title: Factors associated with nutritional decline in hospitalised medical and surgical patients admitted for 7 d or more: a prospective cohort study.
abstract: This prospective cohort study was conducted in eighteen Canadian hospitals with the aim of examining factors associated with nutritional decline in medical and surgical patients. Nutritional decline was defined based on subjective global assessment (SGA) performed at admission and discharge. Data were collected on demographics, medical information, food intake and patients' satisfaction with nutrition care and meals during hospitalisation; 424 long-stay (≥7 d) patients were included; 38% of them had surgery; 51% were malnourished at admission (SGA B or C); 37% had in-hospital changes in SGA; 19·6% deteriorated (14·6% from SGA A to B/C and 5% from SGA B to C); 17·4% improved (10·6% from SGA B to A, 6·8% from SGA C to B/A); and 63·0 % patients were stable (34·4% were SGA A, 21·3% SGA B, 7·3% SGA C). One SGA C patient had weight loss ≥5%, likely due to fluid loss and was designated as stable. A subset of 364 patients with admission SGA A and B was included in the multiple logistic regression models to determine factors associated with nutritional decline. After controlling for SGA at admission and the presence of a surgical procedure, lower admission BMI, cancer, two or more diagnostic categories, new in-hospital infection, reduced food intake, dissatisfaction with food quality and illness affecting food intake were factors significantly associated with nutritional decline in medical patients. For surgical patients, only male sex was associated with nutritional decline. Factors associated with nutritional decline are different in medical and surgical patients. Identifying these factors may assist nutritional care.
authors.affiliation: 1Department of Medicine University Health Network,University of Toronto,Toronto, ON,Canada M5G 2C4.
authors.forename: Johane P
authors.initials: JP
authors.lastname: Allard
authors.affiliation: 2Department of Kinesiology,Schlegel-UW Research Institute for Aging,Applied Health Sciences,University of Waterloo,Waterloo, ON,Canada N2L 3G1.
authors.forename: Heather
authors.initials: H
authors.lastname: Keller
authors.affiliation: 3Department of Medicine, Toronto General Hospital,University Health Network,Toronto, ON,Canada M5G 2C4.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Teterina
authors.affiliation: 4Department of Medicine,St Michael's Hospital,University of Toronto,Toronto, ON,Canada M5B 1W8.
authors.forename: Khursheed N
authors.initials: KN
authors.lastname: Jeejeebhoy
authors.affiliation: 5Clinical Nutrition Department,Réseau de Santé Vitalité Health Network,Campbellton Regional Hospital, NB,Canada E3N 3H3.
authors.forename: Manon
authors.initials: M
authors.lastname: Laporte
authors.affiliation: 6Department of Medicine,St Boniface Hospital,University of Manitoba,Winnipeg, MB,Canada R2H 2A6.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Duerksen
authors.affiliation: 7Department of Medicine,University of Alberta,Alberta Health Services,Edmonton, AB,Canada T5H 3V9.
authors.forename: Leah
authors.initials: L
authors.lastname: Gramlich
authors.affiliation: 8Département des sciences de la santé communautaire, Faculté de Médecine et des Sciences de la Santé,Université de Sherbrooke,Sherbrooke, QC,Canada J1H 5N4.
authors.forename: Helene
authors.initials: H
authors.lastname: Payette
authors.affiliation: 9Jewish General Hospital,Montréal, QC,Canada H3T 1E2.
authors.forename: Paule
authors.initials: P
authors.lastname: Bernier
authors.affiliation: 10Canadian Nutrition Society,Toronto, ON,Canada N2M 2W8.
authors.forename: Bridget
authors.initials: B
authors.lastname: Davidson
authors.affiliation: 11Department of Public Health,Dalla Lana School of Public Health,University of Toronto,Toronto, ON,Canada M5T 3M7.
authors.forename: Wendy
authors.initials: W
authors.lastname: Lou
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D004435:Eating; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D062407:Meals; D015596:Nutrition Assessment; D044623:Nutrition Therapy; D009752:Nutritional Status; D017060:Patient Satisfaction; D011182:Postoperative Care; D011446:Prospective Studies; D012737:Sex Factors; D015431:Weight Loss
keywords: CCI Charlson Comorbidity Index; Food intake; Hospital malnutrition; ICU intensive care unit; Meal satisfaction; Nutritional decline; SGA subjective global assessment