title: Association of nutritional risk and adverse medical outcomes across different medical inpatient populations.
abstract: OBJECTIVE
  The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital.
  
  
  METHODS
  We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index <95 points), hospital length of stay, hospital readmission rates, and quality of life (QoL; adapted from EQ5 D); all parameters were measured at 30 d.
  
  
  RESULTS
  Of 3186 patients (mean age 71 y, 44.7% women), 887 (27.8%) were at risk for malnutrition with an NRS ≥3 points. We found strong associations (odds ratio/hazard ratio [OR/HR], 95% confidence interval [CI]) between nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction < 0.05) based on age and main diagnosis groups.
  
  
  CONCLUSIONS
  Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients.
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Susan
authors.initials: S
authors.lastname: Felder
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Lechtenboehmer
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Bally
authors.affiliation: Nutritional Counseling Team, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fehr
authors.affiliation: Nutritional Counseling Team, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Manuela
authors.initials: M
authors.lastname: Deiss
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Faessler
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutz
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Deborah
authors.initials: D
authors.lastname: Steiner
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Rast
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Svenja
authors.initials: S
authors.lastname: Laukemann
authors.affiliation: Asclepius Medical Communications LLC, Ridgewood, NJ, USA.
authors.forename: Prasad
authors.initials: P
authors.lastname: Kulkarni
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Zeno
authors.initials: Z
authors.lastname: Stanga
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haubitz
authors.affiliation: Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Huber
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland. Electronic address: schuetzph@gmail.com.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease / Q000401:mortality*; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000150:complications*; D009752:Nutritional Status; D016017:Odds Ratio; D010359:Patient Readmission; D011446:Prospective Studies; D011788:Quality of Life; D012959:Socioeconomic Factors; D013557:Switzerland / Q000453:epidemiology; D062606:Tertiary Care Centers
keywords: Length of stay; Mortality; NRS; Nutritional risk screening; Prevalence; Readmission