title: Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review [Formula: see text].
abstract: Malnutrition is associated with poor clinical outcomes among hospitalized patients. However, studies linking malnutrition with poor clinical outcomes in the intensive care unit (ICU) often have conflicting findings due in part to the inappropriate diagnosis of malnutrition. We primarily aimed to determine whether malnutrition diagnosed by validated nutrition assessment tools such as the Subjective Global Assessment (SGA) or Mini Nutritional Assessment (MNA) is independently associated with poorer clinical outcomes in the ICU and if the use of nutrition screening tools demonstrate a similar association. PubMed, CINAHL, Scopus, and Cochrane Library were systematically searched for eligible studies. Search terms included were synonyms of malnutrition, nutritional status, screening, assessment, and intensive care unit. Eligible studies were case-control or cohort studies that recruited adults in the ICU; conducted the SGA, MNA, or used nutrition screening tools before or within 48 hours of ICU admission; and reported the prevalence of malnutrition and relevant clinical outcomes including mortality, length of stay (LOS), and incidence of infection (IOI). Twenty of 1168 studies were eligible. The prevalence of malnutrition ranged from 38% to 78%. Malnutrition diagnosed by nutrition assessments was independently associated with increased ICU LOS, ICU readmission, IOI, and the risk of hospital mortality. The SGA clearly had better predictive validity than the MNA. The association between malnutrition risk determined by nutrition screening was less consistent. Malnutrition is independently associated with poorer clinical outcomes in the ICU. Compared with nutrition assessment tools, the predictive validity of nutrition screening tools were less consistent.
authors.affiliation: 1 Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia.|2 Dietetic and Nutrition Department, Jurong Health Services, Singapore.
authors.forename: Charles Chin Han
authors.initials: CCH
authors.lastname: Lew
authors.affiliation: 1 Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Yandell
authors.affiliation: 3 Department of Gastroenterology and Hepatology, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Robert J L
authors.initials: RJL
authors.lastname: Fraser
authors.affiliation: 4 Department of Respiratory Medicine, Jurong Health Services, Singapore.
authors.forename: Ai Ping
authors.initials: AP
authors.lastname: Chua
authors.affiliation: 5 Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore.
authors.forename: Mary Foong Fong
authors.initials: MFF
authors.lastname: Chong
authors.affiliation: 1 Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miller
mesh_terms: D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
keywords: critical care; malnutrition; mortality; nutrition assessment; nutrition screening; prognosis