May nutritional status worsen during hospital stay? A sub-group analysis from a cross-sectional study

Hospital malnutrition is a detrimental prognostic factor regarding hospital mortality, complications, and length of stay. However, the role of hospitalization itself on nutritional status has not been fully elucidated. We report the results of a secondary analysis from the dataset of a recent cross-sectional study at Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Data from patients evaluated at admission and discharge were collected and compared. One hundred thirty-nine patients were evaluated. Mean length of stay was 13.6 (+/- 7.7) days. Patients at risk of malnutrition, according to NRS-2002, were 75 (53.9%), while 63 (45.3%) were malnourished according to ESPEN Criteria. Compared to admission, at discharge, patients reported a significant decrease in Mid-Upper Arm Circumference (MUAC)from 26.5cm (+/- 3.6) to 25.9cm (+/- 3.7) (p=0.016), a reduction in Phase angle (PhA)from 4.25 degrees (+/- 1.20) to 4.01 degrees (+/- 1.15) (p=0.005), fat-free mass (FFM)from 47.5kg (+/- 9.19) to 44.9kg (+/- 9.4) (p=0.03) and fat-free mass index (FFMI)from 16.9kg/m(2) (+/- 2.3) to 15.8kg/m(2) (+/- 2.7) (p=0.04). Laboratory data showed a reduction of albuminfrom 29.2 (+/- 5.7) to 28.0 (+/- 5.9) (p=0.01) and Onodera's PNI- from 29.1 (+/- 5.6) to 27.6kg (+/- 5.6) (p=0.039). At the multivariate linear regression analysis, the variables significantly associated with a worsening of PhA at discharge are the PhA value at admission and the diagnosis of malnutrition according to ESPEN Criteria. Hospitalization leads to significative changes in nutritional status. A clinical concern should be raised about the quality of hospital food and meal times and on the need for a clinical nutritionist on the ward.