Prevalence of Hospital Malnutrition in Adult Patients

Prevalence and Impact of Hospital Malnutrition on Associated Outcomes

Malnutrition of patients on admission to hospitals are estimated to be as high as 60%, although the prevalence varies between countries. The impact of malnutrition on patient recovery and discharge is severe, with extensive cost implications. This study aims to assess the prevalence of at risk for malnutrition among adult patients admitted to hospital across 3 countries on the African continent.

Study Overview

• Status: Completed
• Conditions: Malnutrition

Detailed Description

The prevalence of malnutrition on admission to hospital varies between 15-60%. Knowing the extent of the problem and identifying at-risk patients should be a priority task since malnutrition is associated with increased hospital-related complications; longer length of stay, increased costs related to treatment and higher mortality. Post discharge, malnourished patients have also been linked to more frequent re-admissions, higher morbidity and mortality. Various screening tools are available, including the Nutrition Risk Screening-2002 recommended by European Society for Clinical Nutrition and Metabolism as the preferred screening tool for malnutrition in hospitals in Europe. ASPEN recommends a more comprehensive evaluation and diagnosis procedure. In South Africa, and the rest of Africa, nutritional screening is not routinely done and the investigators do not have any reliable national statistics indicating the extent of the problem. The aim of this study is to determine the prevalence of malnutrition on admission to hospital and to identify the impact thereof on relevant outcomes. Two different internationally recognised tools will be used and validated for the African context. In this multi-country, multi-centre descriptive cross-sectional study 3 hospitals in South Africa, 1 in Ghana and 2 in Kenya will be included. Adult patients (n=400 per hospital) will be screened on admission and at discharge and relevant outcomes (in-hospital and 3-month post-discharge) will be charted. A 50% sub-sample will be used to validate the 2 instruments.

• Study Type: Observational
• Enrollment (Actual): 2126

Contacts and Locations

Study Locations

• South Africa
  • Western Cape
    • Cape Town, Western Cape, South Africa
      • Tygerberg Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All adult patients admitted to the hospitals (3 in South Africa [Tygerberg Academic Hospital, Cape Town; Grootte Schuur Academic Hospital, Cape Town; Chris Hani Baragwanath Hospital, Johannesburg]; 2 in Kenya [Aga Khan University Hospital, Nairobi; Mbagathi district hospital, Nairobi] and 1 in Ghana [Korle Bu Teaching Hospital, Accra]) during the defined study periods will be eligible for inclusion in the study.

Description

Inclusion Criteria:

• All patients older than 18 years of age
• Males and females
• Admitted to hospital within the past 48 hours
• Conscious
• Informed consent provided

Exclusion Criteria:

• Paediatric patients younger than 18 years
• Pregnant and lactating females
• Patients admitted to ICU, burns or relevant acute care wards
• Patients admitted to psychiatry or eating disorders units
• Patients on dialysis

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in prevalence of risk for malnutrition during the period of hospitalization	Baseline (Admission) data will be gathered during to the first 48 hours after hospital admission. Discharge data (Day 28) is collected on day of actual discharge or on day 28 of hospitalization if patient is staying in hospital longer than that. A NRS-2002 score greater than 3 indicates risk for malnutrition.	Baseline; day 28

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Association between risk for malnutrition and in-hospital and post-discharge nutritional / medical indicators	Baseline (Admission) data will be gathered during to the first 48 hours after hospital admission. Discharge data (Day 28) is collected on day of actual discharge or on day 28 of hospitalization if patient is staying in hospital longer than that. Post discharge data will be gathered 3 months after hospital discharge i.e. day 90 (again within a 48 hour period). Nutritional indications refer to weight changes (gain or loss) and changes in appetite (improved, no change or decreased). Medical indicators refer to nr of new complications requiring medical treatment, mortality or re-hospital admission.A NRS-2002 score greater than 3 indicates risk for malnutrition.	Baseline; day 28 and Day 90
Number of patients obtaining similar screening scores as a measure of relative validity of the different screening tools used against each other	Baseline (Admission) data will be gathered during to the first 48 hours after hospital admission. Discharge data (Day 28) is collected on day of actual discharge or on day 28 of hospitalization if patient is staying in hospital longer than that. A good validity will be indicated by a sensitivity and specificity of more than 80%.	Baseline and day 28

Collaborators and Investigators

• Sponsor: University of Stellenbosch
• Investigators: Principal Investigator: Renee Blaauw, PhD, University of Stellenbosch

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Actual): December 1, 2017
• Study Completion (Actual): December 1, 2017

Study Registration Dates

• First Submitted: May 27, 2015
• First Submitted That Met QC Criteria: July 24, 2015
• First Posted (Estimate): July 27, 2015

Study Record Updates

• Last Update Posted (Actual): June 1, 2018
• Last Update Submitted That Met QC Criteria: May 31, 2018
• Last Verified: May 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition
• Other Study ID Numbers: N14/06/061

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED