Helping understand nutritional gaps in the elderly (HUNGER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients.
OBJECTIVE
Malnutrition and poor intake during hospitalisation are common in older medical patients. Better understanding of patient-specific factors associated with poor intake may inform nutritional interventions. The aim of this study was to measure the proportion of older medical patients with inadequate nutritional intake, and identify patient-related factors associated with this outcome.


METHODS
Prospective cohort study enrolling consecutive consenting medical inpatients aged 65 years or older. Primary outcome was energy intake less than resting energy expenditure estimated using weight-based equations. Energy intake was calculated for a single day using direct observation of plate waste. Explanatory variables included age, gender, number of co-morbidities, number of medications, diagnosis, usual residence, nutritional status, functional and cognitive impairment, depressive symptoms, poor appetite, poor dentition, and dysphagia.


RESULTS
Of 134 participants (mean age 80 years, 51% female), only 41% met estimated resting energy requirements. Mean energy intake was 1220 kcal/day (SD 440), or 18.1 kcal/kg/day. Factors associated with inadequate energy intake in multivariate analysis were poor appetite, higher BMI, diagnosis of infection or cancer, delirium and need for assistance with feeding.


CONCLUSIONS
Inadequate nutritional intake is common, and patient factors contributing to poor intake should be considered in designing nutritional interventions.
Royal Brisbane and Women's Hospital, Herston, QLD, Australia. alison_mudge@health.qld.gov.au
Alison M
AM
Mudge
Lynda J
LJ
Ross
Adrienne M
AM
Young
Elizabeth A
EA
Isenring
Merrilyn D
MD
Banks
D000203:Activities of Daily Living; D000367:Age Factors; D000369:Aged, 80 and over; D001066:Appetite; D015992:Body Mass Index; D015331:Cohort Studies; D003693:Delirium / Q000150:complications; D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage*; D006233:Persons with Disabilities; D002149:Energy Intake; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors
D004044:Dietary Proteins