title: Bedside measures of malnutrition and association with mortality in hospitalized adults.
abstract: OBJECTIVE
  The impact of malnutrition on the outcomes of hospitalized adults in resource-limited settings such as sub-Saharan Africa (SSA) is not fully described. We aimed to determine the association between malnutrition and mortality in adults admitted to hospital in the resource-limited setting of Southwestern Uganda.
  
  
  METHODS
  We performed a cohort study of adults admitted to the medical ward of Mbarara Regional Referral Hospital. Measures of nutritional status included: 1) body mass index (BMI), 2) the mini-nutritional assessment short form (MNA-sf), and 3) mid-upper arm circumference (MUAC). Subjects were followed until death or 30 days from admission. We used proportional hazards regression to assess associations between malnutrition and in-hospital and 30-day mortality.
  
  
  RESULTS
  We enrolled 318 subjects. The prevalence of malnutrition was 25-59% depending on the measure used. In-hospital and 30-day mortality were 18% and 37% respectively. In the adjusted analysis, subjects with MNA-sf score 0-7 had a 2.7-fold higher risk of in-hospital mortality (95% CI: 1.3-5.9, p = 0.011) than those with a score of 8-14, and subjects with malnutrition determined by MUAC (<20 cm for males, and <19 cm for females) had a 1.8-fold higher risk of in-hospital mortality (95% CI: 0.98-3.4, p = 0.06) than those normally nourished. MNA-sf (HR 1.6, 95% CI: 1.02-2.6, p = 0.039) and MUAC (HR 1.6, 95% CI: 1.0-2.3, p = 0.048) were independently predictive of 30-day mortality. BMI <18.5 was not associated with in-hospital or 30-day mortality.
  
  
  CONCLUSIONS
  Malnutrition was common and simple measures of nutritional status predicted in-hospital and 30-day mortality. Further research is needed to understand the pathophysiology of malnutrition during acute illness and mitigate its effects.
authors.affiliation: Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Mbarara Regional Referral Hospital, Mbarara, Uganda.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Asiimwe
authors.affiliation: Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Conrad
authors.initials: C
authors.lastname: Muzoora
authors.affiliation: Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: L Anthony
authors.initials: LA
authors.lastname: Wilson
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA. Electronic address: ccm5u@virginia.edu.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Moore
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000401:mortality*; D008875:Middle Aged; D015596:Nutrition Assessment; D015995:Prevalence; D012044:Regression Analysis; D014454:Uganda / Q000453:epidemiology
keywords: Acute illness; Adult; Africa; Hospitalized; Malnutrition