title: Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force.
abstract: In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS.
  
  
  
  This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization.
  
  
  
  One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%-48%) were malnourished, and based on BMI, 32% (95% CI, 29%-35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1-117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62-0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor.
  
  
  
  Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors.
authors.affiliation: Department of Medicine, University Health Network, University of Toronto, Ontario, Canada johane.allard@uhn.on.ca.
authors.forename: Johane P
authors.initials: JP
authors.lastname: Allard
authors.affiliation: Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Keller
authors.affiliation: Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Khursheed N
authors.initials: KN
authors.lastname: Jeejeebhoy
authors.affiliation: Clinical Nutrition Department, Réseau de Santé Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada.
authors.forename: Manon
authors.initials: M
authors.lastname: Laporte
authors.affiliation: Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Don R
authors.initials: DR
authors.lastname: Duerksen
authors.affiliation: Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Leah
authors.initials: L
authors.lastname: Gramlich
authors.affiliation: Facultée de la Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Helene
authors.initials: H
authors.lastname: Payette
authors.affiliation: Jewish General Hospital, McGill University, Montréal, Québec, Canada.
authors.forename: Paule
authors.initials: P
authors.lastname: Bernier
authors.affiliation: Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Vesnaver
authors.affiliation: Canadian Nutrition Society, Toronto, Ontario, Canada.
authors.forename: Bridget
authors.initials: B
authors.lastname: Davidson
authors.affiliation: University Health Network, Toronto, Ontario, Canada.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Teterina
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Lou
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002170:Canada; D015331:Cohort Studies; D004435:Eating; D005260:Female; D018737:Hand Strength; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support; D009765:Obesity / Q000453:epidemiology; D010343:Patient Admission; D016016:Proportional Hazards Models; D011446:Prospective Studies
keywords: hospital malnutrition; length of stay; malnutrition contributors; nutrition status; obesity