title: Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture.
abstract: BACKGROUND
  One percent of falls in over-75 years old cause hip fracture (HF). Protein-energy malnutrition (PEM) is associated with falls and fracture. PEM screening and perioperative nutritional management are recommended by the European Society of Parenteral and Enteral Nutrition, yet data on nutritional status in elderly HF patients are sparse. The Mini Nutritional Assessment (MNA) score is presently the most effective screening tool for PEM in over-75 years old.
  
  
  OBJECTIVE
  The principal objective of the present study was to determine the prevalence on MNA of PEM in patients aged over 75 years admitted for HF. Secondary objectives were to identify factors associated with PEM and its role as a factor of evolution.
  
  
  METHODS
  A prospective observational epidemiological study included 50 patients aged over 75 years admitted for HF in an 8-bed orthopedic surgery department with a geriatric follow-up unit. PEM was defined by MNA<17/30. Assessment systematically comprised associated comorbidity (Cumulative Illness Rating Scale-Geriatric [CIRS-G]), cognitive status on the Mini Mental State Examination (MMSE), functional status on activities of daily life (ADL), and mean hospital stay (MHS). Scores were compared on quantitative tests (Student t) with the significance threshold set at P<0.05.
  
  
  RESULTS
  Mean age for the 50 patients was 86.1 years (range, 77-94 years). Prevalence of PEM was 28%; a further 58% of patients were at risk for PEM. PEM was associated with elevated CIRS-G (P<0.006), greater numbers of severe comorbidities (P=0.006), more severe cognitive disorder (P=0.005) and functional dependence (P=0.002), and 8 days' longer MHS (P=0.012).
  
  
  CONCLUSIONS
  The present study confirmed the high prevalence of PEM in HF patients aged over 75 years, supporting longer hospital stay. MNA is a diagnostic gold standard, not to be replaced by albuminemia or body-mass index in this perioperative clinical situation. Given the present economic stakes relating to geriatric trauma patients' hospital stay, it is essential to prevent, diagnose and treat PEM in elderly subjects.
  
  
  METHODS
  Level IV; prospective cohort study.
authors.affiliation: Clinique universitaire de gériatrie, CHU de Grenoble, 38000 Grenoble, France. Electronic address: SDrevet@chu-grenoble.fr.
authors.forename: S
authors.initials: S
authors.lastname: Drevet
authors.affiliation: Clinique universitaire de gériatrie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: C
authors.initials: C
authors.lastname: Bioteau
authors.affiliation: Clinique universitaire de gériatrie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: S
authors.initials: S
authors.lastname: Mazière
authors.affiliation: Clinique universitaire de gériatrie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Couturier
authors.affiliation: Clinique universitaire d'orthopédie et de traumatologie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Merloz
authors.affiliation: Clinique universitaire d'orthopédie et de traumatologie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: J
authors.initials: J
authors.lastname: Tonetti
authors.affiliation: Clinique universitaire de gériatrie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: G
authors.initials: G
authors.lastname: Gavazzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology; D015992:Body Mass Index; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000453:epidemiology*
keywords: Elderly; Hip fracture; Protein-energy malnutrition