Malnutrition in hospital: the clinical and economic implications.
BACKGROUND
Undernutrition and malnutrition are common in hospitalized patients. Their combined prevalence on admission is estimated at 25% and is rising.


METHODS
Selective literature review with special consideration of current guidelines and meta-analyses.


RESULTS
The nutritional state of every patient should be assessed on admission with simple, established parameters, and patients suffering from under- or malnutrition should be treated with a targeted nutritional intervention based on the established stepwise treatment algorithm. Under- and malnutrition are an independent risk and cost factor with a significant influence on mortality, morbidity, length of hospital stay, and quality of life. Their direct costs alone amount to some 9 billion Euros in Germany each year. Therapeutic trials and meta-analyses have clearly documented the therapeutic benefit and cost-effectiveness of oral nutritional supplements and tube feeds. Targeted nutritional intervention is an integral part of medical treatment and prevention.


CONCLUSIONS
Undernutrition and malnutrition are common in hospitalized patients and are both medically and economically harmful. If they are detected early by targeted assessment and then treated appropriately according to the established stepwise treatment algorithm, better clinical outcomes and lower costs will result.
Medizinische Klinik Rotes Kreuz Krankenhaus, Kassel, Germany.
Christian
C
Löser
D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D018570:Risk Assessment; D016526:Workload / Q000191:economics*
Nutrition. 2003 Jul-Aug;19(7-8):605-11
12831946
J Am Diet Assoc. 1997 Sep;97(9):975-8; quiz 979-80
9284874
Curr Opin Clin Nutr Metab Care. 2001 Jan;4(1):21-8
11122555
Proc Nutr Soc. 1996 Nov;55(3):841-53
9004328
Nutr Rev. 1996 Apr;54(4 Pt 1):111-21
8710240
Clin Nutr. 2003 Jun;22(3):235-9
12765661
BMJ. 1994 Apr 9;308(6934):945-8
8173401
Clin Nutr. 2008 Jun;27(3):340-9
18504063
Clin Nutr. 2005 Oct;24(5):848-61
16261664
Clin Nutr. 2003 Jun;22(3):321-36
12765673
Clin Nutr. 2002 Aug;21(4):329-35
12135594
Clin Nutr. 2006 Apr;25(2):330-60
16735082
Clin Nutr. 2006 Aug;25(4):563-72
16698132
Clin Nutr. 2008 Feb;27(1):5-15
18061312
Clin Nutr. 2006 Jun;25(3):515-23
16698137
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD000998
15846608
Anaesthesist. 2000 Jul;49(7):675-84
10969394
World Hosp Health Serv. 2008;44(2):12-4
18795500
Dtsch Med Wochenschr. 2001 Jun 15;126(24):729-34
11446031
N Engl J Med. 2000 Jan 20;342(3):206-10
10639550
Ann Nutr Metab. 1992;36(2):97-112
1510351
J Am Diet Assoc. 2000 Nov;100(11):1316-22; quiz 1323-4
11103653
Clin Lab Med. 1993 Jun;13(2):491-507
8319432
Nutrition. 2005 Nov-Dec;21(11-12):1127-33
16308136
Diabetes Care. 2005 Sep;28(9):2267-79
16123506
N Engl J Med. 2005 Dec 15;353(24):2607-12
16354899
JAMA. 1994 Oct 26;272(16):1263-6
7523740
Am J Clin Nutr. 2005 Nov;82(5):1082-9
16280442
Clin Nutr. 2005 Dec;24(6):1005-13
16143430
Int J Oncol. 2006 Jan;28(1):5-23
16327975
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD001880
15846625
Geriatrics. 2006 Jun;61(6):30-5
16768542
Dig Dis. 2003;21(3):245-51
14571098
Clin Nutr. 2003 Oct;22(5):473-81
14512035
Eur J Gastroenterol Hepatol. 2000 Oct;12(10):1101-9
11057455
JAMA. 1999 Oct 13;282(14):1365-70
10527184
Wien Klin Wochenschr. 2003 Feb 28;115(3-4):115-20
12674688
Arch Otolaryngol Head Neck Surg. 1998 Aug;124(8):871-5
9708712
Dig Dis Sci. 1998 Nov;43(11):2549-57
9824149
Clin Nutr. 2005 Dec;24(6):913-9
16046034
Nutrition. 2005 Nov-Dec;21(11-12):1071-7
16308129
Z Gastroenterol. 1998 May;36(5):475-8
9654710
Clin Nutr. 2006 Apr;25(2):245-59
16697500
Br J Nutr. 2004 Jul;92(1):105-11
15230993
Cochrane Database Syst Rev. 2001;(2):CD002008
11406021
BMJ. 2001 Oct 6;323(7316):773-6
11588077
Clin Nutr. 2007 Dec;26(6):778-84
17936442
Ann Intern Med. 2006 Jan 3;144(1):37-48
16389253
Support Care Cancer. 1993 Sep;1(5):272-5
8156240
Cochrane Database Syst Rev. 2003;(4):CD003216
14583961