Nutritional assessment: comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission.
BACKGROUND
Nutritional assessment commonly includes multiple nutrition indicators (NIs). To promote efficiency, a minimum set is needed for the diagnosis of malnutrition in the acute care setting.


OBJECTIVE
The objective was to compare the ability of different NIs to predict outcomes of length of hospital stay and readmission to refine the detection of malnutrition in acute care.


METHODS
This was a prospective cohort study of 1022 patients recruited from 18 acute care hospitals (academic and community), from 8 provinces across Canada, between 1 July 2010 and 28 February 2013. Participants were patients aged ≥18 y admitted to medical and surgical wards. NIs measured at admission were subjective global assessment (SGA; SGA A = well nourished, SGA B = mild or moderate malnutrition, and SGA C = severe malnutrition), Nutrition Risk Screening (2002), body weight, midarm and calf circumference, serum albumin, handgrip strength (HGS), and patient-self assessment of food intake. Logistic regression determined the independent effect of NIs on the outcomes of length of hospital stay (<7 d and ≥7 d) and readmission within 30 d after discharge.


RESULTS
In total, 733 patients had complete NI data and were available for analysis. After we controlled for age, sex, and diagnosis, only SGA C (OR: 2.19; 95% CI: 1.28, 3.75), HGS (OR: 0.98; 95% CI: 0.96, 0.99 per kg of increase), and reduced food intake during the first week of hospitalization (OR: 1.51; 95% CI: 1.08, 2.11) were independent predictors of length of stay. SGA C (OR: 2.12; 95% CI: 1.24, 3.93) and HGS (OR: 0.96; 95% CI: 0.94, 0.98) but not food intake were independent predictors of 30-d readmission.


CONCLUSIONS
SGA, HGS, and food intake were independent predictors of outcomes for malnutrition. Because food intake in this study was judged days after admission and HGS has a wide range of normal values, SGA is the single best predictor and should be advocated as the primary measure for diagnosis of malnutrition. This study was registered at clinicaltrials.gov as NCT02351661.
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Khursheed N
KN
Jeejeebhoy
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Heather
H
Keller
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Leah
L
Gramlich
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Johane P
JP
Allard
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Manon
M
Laporte
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Donald R
DR
Duerksen
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Helene
H
Payette
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Paule
P
Bernier
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Elisabeth
E
Vesnaver
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Bridget
B
Davidson
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Anastasia
A
Teterina
From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL).
Wendy
W
Lou
D000368:Aged; D002170:Canada; D002149:Energy Intake; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000517:prevention & control; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D016896:Treatment Outcome
length of stay; malnutrition; nutritional assessment; readmission rate; subjective global assessment