title: Nutritional status influences the length of stay and clinical outcomes in patients hospitalized in internal medicine wards.
abstract: OBJECTIVE
  The aim of this study was to investigate the relationship between the nutritional status (NS) and clinical outcome and length of stay (LOS) among patients admitted to the internal medicine ward.
  
  
  METHODS
  This is a retrospective observational study performed with the data of clinical patients collected during a one year period. The NS was assessed using: subjective global assessment (SGA), body mass index (BMI), triceps skinfold thickness (TST), muscle arm circumference (MAC) and combined tools. Statistical analysis was performed with a confidence interval of 95% (p < 0.05). For categories comparison the chi-square test was used. To examine the association between length of stay and variables related to the NS Mann-Whitney and Kruskal-Wallis tests was used with multiple comparisons.
  
  
  RESULTS
  396 patients were included in the study, 42.2% were over 60 years of age, what was associated with the presence of hypertension (p < 0.001), diabetes mellitus (p = 0.003) and required diet with modifications consistency (p = 0.003). According to combined diagnostic tools, 45.7% of patients were malnourished. Decreased food intake (p = 0.01), malnutrition according to SGA (p = 0.02) and MAC (p = 0.03) were associated with increased mortality. Patients with tertiary level of care (p = 0.01), decreased food intake (p = 0.001), who died (p = 0.004) and diagnosed with malnutrition by SGA (p = 0.001) and by the combined tools (p = 0.001) had a longer LOS.
  
  
  CONCLUSIONS
  Patients who were malnourished by SGA and who presented decrease food intake at admission had longer LOS and poorer clinical outcomes (highest number of deaths). The diagnosis of malnutrition by MAC was also related to higher mortality.
authors.affiliation: Programa de Posgrado en Niños y Adolescente, Universidad Federal de Paraná, Curitiba, Brazil. anamanuela.ordonez@gmail.com
authors.forename: Ana Manuela
authors.initials: AM
authors.lastname: Ordoñez
authors.forename: Maria Eliana
authors.initials: ME
authors.lastname: Madalozzo Schieferdecker
authors.forename: Talita
authors.initials: T
authors.lastname: Cestonaro
authors.forename: João
authors.initials: J
authors.lastname: Cardoso Neto
authors.forename: Antônio Carlos
authors.initials: AC
authors.lastname: Ligocki Campos
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006748:Hospital Departments / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology*; D012189:Retrospective Studies; D012885:Skinfold Thickness; D016896:Treatment Outcome