIVE
  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 10(9)/L vs 1.62 +/- 0.88 x 10(9)/L and 1.47 +/- 0.50 x 10(9)/L; P < .03), serum albumin level (38 +/- 5g/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.%% 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 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.
authors.affiliation: Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: R A
authors.initials: RA
authors.lastname: Incalzi
authors.forename: A
authors.initials: A
authors.lastname: Gemma
authors.forename: O
authors.initials: O
authors.lastname: Capparella
authors.forename: L
authors.initials: L
authors.lastname: Cipriani
authors.forename: F
authors.initials: F
authors.lastname: Landi
authors.forename: P
authors.initials: P
authors.lastname: Carbonin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002149:Energy Intake; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D012307:Risk Factors; D013217:Starvation / Q000209:etiology*